目的:探讨经直肠超声检查联合血清C角蛋白19片段抗原21-1(CYFRA21-1)水平检测在直肠癌患者术前诊断中的应用.方法:选取我院2016年11月至2018年10月直肠癌患者91例设为研究组,另选取同期健康体检者91例设为对照组,所有患者均接受经直肠超声检查及血清CYFRA21-1水平检测.统计分析研究组与对照组血流动力学参数[舒张末期流速(EDV)、搏动指数(PI)、阻力指数(RI)]及血清CYFRA21-1水平,分析经直肠超声对直肠癌临床分期诊断准确率,比较经直肠超声与血清CYFRA21-1检测对直肠癌单独与联合诊断效能.结果:研究组EDV及血清CYFRA21-1水平高于对照组,RI及PI低于对照组(P<0.05);经直肠超声对直肠癌T分期诊断准确率为89.01％(81/91);联合诊断敏感度(97.80％)、准确度(96.70％)高于经直肠超声(86.81％、92.31％)与血清CYFRA21-1(69.23％、82.42％)单独诊断(P<0.05).结论:经直肠超声检查联合血清CYFRA21-1水平检测可有效提高直肠癌诊断敏感度与准确度,并能准确评估疾病分期,进而为临床制定、调整治疗方案提供可靠依据.

Objective:To investigate the application value of pelvic floor ultrasound in parous female urethras and space occupying lesion of circum-urethras.Methods:By using the prospective study method,283 parous female patients(91 cases of vaginal delivery,192 cases of cesarean section delivery) were examined by pelvic floor ultrasound and ultrasound tomography in condition of resting and maximum Valsalva position and 12 patients who were found with space-occupying lesion of circum-urethras by clinical physical examination were examined with ultrasound contrast by transurethral injection of 0.9％ NaCl at the same time in order to make clear diagnosis.Results:By pelvic floor ultrasound,the images of normal urethras and pathological change of circum-urethras were clearly discernible.Of 283 parous female patients who were examined,70 were normal.Urethra of 53 cases rotated down only.Urethras of 77 cases rotated down with internal urethral orifice funnel.Urethras of 35 casesrotated down with urine salt crystals,and all cases were found with Green]Ⅱ cystocele.Urethras of 29 cases rotated and contorted with Green Ⅲ cystocele.19 cases were found with cystic space-occupying lesions of circum—urethras (including 7 cases of circum-urethral simple cyst,10 cases of urethral diverticulum and 2 cases of skenitis with cyst).125 patients had been undergone surgical treatment and postoperative follow-up for 1 year.1 case were found with rare urethral diverticulum in situ carcinoma by postoperative pathological finding.56 patients had been undergone physical therapy and follow-up for 1 year.Conclusions:Pelvic floor ultrasound can be used for examination of morphological structure for urethras and pathological change of circum-urethras in parous female patients and may provide important information for clinical diagnosis.

Objective To explore the estimated value of ultrasound on old patients with total hysterectomy .Methods 33 cases old patients with total hysterectomy under the transperineal pelvic ultrasound examination at 3 months after total hysterectomy were selected .The ultrasonic parameters of the resting state and the state of valsalva were recorded : the bladder neck descent (BND),bladder neck from the edgeofpubicsymphysisverticaldistance(BSD),urethrarotationangleandposteriorurethrovesicalangle.Results 19cases(57.58%)were diagnosed with bladder prolapse ,rectal prolapse and stress urinary incontinence and other pelvic floor function disorder .On resting state,BND and urethral rotation angle did not display .The other ultrasonic parameters BSD and posterior urethrovesical angle respectively were (-2.68± 0.69)cm,(116.17±12.60)°.On Valsalva,BND was for(2.37±0.52)cm and BSD was for(-0.47±0.22)cm,urethral rotation angle for (58.26±6.73)°,posterior urethrovesical angle for (121.57±19.64)°.On the resting state,the correlation coefficient about BSD and posterior urethrovesical angle between the two ultrasound doctors were 0.684 and 0.901 respectively.On valsalva condition,the correlation coefficient about BND,BSD,urethra rotation angle and posterior urethrovesical angle between the two ultrasound doctors were 0.784,0.829,0.792 and 0.873 respectively.Conclusions The incidence of pelvic floor functional disorder is high in old patients after total hysterectomy .Ultrasound might be an accurate evaluation of postoperative patients with pelvic floor function ,and the repeatability is good .

Objective To evaluate the application value of double contrast-enhanced ultrasound ( DCUS) in the diagnosis of gastrointestinal stromal tumor ( GIST) .Methods A total of 70 cases of gastrointestinal stromal tumor ( GIST) were retrospectively ana-lyzed.The patients were all undergone DCUS and the results were compared with that of pathology .Results There were 70 lesions lo-cated in fundus of stomach,15 in antrum,12 in lesser curvature,8 in greater curvature,6 located in duodenum and 5 in rectum.The ul-trasound characteristics of GIST were a ring-like enhanced contrast around the tumor with inside hyper or hypo-enhanced contrast .Con-clusion The DCUS of GIST has a certain characteristics that have an important value in pre-operative diagnosis ,selection of operation approach and post-operative follow-up.

OBJECTIVE To investigate the value of ultrasound contrast in diagnosis of chronic gastric mucosal in‐flammation infection ,so as to provide reference for the clinical diagnosis of chronic gastritis .METHODS Totally 200 patients with stomach symptoms during Mar .2012-Mar .2015 were collected .Eligible patients were treated with ultrasound imaging ,endoscopy and pathological biopsy .The positive rates of infection by endoscopy and ul‐trasound imaging were compared and the features of ultrasound images were summarized .RESULTS Among the 200 cases ,153 cases were detected as positive for chronic gastritis by ultrasound diagnosis ,the detection rate was 83 .6% .Gastric mucosal thickening and rough was seen in 85 .6% of the patients ,echogenic gastric mucosal layer in 92 .8% ,weakened stomach muscle echo in 79 .1% ,mild stomach muscle thickening in 54 .2% ;increased ,nor‐mal ,and decreased gastric motility in 53 .6% ,26 .8% ,and 19 .6% respectively .All patients had continuous gas‐tric submucosa .Gastroscopy showed there were 183 cases of chronic gastritis and the detection rate was 100%compared to pathological biopsy results ,with significance (P< 0 .05) .CONCLUSION Contrast‐enhanced ultra‐sound has better diagnostic accuracy for infectious chronic mucosal inflammation .Combined with evaluation of clinical symptoms ,it can be used as another effective method for diagnosis of chronic gastritis ,suitable for exten‐sively clinical application .

Objective:To evaluate the value of transabdominal gastric-filling ultrasonography in the diagnosis of early gastric carcinoma. Methods:Medical records of 67 patients treated as early gastric carcinoma in our hospital during the year 2012 to 2015 were analysed. Transabdominal gastric-filling ultrasound scanning were performed to all the patients before operation. With Chi-square test,the ultrasonography findings were compared with pathological results. Results:71 early gastric carcinoma lesions were diagnosed by pathology in the 67 patients,and 58 of the lesions were detected by ultrasonography before operation. Ultra-sonograpy had lower detection rate for those lesions which located in gastric fundus,shaped with flat type,or smaller than 1cm by the size. The difference was statistically significant (P<0.05). Conclusion:Transabdominal gastric-filling ultrasonography has certain value in the diagnosis of early gastric carcinoma,but the lesions could be missed when located in gastric fundus,with plat shape,or smaller than 1 cm. Special attention should be paid in this situation.

目的 探讨超声胃充盈下超声造影(双重超声造影)在胃隆起样病变中的诊断价值.方法 胃隆起样病变患者157例,均行双重超声造影,并与随访及病理结果进行对比分析.结果 共计172个隆起样病灶,其中隆起型胃癌37个,间质肿瘤47个,胃淋巴瘤1 2个,炎性团块7个,胃息肉或腺瘤35个,胃囊肿或胃重复畸形11个,异位胰腺7个,脂肪瘤5个,血管球瘤4个,平滑肌瘤5个,神经鞘瘤2个.结论 通过对胃行超声双重造影检查有利于对隆起样病变的诊断、鉴别诊断及随访观察.

To study the clinical value of double contrast-enhanced ultrasonography(DEUS) and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in Preoperative evaluation of Rectal Cancer.Thirty-five patients with rectal tumour underwent DCUS and DCE-MRI.The results were correlated with the histopathological findings based on the lesion site,morphology,size,contrast enhancement of lesions,the deep layers of the rectal wall and TN stating.Of the 35 patientes,all tumor loctions were correctly diagnosed with DEUS and DCE-MRI.T staging with DEUS correlated with the histopathological findings in 85.7% of patients(kappa=0.782,P0.001),by MRI in 82.9% patients(kappa=0.739,P0.001).Local lymphatic node involvement was correctly diagnosed with DEUS and MRI in 77.1% of patients(kappa=0.624,P 0.001)and 80% of patients(kappa=0.668,P 0.001),respectively.It was useful to correct preoperative identification and precise evaluation of rectal tumour,by DCEUS and DCE-MRI,to decide optimal treatment strate.

Objective To evaluate the practicability and accuracy of three-dimensional ultrasound in the differential diagnosis between benign and malignant gastric ulcer with niche mode.Methods In niche mode,ultrasonic manifestations of 59 patients with benign or malignant gastric ulcer confirmed pathologically were analyzed retrospectively.The contents observed included the shape(X1) and bottom(X2) of the ulcers,submucosa(X3),mucosal convergence sign(X4),gastric stenosis(X5),lymph nodes around stomach(X6),the diameter(X7),the width of soft tissue around ulcers(X9) and thickness of stomach wall(X9).All the data were analyzed statistically.Results The difference between benign and malignant gastric ulcer was significant in width of soft tissue around ulcers and thickness of stomach wall(all P0.05).Submucosa,mucosal convergence sign,the width of soft tissue around ulcers and thickness of stomach wall played an important role in the differential diagnosis between benign and malignant gastric ulcer,and the Logistic regression equation was ln(P/1-P)=-21.292+20.301X3+2.845X4+20.930X8+17.493X9.Conclusion In niche mode,three-dimensional ultrasound is valuable in the differential diagnosis between benign and malignant gastric ulcer.

Objective To evaluate the ultrasound(US) features of diffuse sclerosing variant (DSV) of papillary carcinoma of the thyroid. Methods The US and histopathlogical of 20 DSV patients were retrospectively assessed. Results Among the 20 cases,thyroid single lobe of 12 cases,bilateral lobes of 8 cases and cervical lymph nodes metastases of 18 cases (90%) were involved in DSV of papillary carcinoma of the thyroid. At ultrasound, echo diffuse abnormal change of single lobe or bilateral lobes of thyroid and diffuse scattered microcalcifications were seen in the DSV of papillary carcinoma of the thyroid. The blood flow signals of the abnormal lobes were occupied by 75% of one grade and 25 % of two grades. Conclusions DSV of papillary carcinoma of the thyroid is usually manifested as echo diffuse abnormal change,diffuse scattered microcalcifications and cervical lymphocytic infiltration on ultrasound in relatively young patients.

>甲状腺结节超声敏感性极高,但难以准确判断其性质,尤其是甲状腺癌与其他病灶并存时极易误诊。甲状腺癌在较小时即通过引流淋巴管转移至周围淋巴结,受累淋巴结声像图有其特点,检出并鉴别甲状腺癌的转移淋巴结,对临床治疗和患

社会保障事业是关系我国社会主义市场经济体系建设、构建社会主义和谐社会的一项重要工程。我国社会保障事业发展中还存在一些问题。笔者对此进行了初步分析,并提出对策建议。