小儿盆腔及泌尿生殖系横纹肌肉瘤的超声诊断

Ultrasound Diagnosis of Children's Rhabdomyosarcoma in the Genitourinary and Pelvic Cavity

目的:探讨小儿盆腔及泌尿生殖系横纹肌肉瘤(RMS)的超声表现及其诊断价值。方法:回顾性分析36例经手术及病理证实的原发于盆腔及泌尿系RMS的临床及超声资料。患儿采取相应憋尿的形式经腹探查。结果:36例患者主要临床表现为尿频、排尿困难、血尿、排便困难、腹部疼痛或发现包块、阴道或尿道口脱出肿物。膀胱RMS14例,多发生于膀胱颈三角区呈形态不规则的菜花状的实性低回声块。盆腔RMS12例起自盆腔,为实性不均匀的低回声包块,形态不规则,边界清晰,常包绕或与盆腔大血管关系密切,并可发生早期转移。前列腺RMS7例,为前列腺区的较大的不均匀的实性低回声肿物,将膀胱顶起位置抬高,环绕尿道,内伴有不同程度的坏死无回声区。阴道RMS2例表现为阴道处实性低回声块,子宫有不同程度的受累。尿道RMS1例示尿道内实性低回声块,致尿路梗阻。结论:超声能够明确小儿横纹肌肉瘤的位置、起源、形态、内部结构以及与周围组织的关系,揭示继发的上尿路病变,且无创伤无射线伤害。

Objective： To discuss the ultrasound images of genitourinary and pelvic cavity rhabdomyosarcoma （RMS） in children,and the value of diagnosis. Methods：Thirty-six cases of primary RMS in pelvic cavity and genitourinary system which were proven surgically and pathologically were retrospectively analyzed from 1999 in Beijing Children＇s Hospital. All patients should be overfilled of the bladder. Results：There were 26 males and 10 females with aged ranging from 6 months to 10 years old （mean 4.1 years）. The main clinical manifestations included frequent micturition, dysuria, hematuria, abdominal pain,finding mass or the mass emerged from urethra or vagina. Fourteen cases of bladder RMS showed the irregular and solid, hypoechoic mass just like cauliflower at triangle area in bladder. And the bladder RMS made dysuria easily. Twelve cases of pelvic RMS not only had clear rim, irregular and solid, non-homogeneous, hypoechoic mass, but related with the adjacent blood vessels. Seven cases of prostate RMS manifested as solid,non-homogeneous and hypoechoic mass oppressing the neck of bladder that was raised, and the mass surrounded the urethra. Some non-echoic area with necrosis was shown in the mass. Two cases of vaginal RMS represented solid and hypoechoic mass in vagina and the uterus was infiltrated to varying degrees. Solid and hypoechoic mass in urethra made obstruction of urologic system in one case of urethra RMS. Conclusion： Ultrasound examination can understand many informations about the RMS in children,including the position, origin, shape, structure and the relationship with other organs;It can also realize the secondary changes in the upper urologic system without any invasion and radiation.