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Value of Color Doppler Ultrasonography in Diagnosing Superficial Soft Tissue Masses

【摘要】　目的　探讨高频彩色多普勒超声对浅表软组织肿物的诊断价值。　方法　回顾性分析2008年1-11月70例经手术、活检病理证实的浅表软组织肿物的声像图特征，包括肿物的部位、形态大小、内部回声、边界及其与周边组织的关系、长径与厚度比值（L/T）及病变周边与内部血流分布情况。　结果　超声对浅表肿块病灶的显示率为100%，良性肿瘤有脂肪瘤、表皮囊肿、滑膜囊肿、神经鞘瘤，血管瘤、异物肉芽肿等，恶性肿物包括皮肤纤维肉瘤，转移性腺癌。　结论　彩色多普勒超声对浅表肿块的检出、定位及物理性质可做出准确的诊断，综合分析肿物的边界、形态、内部回声及血流分布等特点对肿物的良恶性诊断具有重要价值。【Abstract】　Objective　To evaluate the value of high-frequency color Doppler ultrasonography in diagnosing the superficial soft tissue masses.　Methods　The clinical data of 70 patients with superficial soft tissue masses from January to November 2008 were retrospectively analyzed. Superficial soft tissue masses was diagnosed by the surgery and biopsy. The sonographic features, including the location, morphology, size, internal echo, boundary, relationship with peripheral tissues, longitude to transverse ratio (L/T), and the vascularity, were observed.　Results　The results of sonographic examination showed that 100% superficial masses could be found. Benign masses included lipoma, sebaceous cysts, synovial cysts, nerve sheath tumors, haemangioma, foreign body granulomas, etc. Malignant soft tissue tumors included fibrous sarcoma and metastatic neoplasms.　Conclusion　Color Doppler ultrasonography can precisely diagnose the presence, localization and the physical characters of superficial soft tissue masses. It is an excellent modality to diagnose the benign or malignant masses by analyzing the boundary, configuration, internal echo and vascularity of the masses.

Application on The Approach of Transecting Anterior Cervical Muscle Group at Sternal End for Removal of Bilat-eral Huge Thyroid Neoplasm

Objective　To explore the advantage of transection the cervical muscles at sternal end and flip fixed in therapeutic bilateral huge thyroid surgery. Methods　The transection of the cervical muscles at sternal end and flip fixed in 53 cases was observation group， 44 cases of the neck white line incision thyroid surgery completed for the control group. The completion of the surgery by the same group of physicians. The operative time， operation field of exposing effect， amount of bleeding in operation， postoperative complications， and postoperative drainage volume were compared between two groups. Results　There was no statistically differences of sex， age， disease composition， and tumor size between two groups （P＞0.05）. Operative time， amount of bleeding， and postoperative drainage volume in observation group were shorter （less） than that in control group （P＜0.01）. The postoperative complication rate in observation group was lower than that in control group（P=0.04）. Surgical field exposure in observation group was better than that in control group （P＜0.01）. Conclusions　The huge bilateral thyroid surgery with the sternal end approach is feasible and simple. The operation field exposure is better than the white line neck incision， complications after operation is less. It is worthy of clinical application.

电视纵隔镜手术诊治胸部疾病36例

目的 探讨电视纵隔镜检查术( videomediastinoscopy, VM)在肺癌术前分期、纵隔疾病诊断中的价值。方法 自2006年2月至2007年4月，我们采用电视纵隔镜对36例拟诊为肺癌、纵隔肿物患者进行检查，33例经颈部行纵隔镜术，采用全身麻醉单腔气管内插管；3例经肋间行纵隔镜术，采用全身麻醉双腔气管内插管。 结果 除术前纤维支气管镜检查确诊4例外，余30例均经电视纵隔镜术检查后确诊；2例诊断不明或可能误诊，其中1例转院失访，另1例经开胸活检证实为肺大B细胞淋巴瘤。平均手术时间55min，平均出血量40ml，术后无死亡患者，无切口感染；发生并发症2例，1例出血，经止血纱布填压止血；1例喉返神经麻痹，经中医针灸治疗后好转。 结论 电视纵隔镜术是肺癌术前病理分期、纵隔疾病的重要检查方法，具有诊断准确率高、安全可靠等优点。

电视纵隔镜术诊治胸部疾病76例

目的探讨电视纵隔镜检查在肺癌的术前分期、纵隔肿物、恶性胸腔积液诊治中的应用。方法76例患者中行颈部纵隔镜术38例，胸骨旁纵隔镜术16例，经肋间纵隔镜术22例。结果经纵隔镜检查确诊为腺癌21例，转移性低分化鳞癌18例，结核6例，胸腺鳞状细胞癌5例，非何杰金淋巴瘤5例，肺小细胞癌4例，胸腺瘤3例，纵隔神经母细胞熘3例，何杰金淋巴瘤2例，胸膜问皮瘤2例，神经鞘瘤1例，胸腺增生1例，原始神经外胚叶肿瘤1例，淋巴结炎症1例，反应性增生1例。2例术前纤维支气管镜病理诊断为左肺下叶鳞癌，经电视纵隔镜检查确诊为右气管旁淋巴结转移。结论电视纵隔镜术不但是肺癌术前病理分期的重要检查方法，还可作为纵隔疾病和恶性胸腔积液诊治的方法之一。

增强型血流显像联合超声引导下穿刺活检技术在乳腺肿物诊断中的价值

【摘要】　目的　总结增强型血流显像（e-flow）联合超声引导下粗针穿刺活检技术在乳腺肿物诊断中的价值。　方法　将2008年1月-2009年12月住院的100例乳腺肿物患者随机分成两组，第1组50例，应用e-flow技术检测，联合超声引导下粗针穿刺活检技术，对乳腺肿物患者穿刺取材送病理检查；第2组50例，在超声引导下，对乳腺肿物患者直接行粗针穿刺取材送病理检查，并将两组穿刺结果与手术后病理结果进行对比分析。　结果　第1组50例穿刺病理检查结果均与术后病理检查结果符合，其中恶性48例，良性2例；第2组50例中46例与术后病理检查结果符合，其中恶性45例，诊断敏感性91.8%，良性1例，假阴性4例。　结论　e-flow联合超声引导下粗针穿刺活检技术在乳腺肿物诊断中具有定位准确、实时监测、可靠性高、创伤小、操作简单等优点，可用作乳腺肿物定性诊断的主要方法。

Effects of Mammary Tumor Surface Positioning Membrane on Results of Mammary Gland Ultrasound Examination

目的　探讨乳房肿物体表定位膜对乳腺彩超结果的影响。方法　回顾性分析2010年12月至2011年1月期间，笔者所在医院乳腺门诊检查触诊阴性的180例患者共236个乳房肿物贴膜前后的彩超检查结果，分析其血运、边界、钙化及分级情况的变化。结果　贴膜后，236个肿物中有2个血运情况有变化，7个边界有变化，5个钙化情况有变化，5个分级有变化，但贴膜前后乳房肿物的血运（P=0.500）、边界（P=0.136）、钙化（P=0.082）及分级（P=0.172）变化情况比较差异均无统计学意义。结论　乳房肿物体表定位膜不影响乳房肿物的彩超检查结果。

腹股沟区良性转移性平滑肌瘤一例

Clinical Efficacy of Recurrent Laryngeal Nerve Monitoring in Video-Assisted Thyroidectomy for Huge Thyroid Nodules

ObjectiveTo investigate effect of recurrent laryngeal nerve monitoring in video-assisted thyroidectomy for huge thyroid nodules. MethodsThe clinical data of 158 patients with huge thyroid nodules underwent videoassisted thyroidectomy from January 2013 to June 2015 were analyzed retrospectively, the recurrent laryngeal nerves were monitored in 79 cases (monitoring of recurrent laryngeal nerve group) while the recurrent laryngeal nerves were not monitored in the other patients (non-monitoring of recurrent laryngeal nerve group). The operative time, blood loss, postoperative drainage, postoperative hospital stay, and the incidences of transient and permanent recurrent laryngeal nerve injury were observed between these two groups. ResultsThe video-assisted miniincision thyroidectomy was successfully completed in these 158 cases. Compared with the non-monitoring of recurrent laryngeal nerve group, the operative time (min) was shorter (76.2±23.4 versus 89.2±29.8, P < 0.05), the blood loss and the postoperative drainage were less (16.3±13.6 versus 20.6±10.7, P < 0.05; 20.7±9.6 versus 25.5±9.1, P < 0.05) in the monitoring of recurrent laryngeal nerve group. But the postoperative hospital stay (d) had no significant difference between the monitoring of recurrent laryngeal nerve group and the non-monitoring of recurrent laryngeal nerve group (3.2±1.3 versus 3.3±1.9, P > 0.05). Eight weeks later, the incidence of transient recurrent laryngeal nerve injury in the monitoring of recurrent laryngeal nerve group was significantly lower than that in the non-monitoring of recurrent laryngeal nerve group [5.6% (5/90) versus 21.8% (17/78), P < 0.05], while the incidence of permanent nerve injury had no statistical difference between the monitoring of recurrent laryngeal nerve group and the non-monitoring of recurrent laryngeal nerve group [0(0/90) versus 1.3% (1/78), P > 0.05]. ConclusionRecurrent laryngeal nerve monitoring under video-assisted thyroidectomy for huge thyroid nodules could effectively reduce incidence of nerve injury and shorten operation time.

ARTHROSCOPIC RESECTION OF BENIGN TUMOR IN THE KNEE POSTERIOR SEPTUM

ObjectiveTo explore the technique of arthroscopic resection of benign tumor in the knee posterior septum and to evaluate its clinical results. MethodsBetween June 2008 and June 2012, 12 cases of benign tumor in the knee posterior septum were treated by arthroscopic surgery. There were 8 males and 4 females with an average age of 36.5 years (range, 22-50 years). The average disease duration was 8.4 months (range, 3 months to 2 years). Of 12 cases, there were 2 cases of chronic synovitis, 5 cases of ganglion, 4 cases of tenosynovial giant cell tumor, and 1 case of synovial hemangioma; solitary tumor involved in the knee posterior septum in 10 cases, and in the posterior septum and other part of the knee in 2 cases. All the patients underwent tumor removal under arthroscope with routine anterolateral and anteromedial portal, additional posteromedial portal and/or posterolateral portal. Trans-septal approach was used in 6 cases because the tumors located in the middle of the posterior septum. ResultsAll wounds healed by first intention with no complications such as infection, haematoma in the knee, injury of vessels and nerves, deep vein thrombosis, osteofascial compartment syndrome, or cutaneous necrosis. All patients were followed up 12-46 months with an average of 18.5 months. All patients achieved relief of knee pain and improvement of knee movement. The range of motion of the knee was significantly improved from (57.08±12.52)° at pre-operation to (120.83±13.95)° at last follow-up (t=-12.84, P=0.00). The visual analogue scale (VAS) score was significantly reduced from 5.00±1.04 at pre-operation to 1.50±0.91 at last follow-up (t=-18.00, P=0.00). The Lysholm score was significantly improved from 49.50±9.07 at pre-operation to 84.58±6.82 at last follow-up (t=-8.04, P=0.00). ConclusionThe benign tumor in the knee posterior septum can be completely resected under arthroscope, and the procedure is minimally invasive and useful to the restore knee function.

髓上皮瘤误诊一例