腹膜假性黏液瘤的声像图特征及超声诊断价值

The ultrasonography and the diagnostic value of pseudomyxoma peritonei

目的探讨腹膜假性黏液瘤(PMP)的声像图表现。方法对11例PMP患者的临床、病理及声像图表现进行回顾性分析,观察低频与高频探头扫查的声像图特征及腹水特征,确定病灶形态、部位和范围及彩色血流情况;观察腹壁、病灶内部结构及其与毗邻脏器的关系,并行超声分型。结果 11例PMP中10例术前超声诊断基本符合或对临床诊断有提示作用,误诊1例,9例出现明显腹水。超声分型表现:以蜂窝状增厚型表现为主3例,分隔多房型表现为主4例,以实块型表现为主3例,3型间有交叉表现;2例表现为全腹病变,4例显示原发灶。11例均未显示血流;高频显示病灶内呈囊泡状表现且对周围脏器有特征性压迹。结论 PMP超声声像图表现有一定特异性:PMP的腹水流动性差,病灶内部多呈囊泡状或可见分隔,典型的病例还可见到絮状或蜂窝样网膜组织包裹腹腔脏器,超声诊断不困难,诊断符合率较高。可作为临床明确诊断的有效检查方法。对于影像学诊断有一定困难的病例,可进行超声引导下穿刺活检以明确诊断。

Objective The ultrasonic appearance on pseudomyxoma peritonei was retrospectively reviewcd in order to improve the ultrasonic diagnosis and differential diagnosis of PMP. Methods A total of ten cases with PMP which were diagnosed by pathology in my hospital during 1998 -2009 were retrospectively analysed. M1 cases were diagnosed by both low and high frequency ultrasound to identify the sharp, location and extent of the diseased region and the status of color blood flow. The characteristics of abdominal wall, internal structure, ascetic fluid and the relation of adjoining organs were reviewed by high frequency ultrasound. Results Ten of eleven cases by ultrasound were consistent with those by clinic diagnosis and only one case was misdiagnosed. The uhrasonography showed cluster of the cystic echo, thin-walled in inequality of size and solid mass and each appearance was overlapped. Two cases extended all over the abdomen and the primary lesion were found in 4 cases. No flowing was found. The surrounding of liver, spleen, uterus were full of liquid with jagged edges. Conclusions The ultrasonographic examination of PMP demonstrated the characteristic appearance with accuracy. The non-mobile echogenic ascites, homogeneous tumour deposites and splits, scalloping of liver and spleen due to adjacent peritoneal implants, thus the sonographic examination could be used for clinical diagnosis. The ultrasound-guided needle aspiration biopsy can identify the cases which were difficult to distribute.