二维及彩色多普勒超声在颌面部间隙感染诊断中应用价值的探讨

Application of two dimensional and color Doppler ultrasound in diagnosis of the maxillofacial space infection

目的:探讨二维及彩色多普勒超声在颌面部间隙感染诊断及鉴别诊断中的应用价值。方法:回顾性分析90例间隙感染及肿瘤的超声表现,并对误诊及漏诊的病例进行分析,以提高超声诊断的准确率。结果:90例中,87例间隙感染53例有脓腔形成,全部经手术切开引流及穿刺证实;2例为非霍奇金淋巴瘤,1例为鳃裂囊肿伴感染。超声表现:①间隙感染回声较肿瘤回声强,95%(83/87)的间隙感染为暗淡/中等光点,而肿瘤2例回声均为无明显光点;②肿瘤周围组织一般不肿胀,回声正常;而间隙感染与周围组织无明显边界,软组织肿胀明显;③间隙感染病变区血流少占87%(76/87),肿瘤内血流均较多;④抗炎治疗后复诊,病变区会明显缩小,血流也会减少,回声增强;肿瘤患者抗炎治疗后均无改变。结论:二维及彩色多普勒超声诊断间隙感染符合率高达92.2%,对于颌面部间隙感染与肿瘤伴感染的鉴别诊断有一定价值,检查费用低,可以作为临床首选检查。

Objective： To evaluate the application of two-dimension and color Doppler ultrasound in diagnosis and differential diagnosis of fascial space infection in maxillofacial region.Methods： Retrospective analysis was conducted on 87 cases of maxillofacial space infections,among which there were 6 suspected cases of accompanying tumor.Results：In the 87 cases,53 had abscess formation,confirmed by operative drainage or puncture biopsy.The pathological studies revealed 2 cases of Non-Hodgkin＇s lymphoma,and 1 case of branchial cleft cyst accompanied with infection.The 3 cases showed characteristic appearance in ultrasonic imaging.The space infection presented stronger echogenicity than that in tumors.In this study,95%（83/87） cases showed grey or medium echogenic dots,while 4.5%（4/87） cases did not show obvious echogenic dots due to a large amount of abscess,and 2 cases of tumors,however,did not show any echogenic dots.In addition,87%（76/87） cases had few blood flow in the lesion areas,and 22%（2/87） cases had much blood flow in the lesion areas.All cases showed that the lesion areas and the blood flow reduced obviously with enhanced echo following anti-inflammatory treatment except 2 cases accompanied with tumor without obvious changes in lesion areas and blood flow.Conclusion： The ultrasonic diagnosis with two dimension and color Doppler ultrasound has high accuracy in diagnosis of maxillofacial space infection,with accordance rate up to 96.6%,much higer than CT/MRI.It is suggested that the two dimension and color Doppler ultrasound can be used as a prior choice of diagnosis.