目的 通过超声造影成像技术( CEUS)观察颈动脉斑块内新生血管的情况,探讨颈动脉斑块的厚度与新生血管的关系。方法 选择颈动脉粥样硬化患者40例,经常规超声确诊存在斑块,共64个,应用CEUS成像技术检测斑块内新生血管情况。结果 不同厚度的颈动脉斑块的增强强度与斑块厚度成正相关(r=0.897 6,P=0.000 0)。结论 超声造影成像技术可以在常规超声的基础上通过检测斑块内的新生血管,进而判断斑块的性质,提供更多有用的信息进一步评估颈动脉斑块内新生血管增强强度与斑块厚度存在线性正相关性。

Objective To evaluate the neovascularization in carotid plaques by gray-scale harmonic contrast echocardiography (CEUS), and to investigate the relationship between the thickness of carotid artery plaque and the neovascularization.Methods 40 patients with carotid atherosclerosis were selected, and 64 plaques were diagnosed by regular ultrasound. The neovascularization in plaques was detected by CEUS imaging technique.Results The enhanced strength of carotid plaques with different thickness was positively correlated with plaque thickness (r=0.8976,P=0.0000).Conclusion Ultrasound contrast imaging can detect angiogenesis within the plaque based on conventional ultrasound, and then determine the nature of the plaque. More useful information is provided to further evaluate the linear positive correlation between the intensity of neovascularization and the thickness of plaque in carotid plaque.

目的 探讨不同分化程度前列腺癌患者的直肠超声图像特征,为前列腺癌分化程度的诊断提供依据。方法 纳入我院收治的前列腺癌患者120例,均接受直肠超声检查,根据Gleason评分评估分化程度分成低分化组(n=41)、中分化组(n=39)与高分化组(n=40)。分析不同分化程度患者的结节大小、血流分级、回声、边界是否清晰以及包膜完整性,并对血流频谱进行观察。结果 低分化组的结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、边界欠清晰、包膜欠完整、高回声占比高于高分化组,且低分化组结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、高回声占比高于中分化组,中分化组结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、高回声占比高于低分化组,差异有统计学意义(P<0.05)。结论 不同分化程度前列腺癌患者的直肠超声表现存在差异,随着分化程度越低,肿瘤边界清晰度、包膜完整性越差,血流越丰富。

目的 观察同轴微切口超声乳化白内障术联合玻璃体腔注射雷珠单抗治疗糖尿病性黄斑水肿的临床疗效。方法 选择2014年7月—2016年11月在我院就诊的68例(72只眼)患有老年性白内障合并糖尿病性黄斑水肿患者,分为2组,治疗组(32例,34只眼)行同轴微切口超声乳化白内障术联合玻璃体腔注射雷珠单抗;对照组(36例,38只眼)单纯行白内障超声乳化摘除;观察指标包括术前、术后最佳矫正视力、眼压及黄斑中心凹视网膜厚度,观察时间为术前、术后1周、1月、3月、6月、12月。结果 术后两组最佳矫正视力与术前相比差异有统计学意义(P<0.01);术前及术后1周2组最佳矫正视力无差异,术后1月、3月、6月、12月治疗组最佳矫正视力均优于对照组;术前2组患者黄斑中心凹视网膜厚度相比无明显差异,术后各个时间点治疗组黄斑中心凹视网膜厚度均低于对照组,二者相比差异有差异性(P均<0.001);两组患者术前及术后眼压无差异(P<0.05)。结论 对老年性白内障合并糖尿病性黄斑水肿患者,术中联合玻璃体腔注射雷珠单抗,可减轻术后黄斑水肿,改善患者术后中、远期视力。

Objective To assess the safety and efficiency of combination of micro incision phacoemulsification (PHACO) surgery and intravitreal ranibizumab injection in patients with cataract and diabetic macular edema. Methods The selected 68 patients (72 eyes) with age-related cataract and diabetic macular edema were randomly divided into two groups: the PHACO and intravitreal Ranibizumab injection (treatment group, 32 cases, 34 eyes), and only PHACO (control group, 36 cases, 38 eyes) in our hospital from July 2014 to November 2016. Preoperative and postoperative best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were recorded. The time points included preoperative day, 1 week, 1 month, 3 months, 6 months and 12months after surgery. Results Postoperative BCVA during the follow-up period was higher than the initial BCVA in both groups (P<0.01). There was no statistically significant difference between both groups in BCVA at pre-operation and 1 week after surgery. In the treatment group, the postoperative BCVA was significantly higher than the control group at 1 month, 3 months, 6 months and 12months after operation. The mean CMT in the treatment group was lower than the control group in all the follow-up time. There was no statistically significant difference in IOP between two groups preoperatively and postoperatively during the follow-up period (P>0.05). Conclusion Additional intravitreal ranibizumab injection after PHACO surgery reduced macular edema and preserved this improvement in the mid-and-long term of BCVA.

目的 对比分析甲氨蝶呤(methorexate,MTX)联合超声监视下清宫与甲氨蝶呤、子宫动脉栓塞术(uterine artery embolization,UAE)联合清宫治疗停经7周内Ⅱ-Ⅲ型剖宫产瘢痕妊娠(ceasarean scarpregnancy,CSP)的效果。方法 回顾性分析我院自2016年1月—2017年12月收治的停经7周内Ⅱ-Ⅲ型CSP患者的临床资料,按随机、平衡、对照原则分别筛选69例MTX+清宫治疗患者作为A组,68例MTX+UAE+清宫治疗患者作为B组,对比两组治疗成功率、一般治疗情况及术后并发症发生率,并统计两组月经周期恢复时间、血β-hCG恢复至正常时间、疤痕妊娠病灶消失时间。结果 两组术后恢复良好,术中、术后均未发生不可控制宫腔出血现象,胎囊组织均全部清出,A组术中出血量、子宫切除发生率、发热、术后盆腹腔疼痛及肝功能损伤发生率均低于B组,术后第1天血β-hCG下降超过50%及治疗成功率、住院时间均高于B组,且该组月经周期恢复时间、血β-hCG恢复至正常时间、疤痕妊娠病灶消失时间亦较B组短(P﹤0.05)。结论 于停经7周内Ⅱ-Ⅲ型CSP患者而言,行MTX+清宫治疗或可在不增加出血风险基础上避免UAE相关并发症及副反应。

Objective To comparatively analyze the effects of methotrexate (MTX) combined with uterine curettage under ultrasonic monitoring and MTX, uterine artery embolization (UAE) combined with uterine curettage in the treatment of cesarean scar pregnancy (CSP) within 7 weeks of menopause. Methods The clinical data of patients with type Ⅱ-Ⅲ CSP within 7 weeks of menopause who were admitted to the hospital from January 2016 to December 2017 were analyzed retrospectively. Another 69 cases treated with MTX combined with uterine curettage were selected as group A and 68 cases treated with MTX+UAE+uterine curettage were selected as group B. The success rate of treatment, general situation of treatment and the incidence of adverse reactions were compared between the two groups. The time of menstrual recovery, the recovery time of blood β-hCG and the disappearance time of scar pregnancy lesions were statistically analyzed. Results The two groups recovered well after operation, and there was no uncontrollable uterine bleeding. All fetal sac tissues were cleared. The intraoperative blood loss, hysterectomy rate, incidence rates of fever, postoperative abdominopelvic pain and liver function injury in group A were less/lower than those in group B, The rate of blood β-hCG decreasing more than 50% on the 1st day after operation, the success rate of treatment and hospitalization time of groups A were higher/longer than those of group B, while the time of menstrual recovery, recovery time of blood β-hCG and the disappearance time of scar pregnancy lesions was shorter than that of group B(P<0.05). Conclusion MTX combined with uterine curettage may avoid complications and side effects of UAE in patients with type Ⅱ-Ⅲ CSP within 7 weeks of menopause, without increasing the risk of bleeding.

目的 分析超声检查前准备质量评价对超声检查效果的影响。方法 对进行泌尿科B超检查150例患者按数字表法随机分为对照组和实验组各75例,两组患者发放超声检查须知,按检查准备要求按预约时间前来完成超声检查;实验组在检查前对患者准备效果进行评价,及时落实检查须知事项。结果 检查前准备知识知晓、检查前准备质量、按时检查率对照组低于实验组(P＜0.05);检查前准备依从性、服务满意度对照组低于实验组(P＜0.05)。结论 开展检查前准备质量评价能促进患者落实超声检查前准备,提高准备依从性和准备知识知晓率,缩短检查等候时间,提高检查前准备质量和患者服务满意度。

Objective To analyze the influence of pre-preparation quality evaluation on the effect of ultrasound examination. Methods According to the digital table method, 150 patients were randomly divided into the control group and the experimental group, 75 cases in the control group and the experimental group each. The two groups were taken the ultrasound examination, and the ultrasound examination was completed according to the preparation requirements. The patients in the experimental group were evaluated before the examination, and the inspection notes were timely implemented. Results Knowledge of pre preparation, preparation quality before examination, and rate of check on time were lower in the control group than that in the experimental group(P<0.05). The control group was lower than the experimental group(P<0.05). Conclusion The preparation quality evaluation before examination may promote the patient's preparation before the ultrasonic examination, improve the preparation compliance and knowledge awareness, shorten the waiting time, and improve the quality of preparation and the satisfaction of patient service.

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.

目的 分析针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的临床效果。方法 选择我院收治的乳腺肿物患者200例进行观察（2012年1月—2017年12月）,针对200例乳腺肿物患者存在的305个乳腺不可触及肿物进行活检检查,采用随机分组的方式将其分成两组后针对常规组100例乳腺肿物患者实施传统手术治疗,针对治疗组100例乳腺肿物患者实施超声引导下微创旋切活检术治疗,对比两组的治疗效果。结果 两组乳腺肿物患者之间对比的术中出血量、术后愈合时间、术后并发症发生率、治疗显效率存在差异（P<0.05）,统计学有意义;且超声引导下微创旋切活检术对于乳腺癌的诊断检出率较高。结论 针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的疗效显著,促进患者预后。

Objective To analysis of the clinical effect of ultrasound guided minimally invasive rotary biopsy for untouchable breast masses. Methods A total of 200 patients with breast masses were selected for observation （January 2012 to December 2017）, and 305 untouchable breast masses in 200 patients were examined by biopsy. It was divided into two groups randomly and then treated with traditional surgical treatment for 100 patients with breast masses in the routine group and 100 patients with breast masses in the treatment group with minimally invasive biopsy under the guidance of ultrasound. The therapeutic effects of the two groups were compared. Results There were differences between the two groups in the amount of intraoperative bleeding, postoperative healing time, the incidence of postoperative complications and the effective rate of treatment （P < 0.05）, and the differences were statistically significant （P < 0.05）. The diagnostic rate of breast cancer was higher with minimally invasive rotary biopsy guided by ultrasound. Conclusion The effect of ultrasound-guided minimally invasive rotary biopsy on untouchable breast masses is significant and promotes the prognosis of the patients.

目的 探究彩色多普勒超声在乳腺良恶性肿瘤鉴别诊断中的应用价值。方法 抽取2012年2月—2016年6月我院门诊、社区普查中的病例中选取符合研究标准的298例乳腺肿瘤疾病患者,所有患者均行彩色多普勒超声检查。通过SPSS 19.0软件对数据进行分析,以病理检查结果作金标准,分析彩色多普勒超声诊断结果,对比良性肿瘤与恶性肿瘤血流分级情况及良性肿瘤与恶性肿瘤收缩期流速峰值(PSV)及(阻力指数)RI水平。结果 经病理检查证实,298例患者中恶性肿瘤32例,良性肿瘤266例;超声诊断恶性肿瘤42例,良性肿瘤256例;超声诊断灵敏度为93.75%(30/32)、特异度为95.49%(254/266)、准确度为95.30%(284/298)。良性肿瘤血流信号检出率为55.26%(147/266),恶性肿瘤血流信号检出率为96.87%(31/32),其中良性肿瘤以0～I级血流为主,为83.83%(223/266),恶性肿瘤以I～III级血流为主,为96.87%(31/32),各分级情况对比,差异有统计学意义(P＜0.05)。恶性肿瘤PSV(20.11±6.76)cm/s、RI(0.65±0.07)均明显高于良性肿瘤[(15.30±9.21)cm/s、(0.56±0.09)],差异有统计学意义(P＜0.05)。结论 彩色多普勒超声在乳腺良恶性肿瘤临床鉴别诊断中具有较高准确度、特异度及灵敏度,可结合血流分级和RI水平提高乳腺良恶性肿瘤鉴别准确度。

目的 回顾性分析不同病理类型乳腺黏液腺癌的超声声像图特征,从而提高术前乳腺黏液腺癌不同亚型的超声诊断准确率。方法 分析43名患者共44例手术切除或穿刺活检证实为乳腺黏液腺癌病灶的声像图资料,包括病灶的边界、边缘、形态、回声类型、生长方向、钙化、后方回声、血流分级、腋窝淋巴结形态,并对病灶进行BI-RADS分类。将超声声像图特征与手术或活检后病理结果进行对比,总结出不同亚型的乳腺黏液腺癌的超声声像图特征。结果 44例乳腺黏液腺癌病理类型分为21例单纯型黏液腺癌和23例混合型黏液腺癌,混合型黏液腺癌大多数表现为病灶边界不清(73.9%)、边缘模糊毛刺(73.9%)、形状不规则(91.3%)、以及内部回声不均匀(87%)、病灶内钙化更多见(52.2%)。混合型黏液腺癌的淋巴结转移率明显高于单纯型黏液腺癌(P<0.05)。对比术前病灶的BI-RADS分类及术后病理诊断,超声对恶性病灶诊断准确率68%,单纯型黏液腺癌和混合型黏液腺癌的诊断准确率分别为48.6%、87%。结论 不同病理类型乳腺黏液腺癌间具有一些不同的声像图特征。混合型黏液腺癌大多数表现为病灶边界不清、边缘模糊毛刺、形状不规则、回声不均匀、病灶内钙化多见;单纯型乳腺黏液腺癌通常表现为边界清晰、形态规则、钙化少见、淋巴结转移少等良性肿块声像特征,超声对其误诊率较高,需提高警惕。

Objective Retrospectively evaluate the sonographic features of different types of mucinous breast carcinoma to improve the preoperative ultrasound diagnostic accuracy rate. Methods Sonographic features of 44 cases of MBC proven by pathological biopsy were analyzed, including the margin,lesion boundary,shape,echo pattern,lesion growth pattern, calcification, posterior acoustic feature,blood flow, lymph node form and data system(BI-RADS)classification for the lesion to sum up the different subtypes of breast ultrasonic ultrasonographic features of mucinous carcinoma. Results 21 cases of pure mucinous carcinoma (PMBC)and 23 cases of mixed mucinous carcinoma(MMBC)were founded. MMBC were more likely to have unclear boundary (73.9%), indistinct or spiculate of margin(73.9%), irregular shape (91.3%), heterogeneous internal echo (87%), more calcification in lesions(52.2%). Lymph node metastasis in MMBC was obviously higher than that of PMBC(P<0.05). Compared with preoperative of the BI-RADS classification and pathological diagnosis, ultrasonography in diagnosing accuracy rate was 68% in malignant lesions, 48.6% in PMBC and 87% in MMBC. Conclusion There are some different ultrasonographic characteristics in different types of breast mucinous carcinoma.MMBC are more likely to have unclear boundary, indistinct or spiculate of margin, irregular shape, more calcification in lesions. On the contrary, PMBC has a circumscribed boundary, abrupt interface edge, rare calcification, rare lymph node metastasis and are easily misdiagnosed as benign lesions. We should pay more attention to avoid misdiagnosis in ultrasonography.

目的 研究超声脐血流与大脑中动脉血流定量检测用于胎儿宫内窘迫的临床应用价值。方法 纳入150例住院分娩孕妇作为研究对象,其中胎儿窘迫组72例,正常对照组78例。对所有孕妇行彩色多普勒超声检查,记录脐动脉(UA)和大脑中动脉(MCA)收缩期末期最大血流速度与舒张末期血流速度比值(S/D)、阻力指数(RI)及搏动指数(PI)。采用受试者工作曲线(ROC)分析超声UA和MCA血流检测在诊断胎儿宫内窘迫中的临床应用价值。结果 胎儿窘迫组UA的S/D、RI及PI均显著高于正常对照组(P＜0.05),MCA的S/D、RI及PI均低于正常对照组(P＜0.05)。UA对预测胎儿宫内窘迫的ROC曲线显示S/D、RI及PI的敏感度为0.986、0.958及0.944,特异度为0.614、0.625及0.534。MCA对预测胎儿宫内窘迫的ROC曲线显示S/D、RI及PI的敏感度为0.897、0.924及0.892,特异度为0.712、0.657及0.684。结论 产前超声联合检测UA和MCA血流参数有助于筛查胎儿宫内窘迫,提高诊断准确性,指导临床。

Objective To study the clinical value of ultrasonic quantitative detection in blood flow and middle cerebral artery blood flow in fetal distress. Methods 150 hospitalized pregnant women were included in the study, including fetal distress group (n=72) and normal control group (n=78). Color Doppler ultrasonography was performed on all pregnant women. The maximal systolic blood flow velocity and end diastolic blood flow velocity ratio(S/D), resistance index (RI) and pulsatility index (PI) of the umbilical artery (UA) and the middle cerebral artery (MCA) were recorded. The application value of ultrasonic UA and MCA blood flow detection were analyzed by the receiver operating curve (ROC). Results The S/D, RI and PI of UA in fetal distress group were significantly higher than those in normal control group(P＜0.05). The S/D, RI and PI of MCA in fetal distress were significantly lower than those in normal control group(P＜0.05). The ROC of UA and MCA showed that S/D, RI and PI of sensitivity were[0.986,0.958,0.944 vs 0.897,0.924,0.892],the specificity were[0.614, 0.625,0.534 vs 0.712,0.657,0.684]. Conclusion The prenatal ultrasound combined detection UA and MCA blood flow parameters are helpful for screening fetal distress, improving diagnostic accuracy and guiding the clinical.