颈部良、恶性肿大淋巴结的超声诊断与鉴别诊断

目的探讨超声对颈部良、恶性肿大淋巴结的诊断与鉴别诊断的临床实用价值。方法118例颈部淋巴结肿大患者应用二维超声、彩色多普勒血流图（CDFI）、彩色多普勒能量图（CDE）和脉冲多普勒（PWD）同步检测和分析肿大淋巴结的形态、边界、淋巴结门、内部回声、长径／横径（L／T）值、CDFI、CDE、PWD特征。结果各种不同病因所致的颈部淋巴结肿大各有其超声特征。二维超声显示：急性淋巴结炎形态呈椭圆形，淋巴结结核形态呈串珠形或融合，恶性淋巴瘤形态呈趋于圆形，淋巴结转移癌趋于形态呈圆形或不规则；急性淋巴结炎边界清楚、规整，淋巴结结核边界不规整，恶性淋巴瘤边界较清、较大或融合者模糊，淋巴结转移癌边界清或欠清、可融合。CDFI及CDE显示：急性淋巴结炎为Ⅰ型或Ⅱ型，淋巴结结核为Ⅰ型或Ⅴ型，恶性淋巴瘤为Ⅱ型或Ⅳ型，淋巴结转移癌为Ⅲ型。淋巴结结核、恶性淋巴瘤、淋巴结转移癌Vmax、RI值与淋巴结炎比较差异均有统计学意义（均P〈0．05），而Vmin值与淋巴结炎比较差异均无统计学意义（均P〉0．05）。结论①超声对颈部良、恶性肿大淋巴结的诊断与鉴别诊断具有重要临床意义。②在作出病因诊断的同时还可提示病变的性质及病变的严重程度。为临床的诊断及预后评价提供依据，可作为首选诊断方法。

Diagnosis and Differential Diagnosis of Benign and Malignant Cervical Lymph Node Enlargement by Ultrasound

Objective To explore the clinical value of ultrasound in diagnosis and differential diagnosis of benign and malignant cervical lymph nodes enlargement. Methods The shape, boundary, hilum of lymph gland,internal echo, L/T ratio,color doppler flow imaging（CDFI）,color doppler energy（CDE）,and pulsed wave doppler（PWD）spectrum feature of cervical lymph node enlargement in 118 patients were studied with two-imensional ultrasound, CDFI,CDE and PWD ultrasound. Results All kinds of cervical lymph nodes enlargement took on all kinds of characters. Acute lymphadenitis oval shape, tuberculous lymphadenitis bead-shaped or integrated, malignant lymphoma were tended to round, lymph node metastasis circular or irregular. The boundary of acute lymphadenitis was clearly structured, node tuberculosis irregular; malignant lymphoma was clearer, larger or the integration fuzzy; lymph node metastatic carcinoma clearless,or integrated. CDFI and CDE display that acute lymphadenitis for type Ⅰ or type Ⅱ ,lymph node tuberculosis for type Ⅰ or type Ⅴ ,malignant lymphoma for type Ⅱ or type Ⅳ ,lymph node metastases for type Ⅲ. Vmax and RI values of tuberculous lymphadenitis,malignant lymphoma and metastatic carcinoma of lymph node were statistically significant differences（all P〈0.05）. Compared with lymphadenitis while Vmin values no statistically significant differences （all P〉0.05）. Conclusion （1）Ultrasound in diagnosis and differential diagnosis of benign and malignant cervical lymph nodes enlargement has important clinical significance. （2）Etiological diagnosis can be made and at the same time it can prompt the nature and severity of disease. So it can provide the basis for clinical diagnosis and prognosis as the preferred diagnostic method.