目的 分析软组织内恶性纤维组织细胞瘤(MFH)的超声表现,以提高对该病的诊断正确率.方法 回顾性分析经病理证实的12例软组织内恶性纤维组织细胞瘤的超声表现及病理资料,观察病灶的回声特点、生长方式、形态大小及彩色血流信号.结果 9例为原发病灶,3例为术后复发病灶.大腿7例,小腿2例,上臂、臀部、后腹膜各1例.大小4.8 ～ 16.9crm,平均大小7.8cm.超声表现为分叶状、团块状及不规则形,以低回声为主,5例有包膜,7例周围结构不清,6例内部见不规则无回声区.CDFI周边均可见较丰富血流信号,内部血流信号多少不等.免疫组化表达Vim、CD68阳性.结论 MFH多发生于四肢软组织,中老年多见,超声表现具有一定特征性,确诊仍需病理检查及免疫组化.

目的 探讨新生儿缺氧缺血性脑病(HIE)的经颅彩色多普勒超声(TCD)脑血流动力学变化特征及与临床预后的关系.方法 选取HIE新生儿136例作为HIE组,同期健康新生儿100例作为对照组(NC组).采用TCD测定大脑中动脉(MCA)的舒张期流速(Vd)、收缩期峰值血流速度(Vs)、平均血流速度(Vm)和阻力指数(RI);出生后28 d复查TCD,并进行中国20项新生儿行为神经测定(NBNA)评分.结果 H1E组新生儿在出生24、48 h时,脑血流速度显著减慢,阻力指数显著升高,MCA的Vs、Vd、Vm均显著低于NC组,RI均显著高于NC组(P＜0.05);出生后72 h,轻度HIE组血流动力学参数与NC组差异无统计学意义(P＞0.05),中、重度HIE组的Vs、Vd、Vm均显著低于NC组,RI均显著高于NC组;HIE患儿随着病情程度增加,Vs、Vd、Vm相对越低,RI相对越高,差异均有统计学意义(P＜0.05);HIE组在出生后28 d随访复查TCD和NBNA,轻、中、重度三组患儿的NBNA评分差异有统计学意义(P＜0.05),预后良好组患儿的Vs、Vd、Vm显著高于预后不良组(P＜0.05),RI显著低于预后不良组(P＜0.05);Pearson相关分析显示,MCA血流动力学Vs、Vd、Vm与NBNA评分呈正相关(P＜0.05),RI与NB-NA呈负相关(P＜0.05).结论 HIE患儿普遍具有脑动脉阻力升高及低脑血流灌注,TCD动态观察HIE患儿的脑血流动力学变化过程对早期诊断及预后评价具有重要价值.

OBJECTIVE:To investigate ultrasound and MRI features of malignant fibrous histiocytoma (MFH) of soft tissue.METHODS:Ultrasound, MRI images and pathological data of 12 patients with malignant fibrous histiocytoma in soft tissue confirmed by operation and pathology were analyzed from January 2012 to August 2018, inlcuding 7 males and 5 females, aged from 36 to 69 years old with an average age of 53 years old; the courses of disease ranged from 4 to 49 months with an average of 28 months. Clinical manifestations were soft tissue masses and pain in the affected limbs. Ultrasound, MRI and contrast-enhanced examination were performed before operation. The lesions, morphology, echo/signal characteristics, color flow signals and enhancement features were observed and compared with pathology.RESULTS:In 12 patients with MFH, 9 patients were primary lesions and 3 patients were recurrent lesions after operation. There were 7 cases of bilateral thighs, 2 cases of calves, 1 case of upper arm, 1 case of buttocks and 1 case of posterior peritoneum. The size ranged from 5.1 to 17.1 cm with an average of 8.7 cm. Ultrasound feature showed lobulated or agglomerate, and focused on low echo; 5 cases had capsule and with clear border; 7 cases were unclear boundary with surrounding tissues; and 6 cases with irregular echo-free. The blood flow signals were around the CDFI, and the internal blood flow signals were different. MRI feature showed lobulated, agglomerate or irregular shape, T1WI showed slightly lower signal or equal signal, T2WI showed high signal and DWI signal increased. Six patients manifested mixed signal inside, 7 patients manifested low signal separation inside, 5 patients with false envelope, and 9 patients manifested infiltration and growth with peripheral edema. T1WI showed uneven strengthening after enhancement. Immunohistochemical expression of Vim, CD68 were positive.CONCLUSIONS:The age, location and imaging features of soft tissue MFH are characteristic. The diagnosis of MFH should be considered when irregular mass occurred in soft tissues of limbs at middle-aged and old people. Echo and signal are homogeneous or mixed. Separation, necrosis and cystic degeneration could be seen in the mass. When the blood flow signals are abundant and solid components are obviously enhanced, the diagnosis of MFH should be considered.

目的 探讨乳腺癌超声弹性成像与组织学特征、分子生物学指标的相关性.方法 选择孕激素受体乳腺癌患者200例,采用超声弹性成像进行弹性评分;采用免疫组化法测定人表皮生长因子受体(Her)-2、雌激素受体(ER)和孕激素受体(PR)表达.观察超声弹性成像评分、组织学特征及Her-2、ER和PR表达阳性情况,超声弹性成像评分与组织学和分子生物学水平的关系.结果 超声弹性成像评分中,评分3分9例、评分4分24例、评分5分167例.肿瘤大小≥2.0 cm患者54例,浸润型导管癌患者168例,淋巴结转移患者73例.Her-2阳性表达患者125例,ER阳性表达患者139例,PR阳性表达患者145例.不同肿瘤大小超声弹性成像评分比较差异无统计学意义(P>0.05);浸润型导管癌超声弹性成像评分5分多于浸润型小叶癌和其他,淋巴结转移超声弹性成像评分5分多于无淋巴结转移,Her-2阳性者超声弹性成像评分5分比例显著多于阴性者,ER阳性者超声弹性成像评分5分比例显著多于阴性者,PR阳性者超声弹性成像评分5分比例显著多于阴性者,差异有统计学意义(P<0.05).结论 乳腺癌超声弹性成像与组织学病理及Her-2、ER和PR阳性表达具有一定相关性,二者联合可作为乳腺癌早期诊断及预后评估指标.

目的 探讨超声在卵巢良恶性肿瘤、交界性肿瘤诊断及恶性肿瘤术前分期中的价值,为卵巢肿瘤临床治疗及预后评估提供影像学依据.方法 回顾性分析2012-2016年经手术病理证实的87例卵巢良性肿瘤、53例卵巢交界性肿瘤及99例卵巢恶性肿瘤患者的术前经腹及经阴道超声影像与病理等临床资料,观察不同病理类型肿瘤的超声影像表现,采用一致性x2及Kappa检验分析超声对卵巢良恶性肿瘤诊断及术前分期与病理结果的差异,采用单因素及多因素Logisitic回归分析超声影像特征与卵巢交界性及浸润性肿瘤的相关性并建立预测模型.结果 超声诊断卵巢良恶性肿瘤的灵敏度、特异度为90.80％、96.05％;超声对于卵巢恶性肿瘤术前分期Ⅰ期、Ⅱ期、Ⅲ期及Ⅳ期的准确率分别为94.12％、89.19％、87.88％及90.32％;多因素Logistic回归分析得到以下变量建立卵巢交界性与浸润性肿瘤预测模型:血清CA125、肿瘤大小、实性成分及厚分隔(P＜0.05),该模型在50岁以下患者的灵敏度、特异度为81.6％、73.5％,在50岁及以上患者的灵敏度、特异度为95.2％、80.8％.结论 超声有助于卵巢良恶性肿瘤的诊断、恶性肿瘤术前分期以及交界性卵巢肿瘤的预测,其对于卵巢肿瘤临床治疗及预后评估具有重要意义.

目的 探究高频超声结合BI-RADS分级在乳腺肿瘤中的临床诊断价值.方法 选择2015年2月～2017年8月在湖州市中心医院进行治疗的128例乳腺肿瘤患者(159个病灶)的临床病历资料进行回顾性分析,应用高频超声对其双侧乳房进行扫查,根据BI-RADS对乳腺病灶进行分级评价.将其BI-RADS分级情况与病理学结果进行对照分析,评价高频超声结合BI-RADS分级在乳腺肿瘤诊断中的临床价值.结果 在159个乳腺肿瘤病灶中,经病理结果明确证实为良性病变98个,恶性病变61个.恶性病变病灶形态不规则、包膜不完整、边缘毛刺状、内部钙化以及腋下淋巴结异常的检出率明显高于良性病变病灶,差异有高度统计学意义(P＜0.01).恶性病变病灶的内部血流较良性病变病灶更加丰富,其Vmax水平、RI值明显高于良性病变病灶(P＜0.01);两组的血流分级比较差异有高度统计学意义(P＜0.01).在BI-RADS分级诊断结果中,共计85个病灶被诊断为3级病灶(7个病理结果为恶性),35个被诊断为4级病灶(有17个病理结果为恶性),39个被诊断为5级病灶(37个病灶结果为恶性).BI-RADS分级超声诊断的敏感度为88.52％(54/61),特异度为79.59％(78/98),准确度为83.02％(132/159).结论 BI-RADS分级在诊断乳腺肿瘤中具有较高的敏感性和特异性.高频超声结合BI-RADS分级对于乳腺肿瘤的诊断定性以及指导治疗方案都具有重要意义.

目的 探讨能量多普勒半定量分级在甲状腺结节细针穿刺中的应用价值.方法 337例(个)甲状腺结节随机分配入研究组(172例)和对照组(165例)进行细针穿刺,研究组细针穿刺时依据结节内能量多普勒半定量分级选择不同穿刺方式,对照组则以(常规)无负压穿刺抽吸,比较两组穿刺成功率及细胞学诊断结果.结果 研究组穿刺成功率95.4％高于对照组86.7％(P=0.005),在有确定意义的细胞学诊断结果中研究组117例(68.0％)高于对照组85例(51.5％)(P=0.002);两组鉴别结节良恶性的灵敏度90.5％比76.9％,特异度92.3％比78.2％,准确率91.3％比77.6％,研究组在灵敏度、特异度及准确率上均优于对照组(P＜0.05).结论 能量多普勒半定量分级能提高甲状腺结节细针穿刺成功率及细胞学诊断效能.

随着高频超声技术的发展及国民健康体检意识的增强,甲状腺结节的超声检出率逐年上升,其中约5％～15％的结节为恶性,因此准确评估甲状腺结节的良恶性非常重要[1-2].甲状腺细针穿刺(fine needle aspiration biopsy,FNAB)是一项安全、经济、可靠的检查方法,如何提高甲状腺结节细针穿刺取材成功率、减少并发症一直是临床工作的重点与难点.既往文献关于负压吸引甲状腺细针穿刺的运用报道较多,但是普遍存在红细胞污染率高、并发症多的问题,取材成功率不高[3-5].本文为避免红细胞污染细胞学涂片,减少穿刺出血,将Adler血流分级运用于甲状腺结节细针穿刺中,探讨其临床运用价值.

Objective To explore the clinical value of real -time ultrasound elastography in the diagnosis of thyroid nodules , and to provide reference for the clinical diagnosis and treatment of patients with thyroid nodular lesions.Methods The clinical data of 62 patients with thyroid nodule occupying lesions were retrospectively analyzed.The results of real-time ultrasound elastography imaging and pathological diagnosis were compared ,and the accuracy ,sensitivity and specificity of real -time ultrasound elasticity imaging in the diagnosis of thyroid nodular lesions were analyzed.Results The patients with elastic grade 0,pathological examination showed follicular adenoma cystic degeneration;The patients with elastic gradeⅠ,pathological examination showed follicular hyperplastic nodules ;The patients with elastic grade Ⅱ,pathological examination showed follicular gland tumor;The patients with elastic grade Ⅲ,pathological examination showed papillary adenocarcinoma;The patients with elastic grade Ⅳ,pathological examination showed papillary adenocarcinoma .In patients with elastic grade 0,3 patients had proliferative nodules , and 5 cases were follicular adenomas .Among the patients with grade Ⅰ,5 cases were proliferative nodules ,8 cases were follicular adenoma ,1 case of papillary adenocarcinoma;of gradeⅡpatients,6 cases of proliferative nodules ,14 cases of follicular adenoma ,2 cases of papillary adenocarcinoma .Among the patients with grade Ⅲ,4 cases were follicular adenomas,and 6 cases were papillary adenocarcinomas .Among the patients with grade Ⅳ,3 cases were follicular adenomas,7 cases were papillary adenocarcinomas .The diagnostic accuracy of real -time ultrasound elastography was 93.5%,and the difference was not statistically significant (P>0.05).The sensitivity and specificity of real -time ultrasound elastography were 100.0% and 72.6%.Conclusion Real -time ultrasound elastography has high accuracy in the diagnosis of benign and malignant lesions of thyroid nodules ,it is worthy of being widely promoted .

目的 分析乳腺肿块患者彩色多普勒超声诊断的临床价值.方法 选择2015年10月至2016年10月期间在我院行乳腺病理学检查,并进行彩色多普勒超声检查的60例患者为研究对象,对患者的诊断情况进行分析.参试患者均采用彩色多普勒超声诊断仪对患者进行检测,设置探头频率为7~14 MHz.参照彩超多普勒检测对患者的血流情况进行分级.结果 彩色多普勒超声影像学初诊结果与手术病理诊断结果一致性较好,乳腺肿块的影像学诊断准确率为91.11%.通过对患者的乳腺肿块血流情况分级,良性肿块中0级31个,I级29个,II级4个,III级0个;恶性肿瘤中0级1个,I级17个,II级21个,III级5个.以Adler≥II级为恶性肿瘤的诊断指标,其诊断的灵敏度为65.91%(29/44),特异性为74.60%(47/63),准确率为71.03%(76/107).结论 彩色多普勒超声诊断乳腺肿块患者,可通过肿块血流情况确定患者肿块的情况,有助于提高临床诊断的准确率,并可以检测患者肿块回声、边缘及轮廓,具有临床参考价值.

Objective To discuss the application of cystic cavity flushing technique in percutaneous ethanol sclerotherapy for the thyroid colloid cysts.Methods A total of 49 patients with thyroid colloid cysts were randomly divided into the study group (n=33) and the control group (n=16).Patients in the study group received cystic cavity flushing treatment by using saline together with α-chymotrypsin,which was followed by percutaneous ethanol injection (PEI).Patients in the control group underwent simple aspiration of cyst fluid followed by PEI.The residual cystic volume,the effective rate and the untoward effects were calculated at one,3 and 6 months after the treatment,and the results were compared between the two groups.Results Striking difference in the changes of postoperative residual cystic volume existed between the study group and the control group.The effective rate of PEI in the study group was 93.9％,which was obviously better than 68.8％ in the control group,the difference between the two groups was statistically significant (P＜0.05).No untoward effect was observed during the performance of aspiration of cyst fluid and flushing of cystic cavity.Nevertheless,bad side effect occurred in PEI procedure in both the study group (6.1％) and the control group (8.3％),but the difference was not statistically significant (P=0.75).Conclusion For the treatment of thyroid colloid cysts,the use of aspiration of cyst fluid together with cystic cavity flushing technique by using saline combined with α-chymotrypsin is safe and reliable,it can improve the curative effect of subsequent PEI.

目的 探讨术中实时超声在颅内胶质瘤显微手术中定位、引导肿瘤切除及实时监测肿瘤切除范围的应用价值.方法 回顾性分析2011年6月～2015年8月入住我院的颅内胶质瘤显微手术患者74例,根据术中是否超声引导分为超声组(39例)和对照组(35例),超声组使用术中超声扫描定位肿瘤,了解病灶的大小范围、形态与周围结构的关系,选择合理的手术入路和皮层切口并监测肿瘤切除范围,对照组术中未使用超声,对比分析两组肿瘤定位准确率及全切率,同时记录术后颅内感染、脑挫伤等并发症情况.结果 超声组肿瘤定位准确率高于未用超声组(100.0％ vs 82.9％,P＜0.05),超声组肿瘤全切率高于对照组(82.1％ vs 51.4％,P＜0.05).超声组无颅内感染、脑挫伤等相关并发症发生.结论 应用术中超声技术切除颅内胶质瘤具有定位准确、有效保护重要结构和大血管、实时监测肿瘤切除范围等优点,可提高手术全切率,减少术后并发症发生.

目的 对比超声引导下肝脓肿经皮穿刺针(PTC)抽吸与超声引导下置管引流的疗效.方法 2014年1月—2015年12月选取在湖州市中心医院超声科就诊的40例细菌性肝脓肿患者,采用随机数字表将40例细菌性肝脓肿患者分为2组,其中A组患者(20例)在超声引导下用PTC针行单纯抽吸术,B组患者(20例)在超声引导下行置管引流术.观察2组一次性治愈率、体温恢复正常时间、疼痛减弱时间、脓肿腔消失时间及住院治疗时间,随访有无复发及并发症发生情况等.结果 B组20例患者治愈,有效率为100％;A组13例患者一次穿刺治愈,有效率为65％,4例2～5d后行第2次穿刺后治愈,其余3例在2次穿刺后仍有较大脓腔,行置管引流术后治愈.2组患者的有效率比较差异有统计学意义(P＜0.05).A组体温恢复正常时间、疼痛减弱时间、脓肿消失时间及住院时间分别为(3.0±0.6)d、(2.5±0.6)d、(12.5±3.5)d、(15.6±4.0)d,均长于B组的(2.0±0.5)d、(1.2±0.5)d、(7.2±2.0)d、(10.3±3.0)d,差异有统计学意义(P＜0.05).A组并发症发生率为40.0％ (8/20),B组并发症发生率为5.0％(1/20),2组并发症比较差异有统计学意义(x2=5.161,P＜0.05).结论 细菌性肝脓肿经超声引导下置管引流管治疗,能有效提高患者治疗效果,减轻患者疼痛感,缩短患者治疗时间,效果显著,值得推广.

目的：比较聚桂醇与无水酒精对肾囊肿超声介入术后硬化的效果。方法选取2011年1月至2014年12月该院超声科收治的肾囊肿患者60例，根据治疗方法不同分为A、B两组各30例。两组均给予超声引导下穿刺抽液治疗，之后A组用聚桂醇硬化治疗，B组用无水酒精硬化治疗，3个月后超声复查囊肿大小，比较两者的治疗效果及不良反应情况。结果两组总有效率差异无统计学意义，但A组不良反应发生率明显低于B组，差异有统计学意义。结论超声引导下穿刺介入后使用聚桂醇硬化治疗肾囊肿疗效肯定，安全，不良反应少，是无水酒精较好的替代物。聚桂醇虽然价格较贵，但未见无水酒精的不良反应。

诊断乳腺疾病目前常用的是超声和X线钼靶摄影， X线钼靶发现乳腺肿块率较高，但鉴别其良恶性准确性不很高，且受辐射线照射对身体有损害。乳腺常规超声检查是目前诊断乳腺疾病最常用的方法，对良恶性作出初步诊断，但不能了解肿块的软硬度，而乳腺肿块的硬度与良恶性相关，学者普遍认为肿块质地较软的多为良性，较硬的多为恶性肿块。最新的超声弹性成像技术突破了这一观念，认为乳腺良、恶性肿块有弹性差异，利用肿块本身具有的弹性差异对鉴别良、恶性有重要临床意义，因此，超声弹性成像已成为乳腺肿块诊断的新方法。本文对此作一探讨。

Objective To compare the use of 16G and 18G biopsy needles in percutaneous ultrasound- guided renal biopsy. Methods Four hundred and eighty six patients undergoing percutaneous ultrasound- guided renal biopsy were as-signed to use 16G Cru- cut biopsy needle (n=216) or 18G needle (n=270). Two specimens of renal tissue were required to be taken for 16G group and 3 specimens were required for 18G group. Results The overal success rate of biopsy was 94.4%, that was 93.6%in 16G group and 95.2%in 18G group (P>0.05). The average biopsy times in 16G group was 2.57±0.34 and that in 18G group was 2.84±0.51(P<0.01). The complication rate in G16 group was 8.80%(gross hematuria 5.56%, subcapsular renal hematoma 3.24%) and that in G18 group was 5.56%(gross hematuria 4.07%, subcapsular renal hematoma 1.48%) (P>0.05). The average number of glomerulum under light microscope in 16G group was 19.33 ±4.91and that in 18G group was 25.27±6.23 (P<0.05). Conclusion Ultrasound- guided renal biopsies using 18G Cru- cut biopsy needle does not increase the incidence of complications, although one more specimen need to be taken compared to using 16G. The specimens of renal tis-sue taken using both needles meet standard of light, immunofluorescence and electron microscopic examinations.

乳腺癌是危害妇女健康和生命的最常见的恶性肿瘤.发病率有逐年增加的趋势[1],在各种检查手段中,超声是乳腺肿块良恶性检查中的首选影像学检查方法,但二维超声成像技术及彩色多普勒超声成像技术在对肿块做出良恶性鉴定时仍有局限性[2].超声弹性成像是近年发展起来的一种成像方法,其可通过提取病变的硬度信息对病灶进行良恶性鉴别诊断,这一技术目前在乳腺疾病诊断中的应用最广泛[3].作者回顾性分析接受超声弹性、二维及彩色多普勒检查的193例乳腺肿块患者资料,探讨超声弹性成像技术在乳腺肿块良恶性鉴别诊断中的临床应用价值,现报道如下.

Objective To discuss relationship of image data of transrectal ultrasound and histopathological types in prostate cancer.Methods Image data and histopathological types of 20 cases with prostate cancer were retrospectively analyzed,and the relationship were studied.Results All 14 cases of gland showed hypoecho,according for 70%.Prostate cancer with rich blood supply and blood flow signal was enhancement.PSV was(29.1 ±11.2)cm/s,RI was(0.83 ±0.09).Dysplasia was 2 cases,high differentiation was 3 cases,moderately differentiated was 5 cases,and poorly differentiated was 10 cases.Dysplasia mainly showed hypoecho and mixed echo.High,moderately and poorly differentiated all mainly showed hypoecho.Conclusion Transrectal ultrasound for prostate cancer shows image sharpen,high-resolution and to observe blood vessels,and so on.To conclude image data of different histopathological types,can provide theory basis for clinical further diagnosis before the operation.

Objective To discuss the application value of differential diagnosis of rectum doppler ultrasonography for BPH and Prostate cancer.Methods Retrospective analyzed clinical data of 20 cases with prostate cancer and 20 cas es with BPH.Image data were compared between two groups.Results Prostatic inner gland volume enlarged.14 cases or prostate cancer showed hypoecho,according for 70%.Prostate blood supply of control group was less,and distributed uniformity.Prostate blood supply of BPH was increased.12 cases were more than 2 degree.Prostate blood supply of prostate cancer was increased,and 17 cases were more than 2 degree.There were significant difference in three groups(P < 0.01).PSV and RI of prostate cancer group and BPH group were higher than control group(P < 0.01).And prostate cancer group was higher than BPH too(P < 0.01).Conclusion Image data of rectum doppler ultrasonography shows different characters.To grasp these characters shows important meanings in differential diagnosis.

目的 探讨难复性小儿肠套叠首次水压灌肠失败后行再次水压灌肠的可行性及注意事项.方法 回顾性分析2007年7月-2011年7月行再次水压灌肠患者的临床资料、超声影像学特点及部分病例手术结果.结果 44例首次水压灌肠失败的患儿经再次灌肠成功21例(其中1例经第3次灌肠成功),失败23例,整复成功率48.0%.结论 再次水压灌肠治疗难复性小儿肠套叠仍有较高的复整率,可降低手术及麻醉对患儿带来的影响及危险,值得推广应用.