多普勒超声与超声造影对肝脏占位性病变穿刺活检的诊断价值研究(1)
[摘要] 目的 探索多普勒超声与超声造影对肝脏占位性病变穿刺活检的诊断价值。方法 在2016年10月—2017年10月期间方便选取117例疑似肝脏占位性病变患者为实验对象，且均进行超声造影和多普勒超声诊断和引导。 结果 该次研究中，诊断正确率最高的为联合诊断，其次为超声造影，组间相比差异有统计学意义(χ2=15.265，P<0.05)，从单方面诊断结果相比，超声造影敏感性(86.00%)、特异性(70.59%)高于多普勒超声;超声造影对病灶大小诊断总正确率(86.00%)、对疾病类型诊断总正确率(86.00%)均高于多普勒超声(χ2=15.265、16.325，P<0.05)。 结论 超声造影在肝脏占位性病变穿刺活检中价值性更高，但通过联合诊断，更能够降低失误率和漏诊率。
[关键词] 多普勒超声;超声造影;肝脏占位性病变;穿刺活检;诊断
[中图分类号] R445 [文献标识码] A [文章编号] 1674-0742(2019)10(a)-0180-03
[Abstract] Objective To explore the diagnostic value of Doppler ultrasound and contrast-enhanced ultrasound in the biopsy of hepatic space-occupying lesions. Methods A total of 117 patients with suspected hepatic space-occupying lesions were convenient selected from October 2016 to October 2017， and were diagnosed and guided by contrast-enhanced ultrasound and Doppler ultrasound. Results In this study， the highest diagnostic accuracy was the combined diagnosis， followed by contrast-enhanced ultrasound， and there was a difference between the groups (χ2=15.265，P<0.05). Compared with the unilateral diagnosis， the contrast sensitivity was (86.00%)， specificity(70.59%) was higher than Doppler ultrasound; the total correct rate of diagnosis of lesion size by ultrasound contrast (86.00%) and the total correct rate of disease type diagnosis (86.00%) were higher than Doppler ultrasound(χ2=15.265， 16.325，P<0.05). Conclusion Contrast-enhanced ultrasonography is more valuable in hepatic space-occupying lesion biopsy， but combined diagnosis can reduce the rate of missed and missed diagnosis.
[Key words] Doppler ultrasound; Contrast-enhanced ultrasound; Liver occupying lesions; Needle biopsy; Diagnosis
肝臟占位性病变具有种类繁多、发病率高、预后差、难治愈等特点，属于临床常见病，为了尽早控制病情恶化，还需加强影像学检查，从而为治疗方案拟定提供依据[1]。早期常选用多普勒超声检查，其具有操作简单、无创伤性、无辐射等优势，但由于肝脏占位性病变存在多发小结节样改变，导致周围血管、病灶组织难以分辨，增加临床误诊率[2]。随着诊断技术的完善和进步，超声造影开始广泛推广于临床，其不仅能够对病灶大小、性质、位置进行定位，了解血流灌注信息，准确分辨小病灶，且更方便取材，进而提高穿刺活检确诊率和成功率[3]。对117例疑似肝脏占位性病变患者(在2016年10月—2017年10月期间收治)进行多普勒超声、超声造影检查，现报道如下。
1 资料与方法
1.1 一般资料
方便选择117例疑似肝脏占位性病变患者为此次研究对象。男性65例，女性52例，平均年龄(55.98±3.26)岁。入选标准：①患者临床资料齐全;②患者均存在疑似肝脏占位性病变临床症状;③患者均签署书面知情同意书;④患者均无抵触情绪。排除标准：①排除年龄超过80岁患者;②排除对造影剂过敏患者;③排除存在重要脏器受损或功能不全患者;④排除凝血功能异常患者;⑤该次研究所选病例已经过伦理委员会批准。
1.2 方法
多普勒超声：该次使用的彩色多普勒超声诊断仪选用美国GE公司提供Logiq7 PRO型号，探头频率为5.0～5.5 MHz，选用腹部凸型探头，首先对肝脏和病变部位进行常规扫描，了解肝内病变所在部位，检查病灶边界是否存在异常以及病灶大小、形态、回声等情况，观察周围血管、器质特征，观察病变区域的血流信号[4]。, http://www.100md.com(林燕明)
[关键词] 多普勒超声;超声造影;肝脏占位性病变;穿刺活检;诊断
[中图分类号] R445 [文献标识码] A [文章编号] 1674-0742(2019)10(a)-0180-03
[Abstract] Objective To explore the diagnostic value of Doppler ultrasound and contrast-enhanced ultrasound in the biopsy of hepatic space-occupying lesions. Methods A total of 117 patients with suspected hepatic space-occupying lesions were convenient selected from October 2016 to October 2017， and were diagnosed and guided by contrast-enhanced ultrasound and Doppler ultrasound. Results In this study， the highest diagnostic accuracy was the combined diagnosis， followed by contrast-enhanced ultrasound， and there was a difference between the groups (χ2=15.265，P<0.05). Compared with the unilateral diagnosis， the contrast sensitivity was (86.00%)， specificity(70.59%) was higher than Doppler ultrasound; the total correct rate of diagnosis of lesion size by ultrasound contrast (86.00%) and the total correct rate of disease type diagnosis (86.00%) were higher than Doppler ultrasound(χ2=15.265， 16.325，P<0.05). Conclusion Contrast-enhanced ultrasonography is more valuable in hepatic space-occupying lesion biopsy， but combined diagnosis can reduce the rate of missed and missed diagnosis.
[Key words] Doppler ultrasound; Contrast-enhanced ultrasound; Liver occupying lesions; Needle biopsy; Diagnosis
肝臟占位性病变具有种类繁多、发病率高、预后差、难治愈等特点，属于临床常见病，为了尽早控制病情恶化，还需加强影像学检查，从而为治疗方案拟定提供依据[1]。早期常选用多普勒超声检查，其具有操作简单、无创伤性、无辐射等优势，但由于肝脏占位性病变存在多发小结节样改变，导致周围血管、病灶组织难以分辨，增加临床误诊率[2]。随着诊断技术的完善和进步，超声造影开始广泛推广于临床，其不仅能够对病灶大小、性质、位置进行定位，了解血流灌注信息，准确分辨小病灶，且更方便取材，进而提高穿刺活检确诊率和成功率[3]。对117例疑似肝脏占位性病变患者(在2016年10月—2017年10月期间收治)进行多普勒超声、超声造影检查，现报道如下。
1 资料与方法
1.1 一般资料
方便选择117例疑似肝脏占位性病变患者为此次研究对象。男性65例，女性52例，平均年龄(55.98±3.26)岁。入选标准：①患者临床资料齐全;②患者均存在疑似肝脏占位性病变临床症状;③患者均签署书面知情同意书;④患者均无抵触情绪。排除标准：①排除年龄超过80岁患者;②排除对造影剂过敏患者;③排除存在重要脏器受损或功能不全患者;④排除凝血功能异常患者;⑤该次研究所选病例已经过伦理委员会批准。
1.2 方法
多普勒超声：该次使用的彩色多普勒超声诊断仪选用美国GE公司提供Logiq7 PRO型号，探头频率为5.0～5.5 MHz，选用腹部凸型探头，首先对肝脏和病变部位进行常规扫描，了解肝内病变所在部位，检查病灶边界是否存在异常以及病灶大小、形态、回声等情况，观察周围血管、器质特征，观察病变区域的血流信号[4]。, http://www.100md.com(林燕明)