20例肝脓肿超声诊断分析(1)
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[摘要] 目的:总结肝脓肿的声像图特征。方法:回顾性分析20例肝脓肿的诊治经过,观察并分析其图像特点及临床资料,以上病例经穿刺活检及超声动态跟踪观察确诊。结果:诊断肝脓肿20例,其中,17例经超声确诊,疑诊2例,误诊1例。结论:超声对及时、准确诊断肝脓肿具有重要的临床意义。
[关键词] 肝脓肿;超声;诊断
[中图分类号] R445.1[文献标识码]B [文章编号]1673-7210(2010)05(b)-082-02
The ultrasound diagnosis and analysis of 20 cases of hepatic abscess
CHEN Shaojuan
(Department of Ultrasound, People's Hospital of Yuhong District, Shenyang City, Liaoning Province, Shenyang 110141, China)
[Abstract] Objective: To summarize the imaging characteristics of hepatic abscess in ultrasound diagnosis. Methods: Retrospectively analyzed the diagnosis and treatment process of 20 cases of hepatic abscess, observed and analyzed their imaging characteristics and clinical information. Theses cases were diagnosed by biopsy and ultrasound dynamic follow-up. Results: 20 cases were analyzed and diagnosed as hepatic abscess. 17 of them were diagnosed by ultrasound, 2 were suspected as hepatic abscess, 1 was misdiagnosed as hepatic abscess. Conclusion: Ultrasound is clinically important in the accurate and timely diagnosis of hepatic abscess.
[Key words] Hepatic abscess; Ultrasound; Diagnosis
近年来,在广谱高效抗生素的应用下,肝脓肿的发病率已日趋减少,往往不被临床医师重视,能否及时、正确诊断对其治疗及预后有重要意义。本文对我院通过超声诊断及穿刺证实的20例肝脓肿患者进行回顾性分析,旨在探讨其声像图特征及诊断价值。
1 资料与方法
1.1 一般资料
2005年1月～2009年10月我院收治的20例肝脓肿患者,其中,男15例,女5例;年龄17～72岁;病程3～42 d,本组病例全部为细菌性肝脓肿。主要临床表现为畏寒、高热、右上腹痛17例,恶心、呕吐1例,无症状2例;其中,12例伴有胆道疾病,6例伴有糖尿病,1例伴有心肌梗死,1例伴有肺内感染;白细胞计数升高15例,中性粒细胞升高8例,肝功能异常5例,轻度黄疸3例。
1.2 方法
采用ALKAO4000超声诊断仪,采取仰卧及左右侧卧等切面扫查清晰显示肝脏肝内胆管,并对异常病灶记录其位置、大小、形态、边界、内部回声及后部回声有无增强,并做详细记录。
2 结果
本组20例患者中,有17例超声诊断正确,疑诊2例,误诊1例,超声诊断符合率为95%。全部为单发病灶,左叶病灶7例,右叶病灶13例;脓肿最大12.0 cm×9.0 cm,最小3.5 cm×3.0 cm。有5例表现为不规则低回声,与周边肝组织界限不清,无明显包膜;2例表现为实质性回声;11例表现为以无回声液性为主的混合性回声、壁厚,其内可见密集流动的细小光点。1例囊内出现气体回声;2例病灶为偏高回声。内部回声不均,其内可见多个无回声区,呈蜂窝状;后方回声轻度增强12例;4例壁内可检出动脉血流信号;8例病灶内可见肝内正常血管走行。
肝脓肿的声像图特点见图1～3。
图1 肝右叶脓肿声像
Fig.1 Ultrasound image of right lobe hepatic abscess
图2 肝内异常病灶蜂窝状结构
Fig.2 Ultrasound image of abnormal hepatic honeycombed mass
图3 肝右前叶低回声病灶内开始液化,周边出现弱回声晕带
Fig.3 The hypoechoic area of the hepatic right anterior lobe started liquefying, and the surrounding area showed poor echo zone
3 讨论
肝脓肿是一种严重的感染性疾病,分为细菌性和阿米巴两类,前者多见,细菌性肝脓肿由化脓性细菌如大肠埃希菌、葡萄球菌及(或)链球菌侵入肝脏所致,其入肝的途径包括门静胆道系统、肝动脉以及由邻近的组织直接侵入肝脏后引起炎症[1] ......
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