肾盂癌超声造影的初步研究

目的分析11例肾盂癌的超声造影灌注过程，初步探讨超声造影对肾盂癌的诊断价值。方法应用对比脉冲序列（CPS）成像技术和声诺维造影剂SonoVue对11例肾盂癌患者行超声造影，记录并分析造影灌注过程。结果注射造影剂后11例肿块均可见强化，肿块开始显影时间为8～20S，显影增强达高峰时间为14～25s，增强开始减退时间为18～30S。肿块显影高峰强度：高于肾实质2例，等同于肾实质4例，稍低于肾实质5例。肿块的血流灌注方式：“快进慢退”2例，“同进慢退”5例，“慢进慢退”4例；7例为整体均～性增强和均一性减退，3例为向心性增强，1例为离心性减退。结论CPS技术结合造影剂SonoVue能描绘肾盂肿块的血流灌注情况，使肾盂肿块显示更清晰，有助于肾盂癌的诊断。     

超声造影在肾盂肿瘤诊断中的临床应用

目的探讨超声造影对肾盂肿瘤诊断的临床应用价值。方法回顾性分析22例肾盂肿瘤常规超声及超声造影的影像表现及诊断结果,评估超声造影诊断准确性。结果 1例常规超声及超声造影均未发现肿瘤,2例诊断为肾盂良性肿瘤,19例诊断为肾盂癌,21例超声造影诊断同术后病理一致。结论超声造影作为一种新技术,在肾盂肿瘤诊断、肿瘤分期等方面具有良好的应用前景,可提高肾盂肿瘤的临床诊断准确率。     

实时双幅灰阶超声造影在肝细胞癌与胆管细胞癌鉴别诊断中的价值

目的评价实时双幅灰阶超声造影对肝胆管细胞癌的诊断与鉴别诊断价值。方法采用超声造影剂SonoVue对20例原发性肝细胞癌与12例胆管细胞癌患者行实时双幅灰阶超声造影检查。所有病例均经超声引导下穿刺活检或（和）手术病理证实。结果肝细胞癌组20例全部呈典型的“快进快退”型超声造影表现。胆管细胞癌组5例表现为早期动脉相呈边框样或中间少许增强，并迅速消退，呈“少进快退”型；另7例于整个造影过程中病灶均未见强化，呈“造影剂充盈缺损”型。结论实时双幅灰阶超声造影能为肝胆管细胞癌的诊断提供更多信息，弥补普通灰阶超声与彩色多普勒超声的不足。     

肝门静脉癌栓的灰阶超声造影检查

目的:探讨灰阶超声造影在肝门静脉癌栓诊断中的应用价值.方法:采用SonoVue造影剂对15例肝门静脉内癌栓,6例门静脉内血栓共21例患者行超声造影,观察造影后栓子的血流增强情况,并与病理诊断对比分析.结果:15例门静脉癌栓,动脉相或门脉相早期快速增强,其中12例整体均匀性高增强;2例周边高增强,中央无增强:1例仅部分高增强;6例门静脉血栓,无一例增强.以超声造影后栓子内有无增强作为诊断门静脉癌栓的指标,与病理结果对比分析,超声造影诊断门静脉癌栓的敏感性及特异性均为100%.结论:超声造影对于门静脉内癌栓的诊断具有重要临床价值.     

免疫脂质体超声造影剂增强荷肝癌裸鼠肿瘤显像的实验研究

目的探讨人肝细胞癌靶向脂质体超声造影剂对荷肝癌裸鼠肿瘤的增强显像效果。方法采用人肝癌细胞株HHCC接种于裸鼠皮下,建立荷人肝癌裸鼠模型;将靶向脂质体超声造影剂或普通脂质体超声造影剂经尾静脉注入荷瘤裸鼠体内,使用二次谐波显像模式观察并记录造影过程;采用目测观察和视频灰阶分析技术,以时间-强度曲线分析来定量评价肿瘤显像的增强效果。结果造影后目测观察,靶向造影剂对肿瘤有延迟增强显像效果,靶向造影剂组肿瘤的增强显影约在8min达到峰值,峰值灰阶强度值为(39.545±10.099)dB;普通造影剂组肿瘤增强显影达峰值时间约为10s,峰值灰阶强度值为(22.438±5.108)dB,与靶向造影剂造影后灰阶强度峰值比较相差显著(P<0.01)。结论人肝细胞癌靶向脂质体超声造影剂可以增强荷人肝癌裸鼠的肿瘤超声显像效果。     

超声造影在囊性肾癌鉴别诊断中的价值

目的观察囊性肾癌的声像学特点,探讨超声造影对囊性肾癌诊断的价值。方法对18例可疑囊性肾癌患者进行超声造影,记录并分析造影灌注过程。结果注射造影剂后,6例囊性肾癌的实性部分或分隔上或囊壁上见造影剂快速充填,后经手术病理证实为透明细胞癌,12例肾囊肿内始终未见造影剂进入。结论超声造影能清楚显示囊性肾癌的血流灌注情况,对囊性肾癌的鉴别诊断具有重要意义。     

肝内胆管细胞癌超声造影与病理对照(附5例报告)

目的 分析肝内胆管细胞癌的超声造影增强模式及其病理基础。 方法 5例患者接受超声造影检查，采用对比脉冲序列成像技术，造影剂为SonoVue。所有肝内胆管细胞癌均经病理检查证实。 结果 静脉注射SonoVue后，4例动脉期病灶边缘等回声增强、网隔样等回声增强，门静脉期可见动脉强化最早的部分轻度消退，但整体仍可见造影剂继续向内部充填，延迟期全部病灶造影剂明显消退。1例动脉期边缘增强及网隔样增强，无向心性充填。病理切片显示肿瘤内血管稀少，癌细胞主要位于边缘部分，中央部分纤维组织丰富，可伴有坏死，这可能是肝内胆管细胞癌超声造影强化模式的病理基础。 结论 胆管细胞癌超声造影的边缘等回声增强、网隔样等回声增强对肝内胆管癌有较高的诊断和鉴别诊断价值。     

输尿管镜钬激光肾盂内切开术的疗效(附30例报告)

目的探讨经尿道输尿管镜钬激光肾盂内切开术治疗肾盂输尿管连接部狭窄的效果。方法2002年4月-2004年9月期间，经尿道输尿管镜下行肾盂内切开治疗成人型肾盂输尿管连接部狭窄30例。狭窄段纵行切开后，输尿管内放置8F双J管内引流，平均留置双J管6周，每间隔3个月行超声、排泄性尿路造影检查。结果术后随访3—22个月，平均18个月，22例临床症状缓解，影像学检查提示内切开段造影剂通过良好，治疗成功；8例手术失败，均为巨大肾盂积水患者，改行Aderson—Hynes离断性肾盂成形术治愈。结论经尿道输尿管镜下钬激光肾盂内切开术创伤小、安全有效，可做为轻中度肾盂积水肾盂输尿管连接部狭窄患者治疗的首选方法。     

经皮穿刺上尿路顺行造影超声检查及其临床意义

目的探讨上尿路系统内直接使用超声造影剂SonoVue进行造影超声检查的方法和临床意义。方法以6例上尿路梗阻患者为研究对象,在进行经皮肾盂穿刺引流手术过程中从引流管直接向肾盂内注射SonoVue2ml（4.8mg/5ml）＋20~40ml灭菌生理盐水。在对比脉冲序列（contrast pulsed sequence,CPS）造影模式下连续观察造影剂强回声从肾盂向输尿管、膀胱运动的过程。造影结束后将尿路内的液体全部吸出,并反复多次冲洗至造影剂强回声明显减弱。结果发现输尿管破裂1例,输尿管肿瘤2例,输尿管开口异位2例。结论经皮肾盂穿刺顺行上尿路造影超声检查是SonoVue非血管途径应用的新尝试,能够诊断常规超声、彩色多普勒超声不能或不明确诊断的梗阻性尿路疾病。临床观察未发现造影剂导致尿路并发症。     

彩色多普勒超声引导肾盂穿刺造影对输尿管梗阻的诊断价值

目的：评价肾盂穿刺造影对肾盂积水梗阻部位及性质诊断价值。方法：应用彩色多普勒超声引导肾盂穿刺注入泛影葡胺56例。结果：51例为输尿管结石，其中上段18例，中段5例，下段28例，4例为输尿管囊肿，1例为肿瘤侵犯输尿管。结论：彩色多普勒超声引导肾盂穿刺造影安全准确，简便易行，可弥补X射线静脉肾盂造影不显影的不足，通过造影剂流行观察，明确不同梗阻部位及性质的诊断，是一种微创的有效方法。     

Value of contrast-enhanced power Doppler sonography using a microbubble echo-enhancing agent in evaluation of small breast lesions

PURPOSE: The purpose of this study was to prospectively evaluate the usefulness of contrast-enhanced power Doppler sonography (PDUS) using a microbubble echo-enhancing agent in differentiating between malignant and benign small breast lesions. PATIENTS AND METHODS: Between July 1, 2000, and September 30, 2001, we performed gray-scale sonographic examination of patients in whom diagnostic sonography or screening mammography had revealed solid breast lesions measuring less than 2 cm in the largest dimension. The patients were then examined on PDUS before and after injection of a microbubble contrast agent. The sonographic findings for all 3 techniques, as well as the morphologic features of the Doppler signals for each patient before and after injection of the contrast agent on PDUS, were independently assessed. Each lesion was classified as "benign" or "malignant" on the basis of specific criteria for sonographic interpretation. A hemodynamic study was performed in which time-transit profiles of the Doppler signals on contrast-enhanced PDUS were generated using a computer-assisted program, and the results for each patient were compared with the findings of a histopathologic examination of surgical specimens. RESULTS: Thirty-six patients (35 women and 1 man) with a mean age of 43.5 years (range, 18-69 years) were evaluated. The tumors ranged from 4 to 19 mm in the largest dimension. Histopathologic examination revealed that 19 tumors were benign and 17 were malignant. For morphologic diagnosis of the malignant lesions, the sensitivity of gray-scale sonography was 100%, compared with 29% for PDUS without contrast enhancement. The specificity of gray-scale sonography was 47%, compared with 74% for PDUS without contrast enhancement. Contrast-enhanced PDUS had a sensitivity of 71% and a specificity of 58%. The diagnostic accuracy was 72% for gray-scale sonography, 53% for PDUS without contrast enhancement, and 64% for contrast-enhanced PDUS. The time-transit profiles of the hemodynamic study did not reveal a statistically significant difference in the accuracy rates of contrast-enhanced PDUS between benign and malignant breast lesions. CONCLUSIONS: Compared with PDUS without contrast enhancement, contrast-enhanced PDUS provides better visualization of the morphology of vascular Doppler signals that is characteristic of malignancy and therefore has a higher sensitivity and diagnostic accuracy, albeit a lower specificity. In differentiating between benign and malignant small breast lesions, contrast-enhanced PDUS can be helpful when used with gray-scale sonography and PDUS without contrast enhancement.     

超声造影谐频成像对原发性肝癌治疗效果的评价

目的：评价超声造影谐频成像在原发性肝癌治疗后疗效判断方面的作用。方法：使用Levovist对27例33个肝癌结节治疗前后分别行超声造影能量多普勒谐频成像和灰阶谐频成像数字减影检查,结果与动态增强CT相比较。结果：以动态增强CT结果为金标准,治疗前33个肝癌结节,超声造影增强的阳性率为93．9％（31／33）;而对治疗后肝癌,能量多普勒成像显示肿瘤内血流信号的敏感性,特性和准确性均为100％,灰阶谐频成像数字减影则分别为93．9％、100％和96．8％,结论：超声造影谐频成像可以敏感而直观地显示治疗后肿瘤内残存的血流信号,即时评估肿瘤的治疗效果,创伤小,值得临床推广。     

肾结石合并肾盂癌的临床特征（附15例报告）

目的探讨肾结石合并肾盂癌的临床特征。方法回顾性分析15例肾结石合并肾盂癌患者的临床资料,术前确诊仅2例,确诊率13%。开放手术治疗9例,PCNL6例。其中4例行二期手术肾输尿管全切,2例拒绝进一步手术。结果术后病理检查证实肾盂腺癌2例,肾盂鳞状细胞癌10例,肾盂尿路上皮癌3例。术后随访1～24个月,11例死于肿瘤全身转移、多器官衰竭,平均生存期为11.6个月。另4例仍在随访中,目前未发现有转移。结论对于肾结石病史长、鹿角形结石、消瘦、贫血,特别是近期有腰痛加重者,应高度警惕有肾盂癌的可能,要进行尿脱落细胞学检查;对于术中发现肾盂、肾盏有新生物或周围粘连、有肿块者应行快速病理检查。     

肾结石并肾盂黏液腺癌（附1例报告并文献复习）

目的探讨肾结石合并肾盂黏液腺癌的发病机制及临床特征。方法报告1例肾结石并肾盂黏液腺癌患者的临床资料,患者行肾及输尿管全长切除术,术后病理报告为黏液腺癌。结合相关文献复习并对本病组织发生、临床特点等进行讨论。结果术后随访6个月,未见肿瘤转移及复发。结论结石并肾盂癌临床表现无特异性,术前诊断率低。结石病史长,反复合并感染者应警惕合并肾盂癌。CT有助于提高其诊断率。影像学检查显示肾脏囊性包块,囊壁不光滑,囊壁部分钙化,囊内液体密度不均,应考虑黏液腺癌可能。尿液中或肾内发现黏液提示肾盂黏液腺癌。肾盂黏液腺癌确诊依赖病理检查。肾盂黏液腺癌应行患侧肾输尿管全长切除术。没有证据表明术后化疗或放疗能改善患者预后,其预后难以估计。     

Ablation therapy guided by contrast-enhanced sonography with Sonazoid for hepatocellular carcinoma lesions not detected by conventional sonography.

OBJECTIVE: We evaluated the usefulness of contrast-enhanced harmonic gray scale sonography with a newly developed sonographic contrast medium as a means of guidance for percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography. METHODS: We examined 85 patients with 108 hepatocellular carcinoma lesions that were identified as hypervascular by multidetector-row computed tomography by using contrast-enhanced harmonic gray scale sonography after injection of Sonazoid (GE Healthcare, Oslo, Norway), a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent. We scanned the whole liver by this modality at a low mechanical index in the late phase to detect lesions not detected by conventional sonography and then scanned the lesions again by this modality at a high mechanical index to visualize tumor vessels and enhancement. We also performed percutaneous ablation therapy guided by this modality to treat viable hepatocellular carcinoma lesions that could not be detected by conventional sonography. RESULTS: Conventional sonography identified 90 (83%) of 108 hepatocellular carcinoma lesions; 15 (14%) additional viable lesions not detected by conventional sonography were detected in the late phase of contrast-enhanced harmonic gray scale sonography at a low mechanical index, and tumor vessels and enhancement were observed in the late phase at a high mechanical index. Contrast-enhanced harmonic gray scale sonography diagnosed 105 (97%) of the 108 viable hepatocellular carcinoma lesions, and 14 (93%) of the 15 lesions not detected by conventional sonography were successfully treated by percutaneous ablation therapy guided by this modality. CONCLUSIONS: Contrast-enhanced harmonic gray scale sonography is useful for guidance of percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography.     

切口脂肪层下引流在妇科腹部手术中的应用

腹部手术切口延期愈合，不仅给受术者带来痛苦和精神压力，增加医疗费用的支出，而且在医患关系紧张的环境下，增加了医疗纠纷。为了预防切口感染，促进切口愈合，笔者对40例接受妇科手术者，行腹部切口脂肪层下放置橡皮引流片引流，无一例切口延期愈合，取得良好的临床疗效。现报告如下。     

肾结石合并肾盂鳞状细胞癌的早期诊断与治疗（附2例报告）

目的探讨。肾结石合并。肾盂鳞状细胞癌的早期诊断与治疗。方法报告肾结石合并肾盂鳞状细胞癌2例,结合相关文献探讨其早期诊断及治疗方法。结果2例均有典型肾绞痛病史及合并血尿,CT检查提示肾盂癌2例。2例术中经冰冻病理确诊后,行根治性患肾切除术,1例术后行全身化疗,5个月后死于全身衰竭,另一类术后随访18个月无复发。2例病理诊断均为鳞状细胞癌。结论肾结石合并肾盂鳞状细胞癌恶性程度高、预后差,临床表现缺乏特异性,易误诊和漏诊,提高对本病的认识,对可疑病例进行多项必要的辅助检查,有助于明确诊断。治疗以根治性患。肾切除为主。     

Correlation between estimates of tumor perfusion from microbubble contrast-enhanced sonography and dynamic contrast-enhanced magnetic resonance imaging.

OBJECTIVE: We compared measurements of tumor perfusion from microbubble contrast-enhanced sonography (MCES) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in an animal tumor model. METHODS: Seven mice were implanted with Lewis lung carcinoma cells on their hind limbs and imaged 14 days later with a Philips 5- to 7-MHz sonography system (Philips Medical Systems, Andover, MA) and a Varian 7.0-T MRI system (Varian, Inc, Palo Alto, CA). For sonographic imaging 100 microL of a perfluoropropane microbubble contrast agent (Definity; Bristol-Myers Squibb Medical Imaging, Billerica, MA) was injected and allowed to reach a pseudo steady state, after which a high-mechanical index pulse was delivered to destroy the microbubbles within the field of view, and the replenishment of the microbubbles was imaged for 30 to 60 seconds. The MRI included acquisition of a T(10) map and 35 serial T(1)-weighted images (repetition time, 100 milliseconds; echo time, 3.1 milliseconds; alpha, 30 degrees ) after the injection of 100 microL of 0.2-mmol/kg gadopentetate dimeglumine (Magnevist; Berlex, Wayne, NJ). Region-of-interest and voxel-by-voxel analyses of both data sets were performed; microbubble contrast-enhanced sonography returned estimates of microvessel cross-sectional area, microbubble velocity, and mean blood flow, whereas DCE-MRI returned estimates of a perfusion-permeability index and the extravascular extracellular volume fraction. RESULTS: Comparing similar regions of tumor tissue seen on sonography and MRI, region-of-interest analyses revealed a strong (r(2) = 0.57) and significant relationship (P < .002) between the estimates of perfusion obtained by the two modalities. CONCLUSIONS: Microbubble contrast-enhanced sonography can effectively depict intratumoral heterogeneity in preclinical xenograft models when voxel-by-voxel analysis is performed, and this analysis correlates with similar DCE-MRI measurements.     

肾结石合并肾盂鳞状细胞癌的早期诊断与治疗(附2例报告)

目的 探讨肾结石合并肾盂鳞状细胞癌的早期诊断与治疗.方法 报告肾结石合并肾盂鳞状细胞癌2例,结合相关文献探讨其早期诊断及治疗方法.结果 2例均有典型肾绞痛病史及合并血尿,CT检查提示肾盂癌2例.2例术中经冰冻病理确诊后,行根治性患肾切除术,1例术后行全身化疗,5个月后死于全身衰竭,另一类术后随访18个月无复发.2例病理诊断均为鳞状细胞癌.结论 肾结石合并肾盂鳞状细胞癌恶性程度高、预后差,临床表现缺乏特异性,易误诊和漏诊,提高对本病的认识,对可疑病例进行多项必要的辅助检查,有助于明确诊断.治疗以根治性患肾切除为主.