胆囊腺肌增生症的超声漏误诊分析(附23例报告)

Ultrasonic misdognosis of gallblader adenomyomatosis: report of 23 cases

目的总结胆囊腺肌增生症的超声特点 ,分析漏、误诊原因 ,提高诊断准确率。方法对 2 3例经手术病理证实的胆囊腺肌增生症 ,术前均行超声检查 ,其中 17例加做彩色多普勒超声检查 ,探头频率 3 5～ 5 0MHZ ,13例第 2天予脂餐试验后进行超声对比扫描。结果 2 3例中胆囊呈弥漫型增生 9例 ,节段型增生 2例 ,局限型增生 12例。术前诊断为胆囊腺肌增生症 8例 ,漏诊 3例 ,误诊 12例。超声表现为胆囊壁弥漫或局限性增厚 ,增厚的囊壁内见小圆形无回声区 ,部分可见强回声光点伴彗星尾征。脂餐试验示胆囊收缩功能亢进。结论胆囊腺肌增生症合并胆囊炎、胆结石致胆囊无收缩排空功能 ,脂餐试验超声图像无特有的胆囊亢进征象是超声误诊的主要原因。熟悉胆囊腺肌增生症的超声特点、临床症状 ,可减少该病的漏误诊 。

Objective To summarize the ultrasonographic features of gallblader adenomyomatosis,to analyze the causes for missed and mistaken diagnosis and to improve diagnostic accuracy. Methods 23 patients with adenomyomatosis of gallbladder confirmed with pathology undertook ultrasound examination before surgical management.17 of them received color Doppler ultrasonic examination with frequency 3.5 to 5.0 MHZ.13 cases had high fat meal the nex tday and comparision was made afterwards. Results Of these 23 cases,8 were diagnosed with diffuse adenomyomatosis;2 cases with segmental type;12 with localizedly thickened wall of gallblandder were demonstrated with small round echoless areas within the wall or with stronger echo spots plus cometal tail sign.Fat meal revealed a increased contractibility of gallbladder. Conclusions When gallblader adenomyomatosis was complicated with cholecystitis and cholelithiasis,non-functioning contractibility of gallbladder was brought about.Therefore,no sign of unique increased contractibility was found on ultrasonography after fat meal test.This was considered as the major casuse for the misdiagnosis.It was of significance to be fimiliar with the ultrasonic and clinical features of gallblader adenomyomatosis so as to reduce the misdiagnosis and to improve the prognosis and therapeutic response.