目的 探讨肺部超声(LUS)在高龄(≥75 岁)感染新型冠状病毒肺炎(COVID-19)患者中的应用及后续对病程的监测及诊断价值。方法 回顾性分析2022年11月1日—2023年1月15日本院内科收治的25例COVID-19高龄患者进行病例归纳总结,除临床资料外,动态监测肺部超声检查情况,并与肺CT结果对比,观察检查结果,以及对病程转归的预判及影响。结果 LUS检查提示患者出现不同程度肺间质损伤,包括离散型B线(间质渗出)或融合型B线(渗入肺泡)以及肺实变(肺泡萎陷)。随着病情好转,LUS可见肺实变范围缩小,B线逐步稀疏到消散,A 线出现。结论 LUS与同期胸部CT结果一致性良好。LUS检查安全简便,重复性好,可实时动态监测,即可作为初筛手段,亦可运用于特殊人群,协助临床治疗决策。

Objective To explore the application and follow-up monitoring and diagnostic value of lung ultrasound (LUS) in elderly patients(≥75y) with novel coronavirus pneumonia (COVID-19). Methods Data of 25 COVID-19 elderly patients admitted to the Department of Internal Medicine from November 1, 2022 to January 15, 2023 were retrospectively analyzed and summarized. In addition to clinical data, dynamic monitoring of LUS was performed, and the results were compared with lung CT results. The examination results, as well as the prediction and impact on the course of disease were observed. Results LUS imaging indicated that patients had different degrees of interstitial lung injury, including discrete type B line (interstitial exudation) or fusion type B line (alveolar infiltration) and lung consolidation (alveolar collapse). With the improvement of the disease, the range of lung consolidation seen in LUS was reduced, the B-line was gradually sparse to dissipate, and the A-line appeared. Conclusions The results of LUS and chest CT in the same period are consistent. LUS examination is safe, simple, reproducible, and can be monitored dynamically in real time. It can be used as a primary screening method, and also be used in special patients to assist clinical treatment decision-making.

目的 探索实体肿瘤内部不同区域的间质液压（IFP）分布的异质性。方法 通过建立新西兰大白兔的皮下浅肌层VX2移植瘤模型,通过超声造影观察肿瘤的大小、形状、血流灌注等成瘤情况,并在超声引导下通过针芯法（WIN法）测量41只荷瘤兔VX2移植瘤内部不同区域的IFP。结果 41只荷瘤兔的VX2移植瘤的中央IFP为（23.79±8.07） mmHg、肿瘤外周1/2IFP为（15.58±5.22）mmHg、肿瘤外周1/4IFP为（8.29±5.47）mmHg,IFP从中央到外周逐步降低（F=70.85,P<0.001）。结论 VX2移植瘤内不同区域的IFP存在异质性,即从中央到外周IFP呈梯度显著降低。

Objective To explore the heterogeneity of interstitial fluid pressure（IFP）distribution in different regions of solid tumors．Methods The model of VX2 tumor was established in New Zealand white rabbits．The size,shape and blood perfusion of the tumor were observed by contrast-enhanced ultrasound,the IFP of VX2 tumor in 41 rabbits was measured by the wick-in-needle method（WIN method）under the guidance of ultrasound．Results The mean values of central IFP,peripheral 1/2 IFP and peripheral 1/4 IFP were（23.79±8.07） mmHg,（15.58±5.22 ）mmHg and （8.29±5.47） mmHg,respectively by statistical analysis,the IFP values changed significantly with different regions（F=70.85,P<0.001）．Conclusions There is heterogeneity of IFP in different regions of VX2 xenografts,that is,from the center to the periphery,the IFP decreased significantly．

目的 探讨超声评分法在体表高分化脂肪肉瘤(WDLPS)和良性脂肪瘤(LP)鉴别诊断中的价值,为两者的鉴别诊断和治疗方式选择提供依据。方法 回顾性分析经病理证实的 14 例(共15个肿块)体表WDLPS和 37 例(共40个肿块)LP临床资料及超声声像图特征,比较2组患者的发病年龄、性别、发病部位、肿块长径、短/长径比、肿块形态、边界、有无包膜、内部回声、回声分布、位置及血流分级等指标。筛选出有统计学差异指标,绘制ROC曲线,计算评分系统的诊断效能。结果 WDLPS和 LP患者在年龄、肿块长径、短/长径比值、有无包膜、位置以及血流分级6个指标有统计学差异(P＜0.05),对以上6个指标赋予0或1分建立病灶评分系统,总分0～6分。计算不同分值对WDLPS的诊断效能,以总分≥3分时诊断效能最高,灵敏度86.7%,特异度77.5%,正确率80%,阳性预测值59.1%,阴性预测值93.9%。结论 基于超声图像特征的评分方法在总分≥3分时,对术前鉴别WDLPS和LP具有较好的诊断效能,能够为临床治疗方案选择提供重要参考依据,值得推广应用。

Objective To evaluate the value of ultrasonography scoring system in differential diagnosis of well-differentiated liposarcomas (WDLPS) and benign lipoma (LP), and to provide evidence for the differential diagnosis and treatment choice. Methods Fourteen WDLPS cases (total of 15 masses) and 37 LP cases (total of 40 masses) were diagnosed by surgical histopathology, which clinical data and the ultrasound images were analyzed retrospectively. The parameters including age, gender, region, mass length, length/width ratio, shape, margin, envelope echoes, echogenicity, texture, location, blood flow were compared between the groups above. A scoring system was established by analyzing the parameters with statistical differences, and the ROC curve was plotted to calculate the best cut-off value and evaluate the diagnostic efficiency of the scoring system. Results There were statistically significant differences between two groups in the following six parameters: age, mass length, length/width ratio, envelope echoes, location, blood flow(P＜0.05). The scoring system was established by assigning 0 or 1 point to each factor, and the total score was 0～6 points. The highest diagnostic efficiency of WDLPS was observed at the cut-off value ≥ 3. The sensitivity, specificity, accuracy, the positive predictive value and the negative predictive value was 86.7%, 77.5%, 80%, 59.1%, 93.9% respectively. Conclusions The ultrasonography-based scoring system has a better diagnostic efficacy in differentiating WDLPS and LP, which can provide an important reference basis for the selection of clinical treatment, and is worthy of promotion and application.

实体肿瘤物理和化学微环境异常阻碍了肿瘤与外界进行物质交换,降低了药物渗入肿瘤组织,是肿瘤对放化疗抵抗的重要原因。目前,已有多种针对肿瘤微环境各个组分的治疗方法,如使血管正常化、降低肿瘤间质液压、降解细胞外基质等,以达到增强药物等的渗出,从而增强肿瘤治疗效果。声学调控是改变肿瘤理化微环境的一种有效方法,本文对声学调控其中几个主要的机制和研究进展进行综述,以期为临床肿瘤治疗提供新思路。

目的 通过研究微泡超声空化增强微波消融对兔VX2肿瘤的热消融效应来探究其在肿瘤治疗中的价值。方法 24只肝脏移植瘤兔随机分为空白对照组、单纯超声空化治疗组、单纯微波消融治疗组、超声空化联合微波消融治疗组4组。利用增强超声显示每组治疗前后肿瘤的大小、形状和轮廓并通过温度针来检测治疗区域的局部温度。结果 联合治疗组血流灌注缺损最严重,微波消融组和联合治疗组缺损体积分别为1.53±0.20和1.68±0.43(P=0.117);微波消融组以及联合治疗组消融治疗时温度达平台时间分别为(21.7±5.0)s和(10.3±5.0)s(P<0.01),最高温度(℃)分别为100.9±5.0和134.1±6.0(P<0.01)。结论 MWA联合MEUS治疗肝癌可使治疗区局部温度急剧升高至峰值温度,有望提高肝癌治疗效果。

Objective To investigate the thermal ablation effect of microbubble ultrasound cavitation combined with microwave ablation on rabbit VX2 tumors. Methods Twenty-four rabbits with liver transplantation tumors were randomly divided into four groups: blank control group, ultrasound-only cavitation treatment group, microwave-only ablation treatment group, and ultrasound-cavitation combined with microwave ablation treatment group. Enhanced ultrasound was used to show the size, shape and contour of the tumor before and after treatment in each group, and the local temperature of the treatment area was detected by a temperature needle. Results The blood flow perfusion defect was the most severe in the combined treatment group. The defect volume of the microwave ablation group and the combined treatment group were 1.53±0.20 and 1.68±0.43 (P=0.117). The temperature reached the plateau time in the microwave ablation group and the combined treatment group. It was (21.7±5.0)s and (10.3±5.0)s (P<0.01), and the highest temperature (℃) was 100.9±5.0 and 134.1±6.0 (P<0.01). Conclusion MWA combined with MEUS for liver cancer can sharply increase the local temperature in the treatment area to the peak temperature, which is expected to improve the treatment effect of liver cancer.

目的 探讨低机械指数诊断超声及低声压治疗超声对造影剂微泡的作用效果。方法 低机械指数的诊断超声及不同声压下低能量治疗超声体外辐照造影剂微泡,通过获得的超声造影图像间接分析微泡总浓度的变化,探讨不同机械指数诊断超声及不同声压治疗超声下微泡发生稳定空化及惯性空化情况。结果 低机械指数(<0.2)诊断超声及低声压(<0.15 MPa)治疗超声下微泡以稳定空化为主,随着机械指数增高或声压增高,微泡以稳定空化和惯性空化两种方式并存,当机械指数>0.3或声压>0.2 Mpa时,微泡以惯性空化为主。结论 微泡在低机械指数及低声压作用下发生不同空化效应,随着机械指数或声压增加,微泡破坏增加,以惯性空化效应为主。

Objective To investigate the effect of low mechanical index diagnostic ultrasound and low acoustic pressure therapy on contrast agent microbubbles. Methods Microbubbles were irradiated by diagnostic ultrasound with low mechanical index(MI) and low energy therapy under different acoustic pressure. To obtain the images, and analyze the change of microbubble concentration,the movement trend of microbubbles under different MI and different acoustic pressure were analyzed, to estimated stable cavitation or inertial cavitation of microbubbles. Results Stable cavitation was the main form of microbubbles under low mechanical index (< 0.2) diagnostic ultrasound and low acoustic pressure (< 0.15Mpa). With the increase of mechanical index or acoustic pressure, stable cavitation and inertial cavitation coexisted. When mechanical index > 0.3 or sound pressure > 0.2MPa, microbubbles were mainly inertial cavitation. Conclusion The cavitation effects of microbubbles under low mechanical index and low acoustic pressure are different. With the increase of mechanical index or acoustic pressure, the damage of microbubbles increases, and main effect is the inertial cavitation.

目的 分析经胸超声心动图在Stanford A 型主动脉夹层的直接征象、间接征象和优缺点,探讨超声心动图在其诊断及预后评估中的应用价值。方法 回顾性收集2018年9月—2020年6月在我院诊治的A型主动脉夹层患者的临床资料,分析超声心动图的应用价值,以及住院期间发生不良预后的高风险因素。结果 经胸超声心动图直接征象诊断 A 型主动脉夹层的敏感性低于CTA,但对受累主动脉瓣结构及其功能评价优于CTA。 院内不良预后的发生率为42%, A型夹层的病因多与高血压相关,主动脉瓣返流、心包积液、手术时间长等是其高风险因素。结论 经胸超声心动图对A型主动脉夹层的早期诊断有较高的初筛价值,在局限于主动脉窦部夹层及观察主动脉瓣是否受累及有独特的优势,对于手术方式的选择和预后的判断有指导意义。

Objective To analyze the direct signs, indirect signs, advantages and disadvantages of transthoracic echocardiography in Stanford A-type aortic dissection, and explore the application value of echocardiography in its diagnosis and prognostic evaluation. Methods Retrospectively collect the clinical data of patients with type A aortic dissection diagnosed and treated in our hospital from Sept 2018 to Jun 2020, and analyze the application value of echocardiography and the high-risk factors for poor prognosis during hospitalization. Results The direct signs of transthoracic echocardiography were less sensitive than CTA in the diagnosis of type A aortic dissection, but it was better than CTA in evaluating the structure and function of the affected aortic valve. The incidence of poor prognosis in the hospital was 42%. The cause of type A dissection was mostly related to hypertension. Aortic regurgitation, pericardial effusion, and long operation time were high-risk factors. Conclusion Transthoracic echocardiography has a higher initial screening value for the early diagnosis of type A aortic dissection. It has unique advantages in confining to the aortic sinus dissection and observing whether the aortic valve is involved, the choice of surgical methods and the judgment of prognosis has guiding significance.

目的 探讨经阴道三维容积超声成像在诊断子宫肌瘤FIGO分类的临床应用价值。方法 对本院收治的手术病理结果证实的219例子宫肌瘤,回顾临床资料分组,99例以经阴道三维容积超声成像作为观察组,120例以经阴道二维彩超检查作为对照组。评估经阴道三维容积超声成像在诊断子宫肌瘤FIGO分类的诊断符合率。结果 两组子宫肌瘤FIGO分类诊断符合率分别为:观察组97.93%,对照组78.33%;经阴道三维容积超声成像检查诊断符合率显著高于二维彩超,差异有统计学意义。结论 经阴道三维容积超声成像较二维彩超能获得更为丰富的诊断信息,诊断子宫肌瘤FIGO分类较二维彩超优势显著,有利于提高诊断准确率,为指导临床个性化治疗提供可靠的理论依据,值得临床推广应用。

Objective To investigate the clinical value of transvaginal three-dimensional volumetric ultrasound imaging in the diagnosis of the FIGO classification of hysteromyoma. Methods To retrospectively analysis data of 219 cases hysteromyoma confirmed by the surgical pathological findings in this hospital. 99 cases treated with transvaginal 3D ultrasound were as the observation group, and 120 cases treated with vaginal 2D ultrasound as the control group. To evaluate the diagnostic coincidence rate of transvaginal three-dimensional volumetric ultrasound imaging in the diagnosis of FIGO classification of hysteromyoma. Results The coincidence rates of FIGO classification of hysteromyoma in the two groups were 97.93% in the observation group and 78.33% in the control group; the diagnostic coincidence rate of transvaginal three-dimensional volumetric ultrasound imaging was higher than that of two-dimensional color Doppler ultrasound, and the difference was statistically significant. Conclusion Transvaginal three-dimensional volumetric ultrasound imaging can obtain richer diagnostic information than two-dimensional color Doppler ultrasound. In the FIGO classification of hysteromyoma, it has significant advantages than two-dimensional color Doppler ultrasound, which is conducive to improving the diagnostic accuracy and providing a reliable theory for guiding clinical personalized treatment. The basis is worthy of clinical promotion and application.

目的 本研究旨在探讨压迫止血法在减少实时超声引导经皮肾穿刺术后并发症中的价值。方法 选取2011年9月1日—2016年12月31日于我院行超声引导下经皮肾穿刺术患者405例。按肾穿刺后是否行立即行压迫止血法分2组,非压迫止血法为对照组(A组),压迫止血法为研究组(B组)。记录患者术前血压、凝血四项、血红蛋白、血小板等指标。记录穿刺次数及每次穿刺所取标本长度。术后24 h复查穿刺点出血情况及肾周血肿情况。穿刺术后24 h内监测血尿情况。结果 与非采用压迫止血法超声定位经皮肾穿刺术后(A组)相比,压迫止血法术后(B组)并发症发生率较低, A组肉眼血尿发生率为8.8 %,B组为4 %,差异有统计学意义(P=0.048);A组24 h肾周血肿发生率为 62.1%,B组为49.8%,差异有统计学意义(P=0.042)。结论 实时超声引导下经皮肾穿刺后立即行压迫止血法,可有效减少术后肾周血肿和血尿。

Objective To discuss how to reduce the post-biopsy complications of real-time ultrasound-guided percutaneous renal biopsy by manual compression. Methods A total of 405 ultrasound-guided biopsies were performed in 404 patients in our hospital, between September 2011 and January 2017, were recruited to this study. They were divided into 2 groups, group A biopsy without manual compression, and group B biopsy with manual compression. All patients' records were retrospectively reviewed and both pre and post biopsy information, as well as complications were collected. Results The gross hematuria rate is 8.8 % (16 patients) in group A, but in group B, the rate is 4 %. The perirenal hematoma rate at 24 h after biopsy in group A detected by ultrasound is 62.1% (113 patients), and 49.8% (116 patients, P vs group A=0.042) in group B. Conclusion Manual compression to the puncture site reduced complications like perirenal hematoma and gross hematuria after real-time ultrasound-guided renal biopsy.

目的 探讨乳腺癌原发病灶超声声像图特点及病理分子分型与腋窝淋巴结转移的相关性。方法 回顾性分析106例接受乳腺超声检查及腋窝淋巴结活检,病理确诊为乳腺癌的患者资料。超声观察乳腺癌原发病灶的位置、大小、有无钙化、纵横比、内部血流、腋窝淋巴结声像图特点,结合临床病理学特点,分析与腋窝淋巴结转移相关的因素。结果 超声诊断未见明显异常的腋窝淋巴结75例,可疑的腋窝淋巴结31例;病理证实腋窝淋巴结未转移70例,转移36例。灵敏度66.7%、特异度90%、阳性预测值77.4%、阴性预测值84%。单因素分析显示原发肿块的位置、最大径、腋窝淋巴结淋巴门消失、ER表达与腋窝淋巴结转移有关(P<0.05 )。多因素分析显示原发肿块的位置、腋窝淋巴结淋巴门消失与腋窝淋巴结转移有关(P<0.05)。结论 腋窝淋巴结常规超声检查结合乳腺癌原发病灶超声声像图及病理分子分型有助于评估腋窝淋巴结状态。

Objective To analyse the ultrasonographic features and pathological molecular typing of the primary lesions and axillary lymph node (ALN) of breast cancer related to axillary lymph node metasta-sis(ALNM). Methods The Grey-scale and color Doppler ultrasound and axillary lymph node biopsy were performed in 106 patients with breastcarcinomas. The observed features included the position,the most dimen-sion,inner calcification,aspect ratio,the type of blood supply of the primary tumor and axillary lymph node image. Combining with the clinicopathological features, we analyzed the factors associated with axillary lymph node metastasis. Results Ultrasound found normal axillary lymphnodes in 70 patients and abnormal in 31 patients. Pathology confirmed axillary lymph node metastasis in 36 patients, and no metastasis in 70 patients.The sensitivity, specificity, positive predictive value, negative predictive value were 66.7%, 90%, 77.4% and 84% r-espectively.Univariate analysis showed that the location, maximum diameter, lymphnode with disappearance hilus and ER expression were related to axillary lymph node metastasis (P< 0.05). Multivariate analysis showed that the location of primary mass and lymph node with disappearance hilus were related to axillary lymph node metastasis (P< 0.05). Conclusion Axillary lymph node routine ultrasound examination combined with ultrasonographic and pathological molecular typing of primary breast cancer is helpful to evaluate axillary lymph node status.