超声对微小肝实质病变良恶性诊断的多因素logistic分析及价值探讨  

Multivariate logistic analysis and value of ultrasound in the diagnosis of benign and malignant micro hepatic parenchymal lesions

作　　者：许春梅[1] 万里凯[2] 胡巧[1] 刘天奇[3] 陈彦红[1] 唐耘天[3] 莫祥兰[4] XU Chunmei;WAN Likai;HU Qiao;LIU Tianqi;CHEN Yanhong;TANG Yuntian;MO Xianglan(Department of Ultrasonography,The People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,Guangxi,China;Center for Reproductive Medicine and Genetics,The People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,Guangxi,China;Department of Hepatobiliary Gland Surgery,The People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,Guangxi,China;Department of Pathology,The People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,Guangxi,China)

机构地区：[1]广西壮族自治区人民医院超声科,广西南宁530021 [2]广西壮族自治区人民医院生殖医学与遗传中心,广西南宁530021 [3]广西壮族自治区人民医院肝胆腺体外科,广西南宁530021 [4]广西壮族自治区人民医院病理科,广西南宁530021

出　　处：《右江医学》2021年第1期26-30,共5页Chinese Youjiang Medical Journal

基　　金：广西科技攻关项目(桂科攻1140003B-65);广西医药卫生自筹课题(Z20170369)。

摘　　要：目的寻找早期筛查微小肝癌的敏感超声指标并对其诊断效能进行评估。方法第一阶段通过回顾性分析163例共163个直径≤2 cm肝实质性病变的超声特征,按病理结果分为良性和恶性两组,对两组间超声指标进行分析,找出对筛查微小肝癌敏感的超声指标;第二阶段用筛查出的超声敏感指标对临床拟诊肝实质性病变164例共178个直径≤2 cm病灶进行诊断效能评估。结果两组间年龄、性别、肝炎病史、酗酒差异无统计学意义(P>0.05);肿块形态、边界、回声强弱、动脉血流参数差异无统计学意义(P>0.05);病灶回声均匀度、浸润挤压征、晕征差异有统计学意义(P<0.05),其中浸润挤压征对良恶性鉴别贡献度较大(OR=60.712,P<0.001);其对微小肝癌诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为75.24%、95.89%、83.71%、96.34%、72.92%、18.31、0.78。结论超声浸润挤压征是早期筛查微小肝癌的敏感超声指标,对早期微小肝癌检出效能高,有较高的临床应用价值。Objective To find sensitive ultrasound screening characteristics of micro-hepatocellular carcinoma and evaluate its diagnostic efficacy in the early stages. Methods In the first stage, the ultrasound characteristics of 163 liver lesions with diameter ≤ 2 cm in 163 patients detected in our hospital were retrospectively analyzed. According to the pathological results, the lesions were divided into benign group and malignant group, and the ultrasound characteristics of the two groups were analyzed and compared to find out sensitive ultrasound characteristics for screening micro-hepatocellular carcinoma. In the second stage, the diagnostic efficiency of 178 lesions(diameter ≤ 2 cm) in 164 patients with clinically suspected hepatic parenchymal lesions were evaluated by using ultrasound sensitive indicators. Results There was no statistically significant difference in age, sex, history of hepatitis and alcoholism between the two groups(P > 0.05);there was no statistically significant difference in shape, boundary, echo intensity and arterial blood flow parameters of the masses(P > 0.05);there was statistically significant difference in echo evenness, invasive extrusion sign and halo sign(P < 0.05), among which invasive extrusion sign contributed significantly to the differential diagnosis of benign and malignant lesions(OR = 60.712, P < 0.001);the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of the diagnosis of micro-hepatocellular carcinoma was 75.24%, 95.89%, 83.71%, 96.34%, 72.92%, 18.31, and 0.78, respectively. Conclusion Ultrasound infiltration compression sign is a sensitive ultrasound index for early screening of micro-hepatocellular carcinoma, which has high detection efficiency and clinical application value.

关 键 词：微小肝癌 超声特征 浸润挤压征 诊断效能 

分 类 号：R735.7[医药卫生—肿瘤]