经直肠超声对表面完全钙化的膀胱癌和膀胱嵌壁结石的鉴别诊断

目的 探讨经直肠超声在鉴别诊断位于膀胱三角区表面完全钙化的膀胱癌和膀胱嵌壁结石的价值.方法 对 47例病灶位于膀胱三角区的患者行经腹及经直肠超声检查,观察病灶活动度,对比分析两种检查途径的二维声像图、彩色多普勒血流成像（CDFI）及膀胱壁情况.结果 经腹超声检查膀胱癌和膀胱嵌壁结石均表现为膀胱腔内不移动强回声后伴声影.经直肠超声可清楚显示膀胱癌低回声肿块和表面强回声,该处膀胱壁层次不清,CDFI可见迂曲树枝状彩色血流信号自膀胱壁进入低回声内,可测及动脉血流频谱.膀胱嵌壁结石经直肠超声检查表现为强回声后伴声影,膀胱壁层次尚清楚,CDFI未探及彩色血流信号.膀胱癌经腹与经直肠超声检查结果比较差异有统计学意义（χ2＝56,P＜0.01）,嵌壁膀胱结石经腹与经直肠超声检查结果比较差异无统计学意义（P＞0.05）.结论 经直肠超声在鉴别诊断位于膀胱三角区表面完全钙化的膀胱癌和膀胱嵌壁结石中有重要价值.

Differential diagnosis of surface completely calcified bladder cancer and recessed bladder stones by transrectal ultrasonography

Objective To explore the value of transrectal ultrasound in differential diagnosis of surface completely calcified bladder cancer located in bladder trigone and bladder recessed stones. Methods Bladder trigone lesions in 47 patients were examined by transabdominal and transrectal ultrasound, the lesion movement was observed, the two - dimensional ultrasound, color Doppler flow imaging （CDFI） of lesions and bladder wall situation were compared and analyzed by two methods. Results Transabdominal ultrasound showed the two type lesions appeared as unmoved hyperechoic lesions in bladder cavity with acoustic shadow. In bladder cancer, low echo masses of bladder and surface hyperechogenicity could be clearly displayed by transrectal ultrasound, the the structure of bladder wall was not clear, CDFI showed tortuous dendritic - like color blood flow signals from bladder wall into the low - echo lesions, arterial blood flow spectrum could be detected. In bladder recessed stones, transrectal ultrasonography showed hyperechogenicity with acoustic shadow, the structure of bladder wall was clear, CDF! showed no color blood flow signals. There was significant difference of surface completely calcified bladder cancer between the two methods （ χ2 = 56, P 〈 0.01 ）, while there was no significant difference of recessed bladder stones between transabdominal and transrectal uhrasonography （ P 〉 0.05 ）. Conclusion Transrectal uhrasonography has important value in differential diagnosis of surface completely calcified bladder cancer located in bladder trigone and bladder recessed stones.