超声引导经皮热消融治疗肝细胞性肝癌

目的评价经皮热消融方法治疗肝细胞性肝癌的疗效。方法97例肝细胞性肝癌病人共190个结节接受了经皮微波或射频消融治疗。结果完全消融率93％。对直径≤2cm、2．1～3．9cm和≥4．0cm的结节完全消融率分别为93％、94％和86％。局部复发率10％，直径≤2cm、2．1～3．9cm、≥4．0cm的结节局部复发率分别为3％、10％和32％。1，2，3年无远处复发生存率分别为47％、35％和31％。1，2，3年累积生存率分别为76％、59％、50％。结论微波及射频热消融是治疗肝癌有效和安全的方法，但在较大肿瘤局部复发率较高。     

超声引导下胃肠道病变穿刺活检

目的探讨超声引导下胃肠道病变穿刺活检的临床应用价值。方法对30例经肠镜、CT或MRI检查发现但未能明确诊断的胃肠道病变(胃来源2例、小肠4例、结肠4例、直肠18例、肛管2例)进行超声引导下穿刺活检,总结活检方法、成功率及相关并发症。结果 30例中,经腹穿刺10例,经直肠穿刺16例,经肛周穿刺4例。标本取材满意29例,目标病灶穿刺成功率96.67%(29/30)。29例取材成功者中,活检病理提示良性病变11例,恶性病变18例,其中7例手术切除,6例活检病理与手术病理相符,1例活检病理不能鉴别未分化癌与间皮瘤,手术病理证实为未分化癌,其余病例与随访结果相符。穿刺后随访1~18个月,所有患者均未出现穿刺相关并发症。结论对于胃肠道病变,尤其是内镜活检困难或无效的病变,超声引导穿刺活检是安全、有效的诊断方法。     

肝血管平滑肌脂肪瘤的超声造影表现

Objective To investigate the features of hepatic angiomyolipoma(AML) on contrast enhanced ultrasound (CEUS). Methods Ten pathologically proved AML lesions in 9 patients were evaluated by using baseline ultrasound and CEUS. CEUS was performed with contrast pulse sequencing technique and the contrast agent of SonoVue. Results On baseline ultrasound, 7 lesions exhibited mixed echoic,which was obvious hyperechoic combined with partly of hypoechoie; 3 lesions exhitited obvious hypereehoic. On color Doppler flow imaging artery signals were detected in all lesions. And the lesions had plenty or slightly plenty of artery supply,with resistive index about 0.53 4±0.10 (0.48~0.62). On CEUS, in the arterial phase, 9 lesions exhibited hyper-enhanced. In the portal phase, 5 lesions exhibited iso-enhancement,1 lesion was slightly hyper-enhancement and 3 lesions was hypo-enhancement. In the late phase 6 lesions were iso-enhancement and 3 lesions were hypo-enhancement. One lesion was all hypo-enhancement in all three phases. Conclusions There are some characteristic manifestations of hepatic AML in CEUS, which are helpful for the diagnosis of hepatic AML in a way,but we still need more experiences.     

肝血管平滑肌脂肪瘤的超声造影表现

Objective To investigate the features of hepatic angiomyolipoma(AML) on contrast enhanced ultrasound (CEUS). Methods Ten pathologically proved AML lesions in 9 patients were evaluated by using baseline ultrasound and CEUS. CEUS was performed with contrast pulse sequencing technique and the contrast agent of SonoVue. Results On baseline ultrasound, 7 lesions exhibited mixed echoic,which was obvious hyperechoic combined with partly of hypoechoie; 3 lesions exhitited obvious hypereehoic. On color Doppler flow imaging artery signals were detected in all lesions. And the lesions had plenty or slightly plenty of artery supply,with resistive index about 0.53 4±0.10 (0.48~0.62). On CEUS, in the arterial phase, 9 lesions exhibited hyper-enhanced. In the portal phase, 5 lesions exhibited iso-enhancement,1 lesion was slightly hyper-enhancement and 3 lesions was hypo-enhancement. In the late phase 6 lesions were iso-enhancement and 3 lesions were hypo-enhancement. One lesion was all hypo-enhancement in all three phases. Conclusions There are some characteristic manifestations of hepatic AML in CEUS, which are helpful for the diagnosis of hepatic AML in a way,but we still need more experiences.     

三维超声在胆囊疾病中的应用价值

目的：评估三维超声在胆囊疾病诊断中的应用价值。方法：对59例患者的胆囊行二维及三维超声检查。由2位有丰富经验的医生分别独立地对三维与二维图像进行比较，评估三维超声对诊断结果的影响。结果：（1）三维超声能形象，直观地显示胆囊息肉表面乳头状或桑甚状的特征，与胆囊壁的关系，基底部的宽窄及有无带蒂；能清楚地显示胆囊癌病灶的形态及对胆囊壁和周围组织的浸润程度。（2）三维超声较二维超声可提供更多的诊断信息，在全部胆囊病变中76．3％（45／59）；在胆囊癌，胆囊息肉和胆囊结石中，分别为77．8％（7／9），75．0％（（15／20）和76．7％（23／30）。（3）在胆囊癌，胆囊息肉，胆囊结石及全部胆囊病变中二位检查者判断的Kappa值分别为1．00，0．69，0．52及0．67（P值均小于0．01）。Spearman相关系数分别为1．00，0．73，0．52及0．67。（4）在1例胆囊息肉和1例胆囊癌中，三维超声明显改变了诊断结果，并得到了手术证实。结论：三维超声较二维超声可提供更为丰富的诊断信息，特别是在胆囊息肉与胆囊癌的诊断中有重要的临床价值。     

低杆温技术扩大肝组织微波消融范围的实验研究

目的通过降低天线杆温来增加微波能量输出以扩大单次微波消融范围,减少穿刺次数,为改善临床局部疗效提供实验依据。方法采用水冷式低杆温微波天线对离体新鲜猪肝和活体猪肝进行单点微波消融,单源能量输出(60～80)W×(300～1500)s,双源能量输出70W×1200s,观察不同消融条件下肝组织凝固范围的大小。结果体外肝和活体肝内单源能量输出(80W×1500s)造成的组织消融范围分别为7.4cm×5.6cm和5.9cm×3.5cm,活体肝内双源消融灶大小为6.7cm×5.4cm。结论运用低杆温天线可加大能量输出,扩大了体外肝和活体肝组织的单点微波消融范围,可望改善临床微波消融治疗肝癌的局部疗效。     

运用低杆温微波电极扩大肝脏消融范围的实验研究

目的:改进微波消融技术以扩大肝组织凝固范围,为临床改善局部疗效提供实验依据。方法:采用一种新型的水冷式低杆温微波电极对离体新鲜猪肝行微波消融,单次能量输出60~90W,5~25min,观察不同消融条件造成的组织凝固范围和形态。结果:单次能量输出造成的组织消融范围为(4.5~8.3)cm×(3.0~6.1)cm。单纯增加输出功率时,凝固灶以纵径增长为主,只有同时延长消融时间才可获得纵横径的显著增大,70~80W,25min最接近类圆形,是比较满意的消融条件。结论:加大微波的输出功率和延长消融时间可以显著扩大肝组织凝固范围,结合使用低杆温电极,临床治疗肝癌时可望改善局部疗效。     

胆总管囊肿合并绒毛状腺瘤超声造影表现1例

患者女，27岁。因全身黄染，尿黄入院。3岁时因胆总管囊肿行囊肿-空肠吻合术。体格检查：皮肤、巩膜轻度黄染，上腹部见手术瘢痕。腹部未扪及肿物。实验室检查血清碱性磷酸酶。     

肝脏局灶性结节增生的超声造影表现及相关因素

目的 探讨肝脏局灶性结节增生(FNH)的CEUS表现,分析其相关因素。方法 对49例经病理确诊的FNH患者行CEUS检查,观察三期增强模式、离心性增强、轮辐状动脉、供血动脉和中央瘢痕,并分析上述各征象与病灶大小及肝脏背景的关系。结果 49例中,三期最常见的增强模式分别为动脉期高增强(45/49,91.84%)、门脉期等增强(25/49,51.02%)及延迟期等增强(21/49,42.86%);离心性增强27例(55.10%),轮辐状血管14例(28.57%),可见供血动脉33例(67.34%),中央瘢痕13例(26.53%)。在≤3 cm和≤5 cm的FNH中分别有15例(15/21,71.43%)和25例(25/38,65.79%)检出离心性增强,在≤3 cm的FNH中未见中央瘢痕,但不同大小的FNH中轮辐状动脉(P=0.78)和供血动脉(P=0.62)的检出率差异无统计学意义。不同肝脏背景的FNH中,4种CEUS典型征象的检出率差异均无统计学意义(P均>0.05)。结论 FNH最常见的三期增强模式为"高-等-等";离心性增强常见于较小的FNH,而较大FNH多可见中央瘢痕。     

大鼠Kupffer细胞内外Sonazoid微泡超声辐照下的动态现象

【目的】 探讨超声辐照对Kupffer细胞内外Sonazoid微泡运动和形态的影响?【方法】 分离大鼠Kupffer细胞?使用倒置相差显微镜观测Kupffer细胞吞噬Sonazoid微泡的情况?并使用临床超声检查仪在不同声压下辐照,观察微泡在Kupffer细胞内外的动态现象?【结果】 Kupffer细胞对Sonazoid微泡吞噬率为91%?游离微泡在机械指数(MI)0.21时由静止出现震动,产生震动的最佳MI为0.21 ~ 0.44,微泡破裂的声压阈值是1.03?MI=1.18是黏附微泡破裂的阈值?被吞噬微泡破裂的阈值为MI=1.37?【结论】 Sonazoid微泡能够被体外培养的Kupffer细胞吞噬?超声辐照下,声压对Kupffer细胞内外Sonazoid微泡的运动和形态有明显影响作用?