喉癌的彩色多普勒高频超声与纤维喉镜及病理的对比研究

Compare Study of Laryngeal Carcinoma Color Doppler Ultrasonography and Its Fibrolaryngoscope and Post Operation Pathology

目的评价彩色多普勒超声对喉癌的诊断价值。方法将探头置于颈部舌骨水平、甲状软骨、环状软骨处行纵切及横切扫查，探头应避开喉结，声束从侧方向对侧扫描，观察喉部解剖结构是否清晰，观察双侧声带活动度及声带中间气体强回声带有无偏移，观察肿瘤大小、形态、内部回声、边界及浸润范围，周围有无淋巴结转移，有无向双侧甲状腺转移，肿瘤与颈部血管的关系，血管有无受压及侵犯。进行分型及分期，并与纤维喉镜及手术病理对照，结果72例喉癌病理诊断全部为鳞状细胞癌，超声诊断喉癌向肌肉深层浸润48例（66．7％），浸润至软骨16例（22．2％）；其中肿瘤向左侧颈总动脉浸润3例，右侧颈总动脉浸润2例，颈部淋巴结转移52例（72．2％）；彩色多普勒血流显像（CDFI）示肿瘤周边及内部短粗的杵状血流信号，肿瘤内见穿通血流信号，CDFI血流显示率为（86．1％），脉冲多普勒（PW）显示动脉频谱，其收缩峰速度为（22．6±0．55）cm／s，阻力指数（RI）为0．58±0．06；超声对喉癌各期分期的；隹确性分别为：T1 77．8％，T2 94．2％，T3～T4 100％；分型符合率为100％．结论彩色多普勒高频超声能清晰显示喉癌的结构、周围组织的浸润范围、深度，进行分期，对手术方式和治疗方案的制定提供参考依据；能早期准确地发现喉癌淋巴结转移，对喉癌颈部淋巴结的清扫及预后有较高的意义。

Objective To evaluate the value of Color Doppler Ultrasonography in the diagnosis of laryngeal carcinoma. Methods Seventy-two cases of laryngeal carcinoma were typed and staged by Color Doppler Ultrasonography and compared with the finding of laryngoscopy and postoperative pathology. Results All 72 cases were squamous carcinoma proved by postoperative pathology. According to the Color Doppler Ultrasonography,there were 48 cases （66.7%） deep muscle infiltration, 16 cases （22.2%） cartilage infiltration, 5 cases common carotid artery infiltration,52 cases （72.2%） cervical lymph nody metastasis. The tumor CDFI was 86.1%. The artery spectra in PW showed systolic peak was （22.6 ±0.55 ） cm/s,the RI was 0.58 ±0.06. The typing accurate rate of Color Doppler Ultrasonography to laryngeal carcinoma was 100%. The staging accurate rate of Color Doppler Ultrasonography to laryngeal carcinoma was T1 77. 8% ,T2 94.2% ,T3 - T4 100% respectively. Color Doppler flow imaging showed irregular signals of blood stream were in the interior and the circumference of the tumor and signals of perforating blood stream were in the interior of the tumor. Artery flow spectrum was showed by Pulse wave Doppler. Conclusion Color Doppler Ultrasonography can apparently improve the accuracy of staging and infiltration of laryngeal carcinoma and is quite import to its clinical therapy.