超声造影在颈部淋巴结结核激光消融中的应用价值  

Application value of ultrasound in diagnosis and treatment of tuberculosis

作　　者：闻波平[1] 杨高怡[1] 徐建平[1] 张文智[1] 张莹 赵丹[1] 李军 Wen Boping;Yang Gaoyi;Xu Jianping;Zhang Wenzhi;Zhang Ying;Zhao Dan;Li Jun(Department of Ultrasound,Zhejiang Chinese Medicine and Western Medicine Integrated Hospital,Hangzhou 310003,China)

机构地区：[1]浙江省中西医结合医院超声科,杭州310003

出　　处：《中华医学超声杂志（电子版）》2019年第1期16-19,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：浙江省医药卫生科技计划项目(2014KYA183);浙江省科技计划项目(2015C33259).

摘　　要：目的探讨超声造影在颈部淋巴结结核激光消融术中的应用价值。方法收集经病理证实的16例颈部淋巴结结核患者的23个淋巴结进行超声引导下激光消融治疗。术中超声造影评估消融范围及有效性,术后第1、3、6、12个月常规超声随访淋巴结体积变化,超声造影观察淋巴结血供以判断治疗效果。结果激光消融前,常规超声观察23个淋巴结的体积为0.5~2.6ml,平均为(1.2±0.3)ml,超声造影示淋巴结整体均匀增强(13个)及不均匀增强(10个)。激光消融术中淋巴结内气化强回声覆盖淋巴结边界时立即停止释放能量,即刻超声造影显示19个淋巴结为整体无增强,4个淋巴结有局部增强区,行补充消融直至淋巴结呈整体无增强。随访期内,超声造影均呈无增强,淋巴结体积至治疗后第12个月平均缩小率达(90.2±8.1)%,消融后淋巴结周围无脓肿及窦道形成。结论超声造影具有实时、安全、可重复性强等优点,其有助于术前适应证的评估、术中消融疗效的精准判断以及术后随访,在颈部淋巴结结核激光消融治疗中的应用具有一定价值。Objective To assess the efficacy and safety of ultrasonography-guided laser ablation (LA) for tuberculous cervical lymphadenitis. Methods Twenty-three lymph nodes of 16 patients with tuberculous cervical lymphadenitis confirmed by percutaneous biopsy had undergone ultrasonography- guided laser ablation therapy. Contrast-enhanced ultrasound (CEUS) was performed to evaluate the scope and effectiveness during LA. Follow-up CEUS was performed 1, 3, 6, and 12 months after treatment to monitor the volume of lymph nodes and the blood supply. Results Before LA, the mean volume of all lymph nodes was (1.2±0.3) ml (range, 0.5-2.6 ml). Thirteen lymph nodes showed heterogeneous enhancement, and 10 showed homogeneous enhancement in CEUS According to CEUS performed immediately after treatment, 19 lymph nodes showed no enhancement and 4 showed focal enhancement. Supplementary LA was performed in these four lesions until thorough non-enhancement was achieved. No lymph nodes showed enhancement on follow-up CEUS. The mean shrinkage rate of lymph nodes was (90.2±8.1)% at the 12th month. There was no abscess or sinus around lymph nodes. Conclusion CEUS has appreciated value in laser ablation of tuberculous cervical lymphadenitis. It has the advantages of safety and repeatability, and is helpful to evaluate indications, accurately assess the ef cacy of laser ablation, and conduct follow-up.

关 键 词：激光消融 超声造影 颈部淋巴结结核 

分 类 号：R445.1[医药卫生—影像医学与核医学] R52[医药卫生—诊断学]