目的 探讨超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中的应用价值。方法 我院52例经皮肺穿刺活检的病例,术前均采用高效抗逆转录病毒治疗,依据CD4⁺T淋巴细胞确定是否手术,术中规范手术方式,做好防护措施,27例行超声引导穿刺,25例行CT引导穿刺,术后应用抗生素预防机会性感染等。结果 所有患者穿刺成功率100%,超声组肺结核13例,真菌感染67例,细菌感染4例,肺腺样囊性癌2例、卡波西肉瘤1例。CT组肺结核11例,真菌感染7例,细菌感染5例,肺腺样囊性癌1例。术后并发症:超声组5例病灶少量气胸,2例周围少量出血,咯血4例;CT组8例病灶少量气胸,4例周围少量出血,咯血7例。结论 经过术前控制患者计数及预防感染治疗,超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中应用更为安全、有效、可行的,值得临床应用及推广。

Objective Objective to investigate the value of ultrasound-guided percutaneous lung biopsy in the diagnosis of peripheral lung lesions in AIDS patients. Methods 52 cases in our hospital of percutaneous pulmonary biopsy cases, preoperative highly active antiretroviral therapy was used, basis of CD4⁺T lymphocytes count determined whether the operation were performed, standard operation mode in the operation. It must to take good protective measures. 27 cases underwent ultrasound guided puncture, 25 cases underwent CT guided puncture and had postoperative application of antibiotics to prevent opportunistic infections. Results The successful rate of puncture was 100% in all patients. Tuberculosis in the ultrasound group was 13 cases, fungal infection was 67 cases, bacterial infection was 4 cases, pulmonary adenoid cystic carcinoma was 2 cases, and Posey's sarcoma was 1 cases. There were 11 cases of pulmonary tuberculosis in CT group, 7 cases in fungal infection, 5 cases in bacterial infection, and 1 cases in adenoid cystic carcinoma of the lung. Postoperative complications included: 5 cases of small pneumothorax in the ultrasound group, a small amount of bleeding around the surrounding, hemoptysis in 4 cases, CT group of patients with 8 cases of a small amount of pneumothorax in the lesions, 4 cases of a small amount of bleeding around the case, 7 cases of hemoptysis. Conclusion After preoperative control count and prevention of infection in patients with treatment, ultrasound guided percutaneous lung biopsy in peripheral pulmonary lesions of AIDS is more safe and effective, worthy of clinical application and promotion.

目的 探讨急性脑卒中患者颈动脉粥样硬化斑块的超声形态学表现以及探讨不同超声形态学表现的诊断价值。方法 对所有入选受检者进行多层螺旋CT或磁共振(MRI)检查、常规颈动脉超声检查、彩色多普勒血流显像(CDFI)、超声造影技术(CEUS)的影像学资料进行回顾性分析;所入选病例组患者在发病2天内完成上述影像学检查,对照组受检者也在2天内完成上述影像学检查。结果 常规超声发现病例组颈动脉斑块45处、对照组11处;CDFI发现病例组颈动脉斑块远端血流频谱改变35例、对照组11例;超声造影发现颈动脉斑粥样硬化斑块处毛细血管现象病例组15例、对照组2例。斑块表面形态以及内部回声分布情况两项结果与对照组比较差异有统计学意义。结论 脑卒中患者与无症状颈动脉硬化受检者的斑块超声声像图中,斑块表面形态以及内部回声分布两项指标具有明显的鉴别诊断意义。提示表面不光整、内部回声分布不均匀的斑块导致急性脑卒中的可能性较大。

目的 根据巨脑回畸形的病理特点,对比其它影像检查,研究该病的超声特点,探讨新生儿期巨脑回畸形的超声诊断价值。方法 对5例新生儿巨脑回畸形的患儿的超声资料进行分析。结果 5例超声检查均表现为大脑脑回明显宽大,脑沟、脑回稀少,皮层明显增厚,大脑表面光滑,且5例均伴有不同程度的其它颅脑畸形。结论 新生儿巨脑回畸形具有一定的超声特征,超声检查在新生儿巨脑回畸形的诊断中具有重要的价值。

目的 探讨彩色多普勒超声在无精子症患者睾丸穿刺活检中的应用价值。方法 回顾性分析2012年11月—2015年2月在我科诊断为无精子症的53例患者的病例资料。所有患者进行常规阴囊超声检查,采用频谱多普勒检测睾丸动脉(TA)、睾丸内动脉(ITA)的收缩期最大速度(PSV)、舒张末期速度(EDV)和阻力指数(RI)。采用彩色多普勒超声观察睾丸内的血管分布及其数目,并进行半定量评分。所有患者进行睾丸穿刺活检并进行Johnsen评分。结果 47例患者诊断为梗阻性无精子症(OA),6例患者诊断为非梗阻性无精子症(NOA)。0A组睾丸的平均体积(15.3±3.6) mL,NOA组睾丸的平均体积(7.1±2.8) mL,差异有统计学意义(P＜0.01);OA组与NOA组患者睾丸的血流参数(PSV、EDV、RI) 结果有统计学意义(P＜0.05);OA组与NOA组睾丸内血管半定量分级有的差异,其差异有统计学意义(P＜0.01)。结论 彩色多普勒超声检查对睾丸生精功能有很好的预测作用,可作为鉴别OA患者和NOA患者的指标。

Objective To explore the application value of color Doppler ultrasound in patients with azoospermia who underwent testicular needle biopsy. Methods Retrospective analysed the clinical data of 53 cases patients with azoospermia from 2012 November to 2015 February in our department.All patients underwent routine scrotal ultrasonography, to detecte the peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI) of testicular artery (TA)and intratesticular artery (ITA)with spectral Doppler ultrasound. Color Doppler ultrasound was used to observe the distribution and the number of blood vessels in the testicle, and semi quantitative score. All patients underwent testicular biopsy and Johnsen score. Results 47 patients were diagnosed as obstructive azoospermia(OA), 6 patients were diagnosed as non obstructive azoospermia(NOA). The average volume of testis was (15.3±3.6)mL in 0A group. The average volume of testis was (7.1±2.8) mL in N0A group.There was significant difference (P<0.01). The blood flow parameters(PSV, EDV, RI) results between OA group and NOA group have obvious difference,the difference was statistically significant (P<0.05). The semi quantitative classification of testicular vessels between OA group and NOA group have obvious difference,the difference was statistically significant (P< 0.01). Conclusion Color Doppler ultrasound is a good predictor of testicular spermatogenic function, can be used as the identification index of patients with OA and patients with NOA.

目的 探讨低频脉冲超声联合微泡对微血管的渗出作用。方法 20只新西兰大白兔分为4组:空白组、单纯微泡组、单纯超声组、超声微泡组,进行实验观察。用频率为1 MHz,声压2000 MPa的脉冲超声辐照兔肠系膜及肠壁血管,在荧光显微镜下观察辐照前后肠系膜及肠壁上微血管的损伤,并静脉注入伊文思蓝溶液,观察超声辐照后对伊文思蓝溶液的渗出。结果 空白组、单纯微泡组、单纯超声组在超声辐照后肠系膜及肠壁上微血管内血流通畅,注入伊文思蓝溶液后,微血管内呈蓝色染色,血管周围未见渗出;超声微泡组在超声辐照后微血管周围可见渗出,部分形成血肿。结论 低频脉冲超声联合微泡对微小血管管壁产生损伤作用,血管周围可见渗出,部分形成血肿。

目的 探讨微泡增强的超声空化对荷瘤兔乳腺癌的治疗效果。方法 建立兔VX2乳腺癌模型,肿瘤兔随机分成两组,超声微泡组及单纯超声组,各组于治疗前及治疗后分别行超声造影,分析造影前后肿瘤灌注情况。结果 超声微泡组治疗前后造影灰阶值改变明显,造影灰阶值从治疗前的(20.26±2.59)降至(3.71±1.61)(P<0.01);而单纯超声组肿瘤造影灰阶值无明显统计学差异(P>0.05)。结论 微泡增强的超声空化对荷瘤兔乳腺癌有一定的治疗效果。

Objective To investigate the treatment effect of microbubbles-enhanced ultrasound cavitation on VX2 breast tumor in rabbits. Methods The rabbit model of VX2 breast tumor were established. The rabbits were randomly divided into two groups, microbubbles-enhanced ultrasound (US+MBs) group and standard ultrasound (US) group. The VX2 breast tumor perfusion were imaged and assessed using contrast enhanced ultrasonography (CUES) before and after treatment. Results The contrast enhanced grayscale value (GSV) of VX2 breast tumors decreased significantly in the US+MBs group, from 20.26±0.59(before treatment) to 3.71±.761 (after treatment)(P<0.01). While there was no significance of GSV before and after treatment (P>0.05) in the US group. Conclusion Microbubble-enhancement ultrasound cavitation has a certain therapeutic effect on the VX2 breast tumor in rabbits.

目的 研究超声内镜(EUS)对结直肠癌(CRC)术前分期和指导手术方案的应用价值。方法 选取我院2014年11月—2015年11月结直肠外科收治的52例CRC患者,均接受根治性切除术治疗并经术中病理观察确诊,并以手术病理TNM分期结果作为金标准。术前对入选患者行超声内镜检查,参考金标准回顾性分析超声内镜的TNM分期诊断效果。结果 该52例CRC患者EUS诊断结果显示肿瘤侵犯浸润T分期(T1～T4)准确率分别为87.50%、80.00%、94.12%、83.33%,较手术病理金标准无差异(P>0.05);EUS诊断淋巴结转移N分期(N0～N2)准确率分别为76.92%、79.17%、86.67%,其中N0、N2准确率较金标准无差异(P>0.05),但N1分期准确率较金标准偏低(P<0.05)。结论 虽然ENS对淋巴结转移程度尤其是N1的诊断准确度存在一定误差,但从整体来看EUS能较好的观察CRC患者肿瘤侵犯浸润深度和判断淋巴结转移情况,术前结合EUS诊断结果有利于患者术前病理分期,并为选择合适的手术方案提供参考依据。

Objective To study the application value of endoscopic ultrasonography (EUS) in preoperative staging of colorectal cancer (CRC) and guidance of surgical procedures. Methods 52 cases of patients with CRC who were admitted in the department of colorectal surgery of our hospital from November 2014 and November 2015 were selected. All of them underwent radical resection and were confirmed by surgical and pathological observation. Surgical and pathological TNM staging results were taken as golden standard. Before surgery, endoscopic ultrasonography was performed in the selected patients. Referring to the gold standard, TNM staging diagnostic effects of endoscopic ultrasonography were retrospectively analyzed. Results The EUS diagnostic results of 52 patients with CRC showed that the accuracy rates of tumor invasion T stage (T1-T4) were 87.50%, 80.00%, 94.12% and 83.33% respectively. There was no significant difference, compared with surgical and pathological golden standard (P>0.05); The accuracy rates of EUS in diagnosis of lymph node metastasis N stage (N0-N2) were 76.92%, 79.17% and 86.67%, respectively. There was no significant difference in accuracy rate in N0 and N2, compared with the gold standard (P>0.05), but the accuracy in N1 stage was lower than that of gold standard (P<0.05). Conclusion Although ENS has some errors in the diagnosis of degree of lymph node metastasis, especially N1, on the whole, EUS can be better to observe the depth of tumor invasion and lymph node metastasis in patients with CRC. The diagnosis combining with EUS before surgery is helpful to the preoperative pathological staging, and provide reference for the selection of appropriate surgical procedures.

目的 探讨健康成人颈段气管的体外高频超声影像特点,为开展体外超声在检测颈段气管病变应用作前期研究。方法 应用体外高频超声观察120例健康成人颈段气管结构的声像表现,并对气管环T1-T4的内外横径、气管环厚度、相邻气管环间距进行测量和统计学分析。结果 120例志愿者均获得了颈段气管前、侧壁声像图,以及气管环T1-T4内外横径、气管环厚度、相邻气管环间距测值。结论 体外高频超声可以清晰显示气管形态和细微支撑结构,并进行部分径线测量,有望成为评估颈段气管病变的一种有价值的辅助手段。

Objective We investigated features of the healthy adult cervical tracheas in order to studying cervical tracheal lesions by extracorporeal high-frequency ultrasound EHFUS. Methods EHFUS examination of the trachea was performed in 120 asymptomatic adult volunteers. We observed imaging features of the healthy adult cervical tracheas, and measured TRID, TRED, TRTh and TRAS to analysis. Results The cervical tracheal anterior and side wall ultrasonograms, and measurements were obtained in all subjects. Conclusion The cervical tracheal shape and the fine structure of support can be seen in EHFUS, and partly of diameter measurements were obtained. Thus EHFUS may be a valuable assistant method to assess cervical tracheal lesions of support structure.

目的 探讨微泡增强的超声空化增加睾丸组织的药物浓度的可行性。方法 18只雄性8月龄性成熟新西兰兔随机分为空白对照组(C)、单纯微泡组(MB)、治疗超声组(TUS)、超声联合微泡辐照组(MEUS)4组,每组各9个。MB组给予静注微泡造影剂 0.1 mL/kg ;TUS组给予超声辐照5min;MEUS组给予静注微泡造影剂0.1 mL/kg的同时超声辐照5min;每组在治疗前5min均经耳缘静脉注射2%伊文思蓝(EB)2.5 mL/kg;治疗后1 h取各组睾丸组织制备组织匀浆测量 EB 浓度。结果 MEUS组兔睾丸组织内 EB 浓度高于其他各组(P<0.05),差异有统计学意义。结论 微泡增强的超声空化可以明显提高睾丸组织内EB浓度。

Objective To investigate feasibility of microbubbles enhanced ultrasound (MEUS) on the concentration of Evans blue (EB) in rabbit,stestis. Methods Eighteen sexually mature male New Zealand rabbits were divided into four groups randomly. Pulsed ultrasound irradiation and intravenous microbubbles injection were both applied in the microbubbles enhanced ultrasound group (MEUS), pulsed ultrasound irradiation and intravenous microbubbles injection were individually applied in the therapeutic ultrasound group (TUS) and the simple microbubbles group (MB). Injection of EB was applied in each group five minutes before the treatment.Concentration of EB in testis tissue was measured homogenated. Results The concentration of Evans blue(EB) in rabbit's testis in MEUS group was statistically higher than the other groups (P<0.05). Conclusion Microbubbles enhanced ultrasound (MEUS) can increase the concentration of Evans blue (EB) in rabbit's testis.

目的 初步探讨微泡增强的脉冲式超声治疗脾创伤出血的作用机制。方法 14只健康家犬随机分为3组,超声微泡组(MEUS组)6只、单纯超声组(TUS组)4只、单纯微泡组(MB组)4只。开腹切割脾建立脾破裂出血模型,MEUS组用脉冲式超声治疗仪辐照伤口,同时静脉匀速推注微泡;TUS组超声治疗时静脉推注生理盐水;MB组超声治疗仪假照的同时静脉推注微泡。治疗完毕,进行超声造影评价,并送病理组织学检查。结果 MEUS组造影示靶区造影增强缺损或者低灌注,但较粗大血管仍为增强显影。病理组织学见脾窦、微小血管扩张充血、血管周围组织水肿,血小板聚集,微小血管血栓形成。结论 微小血管血栓形成、微血管淤血扩张、周围组织水肿压迫是超声联合微泡治疗脾创伤出血的可能机理。

Objective To investigate the mechanism of haemostatic effect induced by microbubble(MB)enhanced therapeutic ultrasound(TUS)on splenic trauma. Methods 14 healthy dogs were divided into 3 groups.Six animals were treated by microbubble-enhanced therapeutic ultrasound(MEUS),the other eight animals were treated with TUS only group(n=4)and the MB only(n=4)served as the controls.The spleens of all animals were surgically exposed and a 20 mm long,5 mm deep incision was created on the spleens using scalpel.Contrast enhanced ultrasound(CEUS)was performed to assess the blocking effects of splenic circulation.The targeted spleens were harvested for pathological examination. Results A non-enhanced or perfusion defect region was formed within the treated area.The histological results showed splenic sinus hyperemia,microvascular hyperemia,perivascular tissue edema,platelet aggregation and intravascular thrombosis. Conclusion The mechanism of haemostatic effect on splenic trauma by microbubble enhanced ultrasound maybe intravascular thrombosis,microvascular hyperemia and perivascular tissue edema oppression simultaneously.