超声组合拳法诊断腹膜后肿块技术研究及其实用价值  

Study of Ultrasound Comprehensive-integrated Method for Diagnosis of Retroperitoneal Masses

作　　者：李国杰[1] 周永昌[2] 赵国海[1] 朱向明[1] 俞咏梅[1] 许立龙[1] 吴赤球[1] 

机构地区：[1]皖南医学院附属弋矶山医院,安徽省芜湖市241001 [2]上海市第六人民医院

出　　处：《中国超声医学杂志》2006年第4期297-300,共4页Chinese Journal of Ultrasound in Medicine

基　　金：安徽省教育厅科研基金重点项目(No.2005065);安徽省卫生厅科研基金项目(No.2002B010)

摘　　要：目的提高超声对腹膜后肿块定位定性诊断率。方法总结采取排除法、追踪法、呼吸移动法、用水充盈法、腰大肌收缩法及腹腔注水成像技术6种方法有机组合,即超声组合拳法诊断技术用来进行诊断,对经手术病理证实的腹膜后肿块147例图像特征进行分析,同时就检查者采取的诊断思路进行介绍。结果尽管腹膜后间隙位置深,范围大,周围组织多,腹膜后肿块声像图表现多种多样,但其中蕴含着8种共同特征:(1)肿块固定,不随手推、呼吸及体位改变而明显移动;(2)肿块位置深,周围及前方有腹腔胃肠道气体存在;(3)有时俯卧位探测比其它体位探测更易显示;(4)原发性肿瘤一般体积较大(大多超过7.0cm);(5)肿块回声程度越低病理性质恶性度越高(炎性除外);(6)恶性肿瘤呈现膨胀性生长,易造成大血管及其分支压迫、移位征象及有关脏器分离现象,而炎性或良性肿块则不然,多呈现扁平状,前后径小;(7)原发性恶性肿瘤彩色血流信号丰富;(8)腹水少见。本研究组超声定位诊断率97.28%(143/147),定性诊断符合率87.07%(128/147)。结论掌握超声组合拳法诊断技术可提高超声对腹膜后肿块定位诊断,结合正确思路与声像图特征将有助于对腹膜后肿块定性诊断。Objective To improve the diagnostic accuracy rate in defining the location and characteristics of retroperitoneal masses. Methods We integrated exclusion, trace, breathing movement ,water filled, psoas contraction and intra-abdominal water injection-6 methods under ultrasound （US） guidance called as （US comprehensive- integrated method, to detect retroperitoneal masses. The diagnoses were confirmed by operation and pathology in 147 cases and the imaging characteristics were analyzed. Meanwhile, our correct thought train was introduced. Results Although the retroperitoneal space is the extensively deeper, with plentiful tissues around them and with varied sonographic appearence. In our opinion, there were 8 ultrasonic characteristics： （1） Fixed masses were unchanged under compressing, breathing, bowel loop movement and body shift, （2） Masses were deeper, with gastrointestinal tract gas around or anterior to the masses ; （3） Sometimes masses were clearer on prone position than other positions ; （4） In general, primary tumors were larger≥7. 0 cm; （5） The more hypoechoic the masses appeared, the more malignant in nature except inflammation; （6） Malignant tumors appeared expanding to make great vessels be compressed or transpositioned or separated between organs; while inflammatory or benign masses appeared flat with the antero-posterior diameter less than the supero-inferior diameter; （7） Malignant tumors were very vascular; （8） Ascites was uncommon. In our study the accurate site correlation rate with operation was 97.28% （143/147）. Ultrasonographic coincidence rate with pathology was 87.07% （128/147） .Conclusions It is suggested that US comprehensive-integrated method provides important valuable information for the location diagnosis of retroperitoneal masses. Combining correct thought train with ultrasonic imaging characteristics may be a great aid for the qualitative diagnosis of retroperitoneal masses.

关 键 词：腹膜后肿块 超声组合拳法 诊断技术 图像特征 正确思路 定位诊断 定性诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学]