超声三维成像技术在隆突性皮肤纤维组织肉瘤术前评估中的应用  

Application of three-dimensional ultrasound imaging in preoperative evaluation of dermatofibrosarcoma protuberans

作　　者：孙祺琳[1] 刘洋[1] 周晓博 龚霞[2] 熊屏 陈骏[1] SUNQi-lin;LIU Yang;ZHOU Xiao-bo(Department of Dermatology and Ultrasonography,Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学附属第九人民医院皮肤科,200011 [2]上海交通大学附属第九人民医院超声诊断科

出　　处：《实用皮肤病学杂志》2020年第5期265-267,271,共4页Journal of Practical Dermatology

摘　　要：目的探讨超声三维成像技术在隆突性皮肤纤维组织肉瘤(dermatofibrosarcoma protuberans,DFSP)术前评估中的应用价值。方法5例DFSP患者术前应用美国GE公司E8超声诊断仪对患者体表肿瘤进行实时三维超声检查,对肿瘤的形状、范围及其与周围组织、血管的关系进行评估并确定手术范围,进行Mohs手术。将三维重建结合Mohs手术的切除范围和指南推荐的扩大切除范围相比较。结果三维超声检查结果显示5例患者的在体肿瘤为不规则生长皮下肿块,病灶内有血管穿入,血流信号丰富。术后组织病理检查均证实为DFSP(普通型)。Mohs显微描记手术处理标本检测切除边缘及基底均阴性,随访1年无复发。5例三维重建结合Mohs手术的切除范围均小于传统扩大切除术的切除范围。结论三维超声是二维超声的有益补充,对于DFSP的术前评估有重要作用,可以缩小手术创面及提高手术清除率,降低围手术期风险及术后复发风险。Objective To explore the application of three-dimensional ultrasound imaging in the preoperative evaluation of dermatofibrosarcoma protuberans(DFSP). Methods Five cases of DFSP from 2 Jan. 2015 to Dec. 2016. were collected, real-time threedimensional ultrasonic inspection were performed with the Voluson E8, a color Doppler ultrasonic diagnostic system of the United States GE company, by which the shape and the scope of the tumors and their relationships with the surrounding tissue and blood vessels were assessed, and the scope of the operations was determined, then the Mohs surgery was performed. Finally, the resection range determined by three-dimensional reconstruction combined with Mohs surgery was compared with the extended resection recommended by the guidelines. Results Threedimensional ultrasound inspection showed all the 5 masses were located in subcutaneous tissue with irregular shape, and there were rich color flow signal inside the tumors. All the 5 patients were confirmed by postoperative pathology as DFSP(conventional type), the resection edges and basal were negative with Mohs surgery, without recurrence during 1 year follow-up. The resection range determined by three-dimensional reconstruction combined with Mohs surgery was smaller than that of the traditional extended resection in all the 5 cases. ConclusionsThree-dimensional ultrasound is a useful supplement of two-dimensional ultrasound, and may play an important role in the preoperative evaluation of DFSP that may reduce the surgical wound and improve the surgical clearance rate, as well as reduce the risk of perioperative period and postoperative recurrence.

关 键 词：皮肤纤维组织肉瘤 隆突性 超声成像 三维超声 Mohs外科 

分 类 号：R730.42[医药卫生—肿瘤] R730.56[医药卫生—临床医学]