目的 探討與評價術中B超定位下經肝膽管取石在肝內膽管結石治療中的手術指征及優劣性。方法 總結2002～2006 年29例肝內膽管結石行肝葉切除+經肝膽管取石患者的臨床資料,對其手術效果及并發癥進行分析。結果 無膽管損傷及手術死亡病例, 并發癥發生率為37.93%，殘石率為10.34%。結論 術中B超定位下經肝膽管取石結合肝葉切除對肝內膽管結石是一種較好的治療方式，主要適用于Ⅱb型肝內膽管結石患者。
目的 評價B超引導下核心針活檢術（CNB）對不可觸及的乳腺病變（NPBL）的診斷價值。方法 采用18G Tru-cut針結合活檢槍對88例患者的96個NPBL行B超引導下CNB，并與切除活檢病理結果比較。結果 NPBL大小4～23mm（平均13.1mm）。在CNB中，86個為良性，2個為可疑惡性，6個為惡性，2個取材不良。在切除活檢中9個為惡性，87個為良性。CNB可疑惡變的2個NPBL均為惡性，1個惡性NPBL誤診為乳腺腺病，取材不良的2個NPBL均為良性。本組NPBL中惡性病變占9.38%（9/96），B超引導下CNB對NPBL的良惡性診斷正確率為98.94%（93/94），診斷乳腺癌的敏感性為88.89%（8/9），特異性為100%（8/8），良性病變的病理診斷符合率為97.70%（85/87），取材不良為2.08%（2/96）。結論 B超引導下CNB對NPBL的診斷具有較高的敏感性和特異性，結果準確可靠。
目的 探討膽源性肝膿腫的診治方法。方法 對我院2000~2004年期間收治并確診為膽源性肝膿腫的12例患者進行分析，在應用抗生素和全身支持的前提下，再依據其病變發生、發展的不同階段采用不同手段治療。結果 4例急性期患者中2例行急診膽道引流手術后治愈，另2例轉為亞急性期（膿腫融合期）； 6例亞急性期患者均經B超導向下行膿腫穿刺抽膿后注入抗生素治療后治愈； 4例慢性期患者行膿腫切開引流后治愈。結論 本病在應用廣譜抗生素（二聯抗生素）和全身支持治療的前提下，再根據病變不同時期采用不同方法治療，可獲得良好效果。
Ｄｕｒｉｎｇ ｔｈｅ ｐａｓｔ ５４ ｍｏｎｔｈｓ ａ ｔｏｔａｌ ｏｆ ２４ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｓｅｃｏｎｄａｒｙ ｈｅｐａｔｉｃ ｃａｒｃｉｎｏｍａ ｈａｖｅ ｂｅｅｎ ｔｒｅａｔｅｄ ｂｙ ｒｅｓｅｃｔｉｏｎ ｏｆ ｈｅｐａｔｉｃ ｍｅｔａｓｔａｓｉｓ ａｎｄ ｐｏｓｔｏｐｅｒａｔｉｏｎ ｐｅｒｃｕｔａｎｅｏｕｓ ｉｎｔｒａｈｅｐａｔｏｐｏｒｔａｌ ｃｈｅｍｏｔｈｅｒａｐｙ（ＰＨＰＣ） ｕｎｄｅｒ ｕｌｔｒａｓｏｕｎｄ ｇｕｉｄａｎｃｅ Ａ ｆｏｌｌｏｗｕｐ ｆｒｏｍ ｆｉｖｅ ｍｏｎｔｈｓ ｔｏ ｆｏｕｒ ｙｅａｒｓ ｓｈｏｗｓ ｔｈａｔ ２１ ｐａｔｉｅｎｔｓ ｈａｖｅ ｓｕｒｖｉｖｄｅ ｆｏｒ ５ ｔｏ ４８ ｍｏｎｔｈｓ ｅｘｃｅｐｔ ３ ｅｘｔｒｅｍｅｌｙ ａｄｖａｎｃｅｄ ｃａｓｅｓ． Ｔｈｅ ａｕｔｈｏｒｓ ｓｕｇｇｅｓｔ ｔｈａｔ ａ ｃｏｍｂｉｎｅｄ ｔｈｅｒａｐｅｕｔｉｃ ｍｅｔｈｏｄ ｆｏｒ ｔｒｅａｔｉｎｇ ｓｅｃｏｎｄａｒｙ ｈｅｐａｔｉｃ ｃａｒｃｉｎｏｍａ ｉｓ ｍｏｒｅ ｅｆｆｅｃｔｉｖｅ ｔｈａｎ ｅｉｔｈｅｒ ｓｉｍｐｌｅ ｈｅｐａｔｅｃｔｏｍｙ ｏｒ ｃｈｅｍｏｔｈｅｒａｐｙ．
目的:探討B超檢查對急腹癥的臨床應用價值。方法:回顧性分析326例急腹癥的超聲表現并與手術后、病理診斷以及隨訪結果進行對照。結果:326例急腹癥中以急性膽囊炎、輸尿管結石、急性闌尾炎以及婦科急癥常見,共289例,占88％,其他急腹癥37例,占12％。經手術和病理證實217例,109例臨床隨訪證實。超聲符臺率89.9％。結論:B超檢查對急腹癥的早期診斷以及鑒別診斷具有重要臨床意義,是急腹癥首選的診斷方法。
Objective To evaluate the urine cytology silver staining combined with ultrasonography（USG）in the detection of bladder transitional cell carcinoma （TCC） recurrence after transurethral resection of bladder tumor（TURBT）in terms of sensitivity and specificity. Methods Cystoscopy was used as “gold standard”. Urine cytology combined with USG or cystoscopy was measured separately and blindly. AgNORs protein stained by silver were used in cytology with Kappa of inter-observers 0.81. For the USG, the patients were scanned with trans-rectal probe with Kappa of inter-observers 0.76. The results of urine cytology combined with USG （Positive when urine cytology and/or USG positive. Negative when both urine cytology and USG negative） were compared with “gold standard”. Results The 148 consecutive superficial TCC patients with TURBT one year previously were included in this study. Fifty seven recurrenced cases were detected. Recurrence rate was 38.51%. The sensitivity and specificity of urine cytology silver stain were 89.47% （95% CI 0.82 to 0.98） and 87.91% （95% CI 0.81 to 0.95）. Area under ROC curve was 82.22%. The sensitivity and specificity of USG were 57.90% （95% CI 0.45 to 0.71 ） and 90. 11% （ 95% CI 0.84 to 0.96）. Area under ROC curve was 73.13% . The sensitivity was improved to 94. 74% （95% CI 0.89 to 1.00） when cytology combined with USG. But specificity decreased to 84. 62% （95% CI 0.77 to 0.92 ）. Area under ROC curve was improved to 98.28%. Conclusions Urine cytology silver stain combined with USG improves the high sensitivity for follow-up TCC patients after TURBT. The non-invasive protocol is suggested.
B-type ultrasound images have important applications in medical diagnosis. However, the widely spread intensity inhomogeneity, low-scale contrast, constructed defect, noise and blurred edges all make it difficult to implement automatic segmentation of lesion in the images. Based on region level set method, a subordinate degree region level set model was proposed, in which subordinate degree probability of each pixel was defined to reflect the pixel subjection grade to target and background respectively. Pixels were classified to either target or background by calculation of their subordinate degree probabilities, and edge contour was obtained by region level set iterations. In this paper, lesion segmentation is regarded as local segmentation of specific area, and the calculation is restrained to the local sphere abide by the contour, which greatly reduce the calculation complexity. Experiments on B-type ultrasound images showed improved results of the proposed method compared to those of some popular level set methods.
目的報告8例肝血管平滑肌脂肪瘤的影像學特征及病理學特點，探討其診斷與治療方法。方法對8例經手術及病理證實的肝血管平滑肌脂肪瘤的術前影像學表現（B超、CT、MRI、99mTcPMT）、手術情況及病理特點進行分析。結果B超： 腫瘤呈強回聲光團6例，低回聲光團2例； 邊界清楚7例，血供豐富、內部回聲不均勻4例，其中1例內部呈分隔網狀結構。彩色Doppler超聲示腫瘤血供豐富，均測及動脈頻譜，阻力指數為0.4～0.5。靜脈造影示腫瘤內血流信號明顯增加。CT： 平掃示腫瘤呈低密度影7例，不均勻5例，邊界清楚7例，腫瘤內見軟組織影2例，脂肪成分2例。增強掃描示動脈期明顯強化，門脈期及延遲期逐漸呈低密度。MRI: 腫瘤呈短T1、長T2信號，增強后強化明顯，脂肪抑制后短T1變成長T1。99mTcPMT示腫瘤呈放射性增強，5 min相腫塊區呈放射性缺損，2 h、5 h延遲相腫塊區未見放射性填充，肝血池相腫塊呈放射性填充。病理及免疫組化： 腫瘤由成熟的脂肪、血管及平滑肌組成，HMB45陽性。術前確診3例。結論B超示強回聲光團，CT呈低密度影中出現軟組織影、脂肪成分，增強明顯，MRI出現脂肪信號，脂肪抑制后短T1變成長T1，增強明顯。99mTcPMT示腫瘤呈放射性增強，5 min相呈放射性缺損，延遲相未見放射性填充，肝血池相呈放射性填充。這些是肝血管平滑肌脂肪瘤的影像學特點，結合病史可作出診斷。此病應盡早手術治療，行肝部分切除術。最后確診依靠病理檢查及免疫組化分析。
【摘要】目的探討成人腸套疊的臨床特點和診治原則。方法對1980年1月至2004年2月期間我院收治的167例成人腸套疊臨床資料進行回顧性分析。結果術前確診79例，占47.3%。167例中159例行手術治療，其中116例為腸道腫瘤,良性48例，惡性68例； 余51例為手術或外傷后、腸道炎癥、盲腸過長等。共有117例行腫瘤根治性切除術或相應腸段切除術，50例行單純復位或復位后固定術。2例術后死亡，余均恢復良好，134例隨訪2個月～10年，無腸套疊復發。結論提高對成人腸套疊的認識是診斷的關鍵，檢查應選用B超、CT、鋇灌腸等，治療則首選手術治療。