肝结核超声诊断价值及其病理基础.docVIP

肝结核超声诊断价值及其病理基础[摘要] 目的:探讨肝结核的超声诊断价值及其病理基础。方法:对21例临床和病理证实的肝结核患者的超声图像进行回顾性分析,总结其声像学和血流表现特征及其与病理变化的关系。结果:肝结核病灶声像表现复杂多样,不同病理阶段有不同表现。结论:超声可提示、检出肝结核病灶及动态观察病灶,但其超声表现与病理变化密切相关,缺乏特异性,须结合临床资料及其他检查。 [关键词] 肝结核;超声;病理 [中图分类号] R445.1[文献标识码]B [文章编号]1673-7210(2010)05(b)-080-02 Diagnostic evaluation of hepatic tuberculosis by ultrasonography and their pathology HU Zhiwen, RAN Hong, ZHANG Xiaoman (Department of Functional Examination, the First People’s Hospital of Guangzhou City, Guangzhou 510180, China) [Abstract] Objective: To investigate diagnostic evaluation of hepatic tuberculosis by ultrasonography and their pathology. Methods: 21 patients with hepatic tuberculosis confirmed by clinical and pathology were retrospectively analyzed to summarize their imaging characteristics and the relationship with pathological changes. Results: The imaging characteristics of hepatic tuberculosis lesions were complex and diverse, there were different manifestations in different pathological stages. Conclusion: Ultrasonography may find and dynamically observe hepatic tuberculosis lesions, however, their imaging characteristics are closely related to pathology and have poor specificity. Therefore, clinical data and other examination methods must be combined. [Key words] Hepatic tuberculosis; Ultrasonography; Pathology 近年来,由于超声、CT等影像及穿刺技术的广泛应用,使肝结核的发现率增加。当发生肝结核时,因机体免疫状态不同,可存在不同的病理状态变化。研究肝结核超声声像图表现与病理变化的关系,有助于提高超声影像特征的认识。本文对21例经临床病理证实的肝结核超声图像进行分析,总结其声像学特征及其与病理变化的关系,旨在探讨肝结核的超声诊断价值及其病理基础。 1 资料与方法 1.1 一般资料 本组病例为我院1998～2008年经临床(7例经超声并CT或磁共振检查后,接受抗结核治疗肝内病灶有效)或病理证实(14例经肝穿刺活检或术后病理证实)的21例肝结核,其中,男9例,女12例;年龄8～67岁,平均(38.6±16.2)岁。本组病例大多有全身结核中毒症状:16例发热,10例右上腹或肝区疼痛,2例黄疸,11例肝脏肿大或周围淋巴结肿大。另外,大部分伴有肝外结核病灶:9例同时患肺结核,3例有肺结核病史(已治愈),3例同时患肺结核和肠结核,3例同时患肠结核,1例同时患腰椎结核。 1.2 检查方法 使用LOGIC 7超声显像仪,探头为凸阵,频率3.5 MHz。患者空腹状态下行常规肝脏及腹腔实质性脏器扫查,重点观察肝脏的大小、实质回声、有无肿块及其大小、数目、边缘、内部回声、有无钙化、液化等情况,对肿块内部及周围行彩色多普勒检查,观察血流情况。回顾性分析患者的病史、临床治疗及病理结果。 2 结果 肝结核按病程进展可分为弥漫粟粒型、结核瘤(巨结节)型和结核性肝脓肿3个亚型[1]。本组病例中,①弥漫粟粒型:7例,