超声引导下穿刺活检诊断小儿肝母细胞瘤

目的 探讨超声引导下穿刺活检在小儿肝母细胞瘤诊断中的应用价值.方法 对2008年1月至2010年12月上海交通大学医学院附属新华医院收治的19例小儿肝脏肿块进行超声检查,根据声像图特点在超声引导下对肝脏肿块进行穿刺活检病理组织学检查.结果 19例小儿肝脏肿块巨大,为74 mm×63 mm×68 mm～105 mm×83 mm×87 mm,平均(89.9±8.3)mm,位于肝右叶14例,同时累及肝左右叶5例;肝内肿瘤多呈单个球形(12例)或分叶状融合的实性肿块(7例);边界清,回声多不均匀(等回声6例,低回声3例,强回声5例,混合回声5例,8例伴有钙化,6例伴有出血坏死);肿瘤周边肝实质正常.超声引导下肿块穿刺获取病变组织均为一次成功(19/19),无并发症发生.病理分型诊断:胎儿型9例,胚胎型5例,胎儿型与胚胎混合型5例.结论 根据超声声像图特点,在超声引导对小儿肝脏肿块进行穿刺活检安全有效,可对小儿肝母细胞瘤作出明确诊断,对指导小儿肝母细胞瘤的临床手术和治疗有重要应用价值.     

重症型华支睾吸虫病的灰阶超声诊断

本文报告8例重症型华支睾吸虫病,肝胆切面图象特征,并通过对图象分析总结,提出本病灰阶超声诊断和鉴别诊断要点。本组病例肝胆切面表现:1.肝内胆管:广泛扩张(内径0.4～0.8cm),扩张的小胆     

小儿常见后腹膜肿瘤超声检查与病理对照(附68例分析)

小儿常见后腹膜肿瘤有肾胚胎瘤、神经母细胞癌、畸胎癌等。我院自1989年～1992年4月经手术及病理证实的后腹膜肿瘤共68例。本文简要分析68例后腹膜肿瘤超声检查与病理对照结果,术前超声诊断肾胚胎瘤33例,神经母细胞瘤24例,畸胎瘤10例,肝左叶占位1例;术后病理诊断为肾胚胎瘤34例(其中2例为神经母细胞瘤误诊病例),神经母细胞瘤25例(其中1例为肾胚胎瘤误诊病例,1例为肝左叶占位误诊,1例为畸胎瘤误诊),畸胎瘤8例,良性脂肪母细胞瘤1例(为畸胎瘤误诊)。后腹膜肿瘤多以腹部包     

疑难肝病超声图象与手术病理对照分析之一——肝局灶性脂肪病变,肉芽肿及纤维疤痕

四年间17例声检查分别提示为肝实质性占位(10例)。肝血管瘤(5例)、肝小囊肿(1例)、不明病变(1例),经手术病理证实肝脂肪病变7例、各种肉芽肿及纤维瘢痕10例。现将术前超声图象与手术病理所见对照分析,以提高超声诊断的准确性。     

超声诊断肝外胆管癌的价值

目的分析肝外胆管癌的声像图特点,探讨早期超声诊断的临床价值。方法50例超声拟诊为肝外胆管癌患者,经临床手术、其他影像学及(或)经皮胰胆管逆行造影证实,分析其患者临床及超声影像学资料。结果肝外胆管癌超声直接征象分为乳头型、团块型、截断型和狭窄型;间接征象为肝内及肝外胆管扩张、肝内及肝门部淋巴结转移和腹水。误诊3例,其中1例为胆总管结石,2例为十二指肠憩室。结论超声显像对肝外胆管癌的诊断有重要价值。     

肝肿瘤超声病理学研究

本文通过30例肝肿瘤(肝癌26例、海绵状血管瘤4例)术前B型超声图象变化与切除肿瘤标本巨检和病理组织学改变对照分析,发现肝肿瘤超声图象强弱变化主要与肿瘤纤维间质的量变及有无出血坏死密切相关,二者反映病程的长短,瘤细胞生长速度、瘤体大小及扩散方式等因素。并认为弱回声晕形成的机理是多种因素作用的结果。     

肝脏小肿块的超声介入性检查的价值

本文通过103例肝脏肿块的超声介入性检查与超声图象诊断多方面对照分析,认为前者可弥补超声图象定性诊断方面的不足,尤其是对于≤3cm肝脏肿块的良恶性鉴别,具有显著性意义(P<0.01)。同时还讨论了超声介入性检查对肝脏肿块的具体鉴别方法。     

儿童肝母细胞瘤的超声诊断与鉴别

目的:讨论儿童肝母细胞瘤超声诊断的应用价值。方法:将我院2015年3月至2020年1月接诊的40例肝母细胞瘤患儿当作观察对象,将患者肿瘤超声诊断结果与病理检查结果做比较,了解超声检查方式的应用价值。结果:超声与病理检查方式在边界、包膜、钙化、坏死、囊变等方面的检出率比较存在统计学差异,P<0.05;超声在显示肿瘤形态方面与病理检查方式的检出率一致,数据比较无统计学差异,P>0.05。超声检查儿童肝母细胞瘤,应当注意与腹膜后神经母细胞瘤、右肾胚胎瘤、肝错构瘤等儿童常见肿瘤的鉴别诊断。结论:超声定位肝母细胞瘤无创、简捷、准确,显著肿瘤囊变与钙化、形态等表现优势明显,在治疗方案制定与预后评价中有着较高的临床应用价值。     

微泡型多囊肝的超声诊断

目的 探讨并分析微泡型多囊肝的声像图特点，以提高超声诊断的准确率。方法 回顾性分析26例微泡型多囊肝的声像图表现并与CT、MR图像进行对照。结果 26例中超声首诊明确诊断22例，诊断不明确2例，被误诊为肝硬化并发弥漫型肝癌2例，所有患后经CT、MR及实验室检查被确诊为微泡型多囊肝。超声诊断符合率达84．6％(22／26)。结论 尽管CT和MR的诊断准确率比超声高，但微泡型多囊肝的声像图仍具有特征性，有较高的临床价值。     

内科急诊与超声

临床上内科急诊病例的诊断极为辣手,常易导致误诊和漏诊。本文复习了近年来胸肺、肝、胆、胰、肾等内科急诊疾病的B型超声图象特征,以便为正确诊断和及时治疗提供了可靠的依据。 超声对内科急诊病例的诊断具有重要的诊断价值,其应用也日趋广泛,现就近年来内科急诊病例的超声作一简述。     

肝母细胞瘤的诊断与治疗

肝母细胞瘤(hepatob lastom a)起源于上皮组织,组织特征重复了肝脏发育生长的不同阶段,为胚胎性肿瘤,是婴幼儿时期最常见的肝脏恶性肿瘤[1],未经完整切除的肝母细胞瘤患儿往往预后不良。近20年来随着家长对子女预防保健意识的提高,以及临床上对肝母细胞瘤诊治经验的总结与积累,     

小儿肝母细胞瘤的影像学诊断

目的　分析小儿肝母细胞瘤的影像学特征 ,比较CT、MRI诊断准确性。方法　经手术病理证实的肝母细胞瘤3 0例 ,分别行CT/MRI检查。CT检查平扫 /增强为 3 0 /12例 ,MRI检查 2 0例。结果　肝母细胞瘤的定位准确率 ,CT检查为 97% ,MRI检查为 10 0 %。定性准确率 ,CT检查为 93 % ,2例术前定性误诊 ,MRI检查为 95 % ,1例术前定性误诊。比较两种检查方法 ,CT与MRI对肿瘤均能明确作出定性诊断 ,两者之间无差异 (P >0 .0 5 )。但MR由于多轴位成像 ,显示毗邻关系清晰 ,定位诊断准确 ,优于CT。结论　CT与MRI相结合 ,能更全面提供临床诊疗信息 ,有利于鉴别诊断 ,具有重要诊断价值。     

超声引导下儿童肝母细胞瘤穿刺活检术后迟发性严重出血1例

<正>患儿男，3岁，因扪及右上腹肿块，伴腹痛呕吐4+d就诊。体格检查：身高95 cm，体质量14 kg，于右上腹触及一大小约7 cm×6 cm肿块，质硬，活动度受限，与周围组织粘连，肝脏肋下6 cm可触及。实验室检查：甲胎蛋白>1210 ng/ml，癌胚抗原5.49 ng/ml，肝功能及凝血功能检查均正常。超声检查：肝脏形态失常，实质回声稍欠均匀，肝右叶见一大小约8.1 cm×4.5 cm×8.1 cm团状混合回声，边界不清楚，形态不规则，内见数个斑片状强回声；CDFI于其内及周边可探及点线状血流信号。门静脉主干、左右支及脾静脉近心端内见弱回声充填，内可探及点线状血流信号（图1）。超声提示：肝母细胞瘤伴门静脉主干、左右支及脾静脉近心端弱回声：癌栓？     

肝母细胞瘤患儿超声征象变化及其与临床病理特征的关系分析

目的：分析肝母细胞瘤患儿超声征象变化及其与临床病理特征的关系。方法：回顾性分析2018年1月-2023年1月在本院收治的36例肝母细胞瘤患儿的超声及病理资料,对比不同病理分型(完全上皮细胞型、不伴畸胎样混合型、伴畸胎样混合型)患儿的超声征象变化。结果：36例肝母细胞瘤患儿超声检查结果显示,13例完全上皮细胞型患儿中,有7例肿瘤位于肝右叶,3例肿瘤位于左右叶,左叶2例,尾叶1例,瘤体平均大小为(286.34±23.75)cm₃^,规则单发病灶10例,分界清晰病灶9例,不规则瘤内坏死囊变11例;9例不伴畸胎样混合型患儿中,有4例肿瘤位于肝右叶,2例肿瘤位于左右叶,左叶2例,尾叶1例,瘤体平均大小为(282.59±21.98)cm₃^,规则单发病灶6例,分界清晰病灶5例,不规则瘤内坏死囊变7例;14例伴畸胎样混合型患儿中,有8例肿瘤位于肝右叶,3例肿瘤位于左右叶,左叶2例,尾叶1例,瘤体平均大小为(284.61±22.07)cm₃^,规则单发病灶11例,分界清晰病灶10例,不规则瘤内坏死囊变12例。三种病理类型的患儿病灶特征相比,差异无统计学意义(P＞0.05);完全上皮细胞型患儿的肿瘤强回声占比均高于伴畸胎样混合型患儿,不伴畸胎样混合型肿瘤强回声占比又高于伴畸胎样混合型患儿;完全上皮细胞型瘤体的钙化程度明显低于不伴畸样混合细胞型和伴畸样混合细胞型,差异有统计学意义(P＜0.05)。结论：通过分析患儿的肿瘤钙化和强回声占比等超声征象变化能初步判断肝母细胞瘤患儿的病理分型。     

Laparoscopic resection of hepatoblastoma: Report of a case

Despite the increasing number of recent reports on laparoscopic resection of malignant liver tumors in adults, there have been few reports involving children. In this paper we discuss the laparoscopic resection of a hepatoblastoma in a 1‐year‐old boy. The CT scan revealed an exophytic hepatic tumor on S5 measuring 6 × 5 × 4 cm after preoperative chemotherapy. The operation time was 225 min with an estimated blood loss of about 38 mL; intraoperative transfusion was not required. Radiofrequency‐assisted precoagulation was performed. The patient had an uncomplicated recovery and started postoperative chemotherapy on postoperative day 12. Our literature search revealed only five reported cases of laparoscopic resection of hepatoblastoma in which there was no postoperative complication or recurrence. Laparoscopic resection of a hepatoblastoma in a selected subgroup of patients can be safe and feasible.     

Efficacy of CT‐guided localization followed by video‐assisted thoracoscopic surgery in children with tiny pulmonary nodules

CT‐guided localization followed by video‐assisted thoracoscopic surgery was performed in three children with pulmonary nodules less than 5 mm in diameter. The patients' respective primary diagnoses were Wilms tumor, hepatoblastoma, and osteosarcoma of the femur. The pulmonary nodules were marked preoperatively by a percutaneously placed hook‐wire or dye under CT guidance. Although none of the nodules was grossly detected during the operation, they were correctly resected under the guidance of the hook‐wire wound or dye. A histological assessment revealed viable metastatic lesions in the case of hepatoblastoma, completely necrotic lesions in the case of Wilms tumor, and inflammatory nodules in the case of osteosarcoma. CT‐guided localization followed by video‐assisted thoracoscopic surgery appears to be a beneficial procedure in children with tiny pulmonary nodules.     

小儿肝母细胞瘤的超声表现与手术病理对照分析

目的 与手术及病理所见对照,探讨彩色多普勒超声对小儿肝母细胞瘤的诊断价值。方法 收集8例经手术病理证实为肝母细胞瘤、且具有完整的临床及超声检查资料的患儿,对肿瘤的超声表现与手术及病理所见进行回顾性对照分析。应用SPSS 11.5统计学软件,对超声所测与术中实测的肿瘤体积进行配对样本均数t检验,对超声所见与术中及病理所见的一致性进行Kappa检验。结果 超声检查除将1例发生于肝左叶的肿瘤误诊为累及左、右两叶外,其余7例定位诊断均与术中所见相符。超声与术中所测肿瘤体积差异无统计学意义(t=－0.765,P=0.470)。超声检查对肿瘤形态的显示与术中所见具有一致性(K=1.00,P=0.005);6例巨块状及2例结节状肿瘤经超声检查均诊断正确。超声检查对肿瘤内钙化或骨化(K=0.75,P=0.028)及囊变(K=0.71,P=0.035)的显示与病理观察具有一致性;5例肿瘤内钙化或骨化超声正确诊断4例,3例肿瘤内囊变超声正确诊断2例。超声检查对肿瘤边界情况、包膜完整性及肿瘤内坏死的显示与手术及病理所见无一致性(K=0.60、－0.23、－0.26,P均＞0.05)。结论 超声检查可较为准确地对小儿肝母细胞瘤进行定位,且在显示肿瘤形态和肿瘤内钙化或骨化及囊变方面具有优势,有助于制定肿瘤治疗方案及疗效评价。     

上皮细胞黏附分子与肝母细胞瘤患儿病理特征及预后的相关性

目的:研究上皮细胞黏附分子(epithelial cell adhesion molecule,Ep-CAM)表达与肝母细胞瘤患儿病理特征及预后的相关性。方法:以西安市儿童医院2015年1月至2017年1月收治的62例肝母细胞瘤患儿的肿瘤组织和癌旁组织为研究材料,采用免疫组织化学法检测Ep-CAM表达。分析Ep-CAM表达情况与患儿性别、年龄、病理分期、病理类型等病理特征的关系,并绘制患儿生存曲线,分析上皮细胞黏附分子表达水平与预后的相关性。结果:62例肝母细胞瘤肿瘤组织和癌旁组织EpCAM表达阳性率分别为75.81%和0.00%,差异有统计学意义(P<0.05)。肝母细胞瘤组织中Ep-CAM表达阳性与PRETEXT术前分期有关,与患儿年龄、性别、术前甲胎蛋白水平和病理类型无关。PRETEXT分期Ⅲ期和Ⅳ期患儿肿瘤组织中Ep-CAM阳性表达率显著高于Ⅰ期和Ⅱ期患儿(P<0.05)。Ep-CAM阳性和阴性患儿2年总生存率分别为34.04%(16/47)和86.67%(13/15),差异有统计学意义(P<0.05)。Log-rank分析Ep-CAM阳性和阴性患儿总的生存率差异有统计学意义(P<0.05)。结论:Ep-CAM蛋白在肝母细胞瘤组织中呈高表达,与PRETEXT分期存在相关性,是影响预后的关键因素,可能作为肝母细胞瘤诊断和预后评估的新靶点加以深入研究。     

Robot-assisted gallbladder-preserving hepatectomy for treating S5 hepatoblastoma in a child: A case report and review of the literature

BACKGROUND Hepatoblastoma(HB) is the most common hepatic malignant tumour in children,accounting for approximately 50%-60% of primary hepatic malignant tumours in children, mostly in children under 3 years old. In Western countries, the incidence of hepatoblastoma is approximately 1-2/100000. Da Vinci surgical system is fast becoming a key instrument in microinvasive surgery. The past decade has seen the rapid development of robot-assisted laparoscopy, which expends many fields including the liver surgery. This paper discusses the significance and feasibility of robot-assisted gallbladder-preserving hepatectomy for treating S5 hepatoblastoma in children. The aim of this essay is to compare the safety and effectiveness of robotic surgery with conventional laparoscopic surgery, and explore the meaning of preservation of the gallbladder by sharing this case.CASE SUMMARY A 3-year-old child with a liver mass in the 5 th segment was treated using the Da Vinci surgical system, and the gallbladder was retained. The child was admitted to the hospital for 20 d for the discovery of the right hepatic lobe mass.Ultrasonography revealed a low echo mass, 46 mm × 26 mm × 58 mm in size,indicating hepatoblastoma in the right lobe, and enhanced computed tomography showed continuous enhancement of iso-low-density lesions with different sizes and nodules and unclear boundaries, without the dilation of the intrahepatic bile duct, no enlargement of the gallbladder, and uniform thickness of the wall. The diagnosis was "liver mass, hepatoblastoma". It was decided to perform S5 liver tumour resection. During surgery, the tumour and gallbladder were isolated first, and the gallbladder could be completely separated from the tumour surface without obvious infiltration; therefore, the gallbladder was preserved. The cutting line was marked with an electric hook. The hepatic duodenal ligament was blocked with a urethral catheter using the Pringle method, and the tumour and part of the normal liver tissue were completely resected with an ultrasound knife along the incision. The hepatic portal interdiction time was approximately 25 min. An abdominal drainage tube was inserted. The auxiliary hole was connected to the lens, and the specimen was removed. The patient's status was uneventful, and the operation time was 166 min. The robotic time was 115 min, and the bleeding amount was approximately 200 mL. In total, 300 mL of red blood cell suspension and 200 mL of plasma were injected. No serious complications occurred. Pathological findings confirmed fetal hepatoblastoma and R0 resection. A gallbladder contraction test was performed two weeks after surgery.CONCLUSION Robot-assisted S5 hepatectomy with gallbladder preservation is safe and feasible for specific patients.