彩色多普勒血流显像对恶性滋养细胞肿瘤的诊断

Diagnosis of malignant trophoblastic tumor with color Doppler ultrasonography

目的探讨彩色多普勒超声对恶性滋养细胞肿瘤（ＭＴＴ）的诊断价值。方法对３５例患者子宫作二维超声及彩色多普勒血流显像（ＣＤＦＩ）观察，并用ＰＤ取样法分析测量病变区血流速度及阻力指数（ＲＩ）的改变。结果二维超声将ＭＴＴ分为三型：弥漫型、局灶型、结节型。ＣＤＦＩ表现为病变区五彩镶嵌的丰富的低阻力血流频谱，ＲＩ＝０．４４±０．０５。动态观察化疗过程中β－ｈＣＧ的下降和ＲＩ的升高呈负相关（ｒ＝－０．５７，Ｐ＝０．０００１）。动－静脉瘘的存在与化疗效果亦呈负相关（ｒ＝－０．６０，Ｐ＝０．００４４）。结论①ＣＤＦＩ对ＭＴＴ有明确的诊断价值；②ＣＤＦＩ对ＭＴＴ化疗效果的观察及预后有指导意义；③ＣＤＦＩ与β－ｈＣＧ相结合是诊断ＭＴＴ更有效的方法。

Objective\ To evaluate the diagnostic value of color Doppler ultrasonography in malignant trophoblastic tumor(MTT). Methods\ The two dimensional ultrasonography and color Doppler flow imaging(CDFI) in the uteri of 35 patients were observed, and the changes of blood flow velocity and its resistance index by pulse Doppler were measured. Results\ MTT could be divided into three types by two dimensional ultrasonography as diffused type, focal and nodular type. In CDFI, a colorful and rich low resistance flow spectrum were observed in the tumour area (RI=0.44±0.05). In the dynamic observation during chemotherapy, a negtive correlation was found between the decrease of β hCG and the increase of RI (r= -0.57 , P=0.0001). The existence of arteriovenous fistula also had a negtive correlation with the chemotherapeutic effect (r=-0.60, P=0.0044). Conclusions\ ①CDFI had clear diagnostic value to MTT. ②CDFI could be looked as a guide for observing the chemotherapeutic effect and prognosis of MTT. ③The combination of CDFI and β hCG is a more effective method to the diagnosis of MTT.