经皮射频消融治疗胆囊旁肝肿瘤

[目的]探讨冷循环超能射频肿瘤治疗系统经皮治疗胆囊旁肝肿瘤的可行性和有效性。[方法]在超声引导下,采用冷循环电极对11例胆囊旁肝肿瘤病人15个肿瘤结节进行经皮射频消融治疗。[结果]11例病人中,9例术后出现腹痛,持续时间2~17天(7.5±4.2天);5例术后发热,体温≥38.5℃;2例术后白细胞>10.0×109/L,2例术后AFP和1例术后CEA降至正常范围。术后CT或超声证实,9例病人肿瘤完全毁损,其中3例病人在随访期间局部复发。[结论]冷循环超能射频肿瘤治疗系统治疗胆囊旁肿瘤是安全和有效的。     

射频消融联合经门静脉化疗栓塞治疗原发性肝癌

目的:探讨射频消融(radio-frequency ablation,RFA)联合经门静脉化疗栓塞术治疗原发性肝癌的可行性及其临床疗效. 方法选取经肝动脉化疗栓塞术(transcatheter arterial chemoembolizalion,TACE)治疗效果不理想的原发性肝癌患者28 例共49个癌灶,行经皮超声引导下的RFA,随后穿刺供瘤门静脉分支,对肿瘤行化疗栓塞术 (碘油+丝裂霉素C),治疗后1个月、3个月以临床表现、AFP、B超、CT指标综合评价治疗效果.结果: 28例中成功施行RFA+经门静脉化疗栓塞术26例共46个病灶.治疗后1个月、3个月发生肝区疼痛、腹胀、乏力、纳差、消瘦、黄疸等症状的患者例数明显减少,同术前比较有显著性差异(P<0.05);治疗前、治疗后1个月、3个月的平均肝功能Child评分分别为(9.8 ±2.4 )分、(9.3±2.1)分和(8.1±1.9)分,治疗后1个月和治疗前的评分差异无统计学意义(P>0.05),而治疗后3个月评分则显著低于治疗前(P<0.05); 治疗后1个月、3个月AFP>400 μg/L的患者比例及AFP测值均显著低于治疗前(P<0.05);综合B超和CT结果示治疗后1个月86.4%的肿瘤病灶被彻底毁损,复发或未被彻底毁损继续行上述治疗,3个月时肿瘤病灶的完全毁损率达94.9%.所有患者在治疗中和治疗后未发生严重并发症. 结论RFA联合经门静脉化疗栓塞术治疗肝癌操作简单,安全有效,可作为对TACE疗效不佳的肝癌患者的一种候选治疗手段.     

浆细胞性乳腺炎的超声诊断价值

浆细胞性乳腺炎与乳腺癌声像图表现有相似之处，所以应加强对该病的认识。     

彩超对乳腺癌术后腋窝血管血流动力学改变的临床观察

目的：探讨乳腺癌术后患者腋窝血管的血流动力学状态是否存在改变及应用彩色多普勒超声检查的可行性。方法：搜集我院69例右乳腺癌改良根治术后复查患者,用彩色多普勒超声观察其腋动脉、静脉的内径（internal diameter,ID）、收缩期最大流速（peak systolic velocity,PSV）、舒张末期流速（end diastolic velocity,EDV）、平均流速（time averge velocity,TAV）、搏动指数（pulsatility index,PI）及阻力指数（resistivity index,Ⅲ）,与正常组作对照,进行统计学处理。结果：术后患肢腋静脉的PSV、EDV、TAV值较正常对照组减慢约24．0％,36．7％,34．9％;患肢腋动脉收缩期、舒张期、平均流速分别降低23．7％,47．9％,28．3％,差异均有统计学意义（P〈0．05）。术后血管工ID、PI、RI未见明显改变。术后有上肢水肿者较无症状者腋静脉PSV、EDV、TAMAX值明显下降（P〈0．05）,而腋动脉各参数无明显改变（P〉0．05）。结论：乳腺癌改良根治术对腋窝血管的处理一定程度影响患侧上肢的血供。彩色多普勒超声检查腋窝血管血流动力学是一种可靠的方法。     

超声造影定量分析对甲状腺结节血流灌注的研究

目的 评价超声造影定量分析参数对甲状腺结节血流灌注的意义.方法 对78例甲状腺结节患者,术前应用超声造影检测结节的血流灌注参数,术后对手术标本行CD34因子免疫组化染色,计算微血管密度,行统计学对比分析.结果 结节性甲状腺肿组与甲状腺癌组的造影参数比较,直径＜1 cm结节的拟合曲线峰值强度、最大灌注强度、平均灌注强度在两组间差异有统计学意义(P＜0.05),两组结节间微血管密度差异无统计学意义(P＞0.05);两组间直径≥1 cm结节的局部血容量差异有统计学意义(P＜0.05),且两组结节的微血管密度差异也有统计学意义(P＜0.05).结论 不同大小、不同性质的甲状腺结节血流灌注特点不同,超声造影定量分析技术可为临床提供许多有价值的信息.

Abstract：

Objective To assess the value of blood perfusion of thyroid nodules using contrastenhanced ultrasonography(CEUS). Methods Blood perfusion parameters of 78 preoperative patients with thyroid nodule were examined using CEUS. Microvessel density(MVD) in the thyroid nodule specimens was calculated by immunohistochemical staining using anti-factor CD34. Results Compared to papillary thyroid carcinoma (PTC) and nodular goiter (NG), there was significant differences in peak value(PEAK),maximum value of video signal intensity(Slmax), and mean value of video signal intensity(SImean) in thyroid nodule with diameter ＜ 1 cm ( P ＜ 0. 05 ), the MVD of thyroid nodules was not statistically significant ( P ＞ 0.05). There were significant differences in regional blood volume and MVD in thyroid nodule with diameter ≥ 1 cm between two groups ( P ＜ 0.05). Conclusions The characteristics of blood perfusion are dissimilar for thyroid nodules with different sizes and properties. The quantitative analysis with CEUS can provide valuable information for clinical diagnosis.     

超声引导下粗针穿刺活检在乳腺癌新辅助化疗中的应用价值

乳腺癌新辅助化疗又称术前化疗,是目前世界上乳腺癌治疗的新趋势,它能使肿瘤缩小,降低分期,有利于局部病灶的手术切除和增加保乳机会,同时有助于了解肿瘤对化疗的敏感程度,为进一步化疗提供有价值的依据.研究表明,新辅助化疗对乳腺癌总体治愈率、生存率的提高有积极意义[1].因此寻求一种简单、快速的方法以获取病灶准确的病理组织学诊断结果和免疫组化检测即显得非常重要.笔者对近年收治的行新辅助化疗的乳腺癌患者超声引导下粗针穿刺活检的临床资料作一回顾性分析,旨在评价超声引导下粗针穿刺活检在乳腺癌新辅助化疗中的应用价值.     

超声引导细针定位在乳腺隐匿性病灶切除中的应用

目的 探讨超声引导细针定位在乳腺隐匿性病灶定位切除中的应用价值及其操作技巧。方法 超声引导下细针定位后切除的乳腺隐匿性病灶患者43例共48枚病灶,对其细针穿刺过程、穿刺准确程度进行回顾性分析;同时对细针定位行乳腺区段切除的患者与同期35例行体表标记定位区段切除患者的术后乳房美容效果评价进行对比分析。结果 48枚病灶除两枚针芯穿刺过深外,其余均定位准确。术后3个月超声复查所有病灶均被准确切除。43例患者中4例为恶性肿瘤（9．3％）,行全乳切除,其余39例行区段切除术的术后3个月与35例体表定位区段切除术患者美容效果评价,良好者分别为37例（94,87％）,24例（68,57％）,两者差异有统计学意义（P〈0,01）。结论 超声引导下细针定位简便易行,定位准确,是乳腺隐匿性病灶定位切除较好的方法。     

超声造影在肝局灶性结节增生诊断和鉴别诊断中的价值

[目的]探讨超声造影在肝局灶性结节增生（FNH）的诊断以及与原发性肝癌（PHC）鉴别诊断中的价值。[方法]经病理学检查证实的原发性肝癌22例和肝局灶性结节增生病变16例,采用GE-LOGIQ9彩色多普勒系统,具有CPS（contrast pulse sequence）造影专用程序和造影剂Sonovue进行超声造影成像,造影时记录肝实质及病灶的充填过程、充盈方式及增强程度。[结果]22例原发性肝癌的造影方式均呈典型的快进快退型。16例FNH在动脉期呈强回声,而门脉相呈等回声。在延迟相,15/16例（94%）FNH病灶呈等回声或稍高回声,1/16例（6%）较肝实质回声稍低;11/16例（69%）病灶在门脉和延迟相可见中央瘢痕。[结论]超声造影能清楚显示肝局灶性结节增生和原发性肝癌的造影充填过程及充填方式,在两者的诊断和鉴别诊断中具有重要意义。     

鼻咽癌颈部转移性淋巴结的超声造影特征及时间强度曲线分析

Objective To study the character of cervical lymph nodes metastasis in nasopharyngeal carcinoma(NPC) by contrast-enhanced uhrasonography(CEUS) and time-intensity curve. Methods Forty-one lymph nodes of metastasis from 32 patients were studied by CEUS. The enhancement of echogenicity was evaluated,and the time-intensity curve was analyzed. Results Of the 41 lymph nodes examined, 10 (24.4%) showed intense homogeneous enhancement by CEUS, 23 (56.1%) showed inhomogeneous enhancement and 8 (19.5 %) showed scarce intranodal enhancement. There were 20 (48.8%) lymph nodes showed necrosis. Most of the lymph nodes (92.7%) showed peripheral type blood flow, 3 (7.3) % showed mixed type blood flow. There were significant differences in them(P < 0.01). The time-intensity curve displayed steeply in upslope, and gently in decent. The arrival time(AT), time to peak(TTP), peak intensity (PI) ,area and gradient were (7.2±2.5)s,(7.6±2.3)s,(9.5±3.3)dB,(203.4±45.7)dB· s,1.2±0.5 respectively. Between the lymph nodes with envelope infringed and not, there were significant differences in PI and area, while there were not significant differences in AT, TTP and gradient. Conclusions The metastasis cervical lymph nodes of NPC had specific character by CEUS and time-intensity curve. In this way,it may help us to diagnosis cervical lymph nodes metastasis of NPC,and provide more information for the therapy and prognosis judgement.