导管超声在鼻腔鼻窦占位性病变中的应用价值  

Intra-nasal scanning of tumors in nasal cavity and paranasal sinus with endoscopic ultrasonography

作　　者：陈雷[1] 崔婷婷[1] 王刚[1] 李良玉[1] 石文媛[2] 倪晓霞[2] 

机构地区：[1]解放军总医院耳鼻咽喉头颈外科,北京100853 [2]解放军总医院超声科,北京100853

出　　处：《中华耳鼻咽喉头颈外科杂志》2007年第1期23-26,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：军队"十五"课题基金资助(01M A107)

摘　　要：目的探索导管超声探头在鼻腔、鼻窦占位性病变中的应用价值。方法鼻腔、鼻窦占位性病变患者18例,其中良性肿物12例,恶性肿瘤6例。应用 Siemens Squia512超声仪,电视鼻内镜引导导管超声探头经鼻腔扫查鼻腔内肿物。灰阶超声观察病变区的大小、形态、边界、回声及其与周围组织的关系;彩色多普勒观察病变的血流分布,频谱多普勒进一步分析血流的性质和速度。结果内镜引导下用导管超声探头可准确地扫查鼻腔内肿物。灰阶超声检查显示肿物多呈不均质低回声,富含血管的肿瘤回声更低,部分瘤内可探及粗大血管所形成的不规则透声区。神经纤维瘤边界清楚、规则,有较完整的包膜;脊索瘤边界欠清,无明显包膜。1例破坏蝶窦骨质突入鼻腔的垂体瘤,超声可清楚地显示肿块与颈内动脉的关系。彩色多普勒能显示肿物内血供是否丰富,频谱多普勒可区分动脉或静脉血流信号,并测量流速。血管纤维瘤内血供丰富,而恶性肿瘤一般血流丰富,流速较高。结论鼻内镜引导下的鼻腔软组织占位病变超声检查定位准确,图像清晰,分辨率高,能敏感地显示肿物的血供并区分动、静脉血流。丰富了鼻腔、鼻窦占位性病变的影像检查方法。Objective To evaluate endoscopic ultrasonography for masses in nasal cavity and paranasal sinus. Methods Under the guidance of nasal endoscope, sonographic scan of 18 masses within nasal cavity and paranasal sinus was performed by using 10 MHz catheter transducer with diameter of 3.3 mm under local anesthesia. Twelve of them were benign tumors and 6 of them were malignant ones, which were confirmed by pathological examination of resected specimens. Results Under the guidance of nasal endoscope, masses could be observed accurately with catheter transducer. On gray scale ultrasound, most masses were heterogeneous hypoechoic, tumors with rich blood vessels were lower hypoechoic, and some showed irregular anechoic area due to dilated vascular net. Neurofibroma was with well-defined and regular border and entire capsule ; chordoma was without distinct edge and capsule. A giant pituitary tumor eroding bone of sphenoid sinus and intruding into nasal cavity. The relationship between mass and internal carotid artery could be demonstrated using color Doppler flow imaging （CDFI）. Blood flowing signals in masses could be detected by CDFI, and spectral Doppler could discriminate arterial or venous blood flowing signals and measure its velocity. The rich blood supply was observed in fibroangioma, the rich flow signals and high velocity could be detected in malignant tumors. Conclusions Nasal endoscope-guided sonography for soft tissue ＂masses in nasal cavity is of exact location, clear image and high resolution, which can reveal blood flow signals sensitively, differentiate arterial and venous blood signals and measure the velocity of them. It provides a new imaging modality for masses within nasal cavity, sinuses and skull base.

关 键 词：鼻肿瘤 腔内超声检查 超声检查 多普勒 彩色 

分 类 号：R765[医药卫生—耳鼻咽喉科]