小儿肝母细胞瘤的超声表现与手术病理对照分析

Infantile hepatoblastoma:Comparative analysis of ultrasonographic and surgical pathologic manifestations

目的与手术及病理所见对照,探讨彩色多普勒超声对小儿肝母细胞瘤的诊断价值。方法收集8例经手术病理证实为肝母细胞瘤、且具有完整的临床及超声检查资料的患儿,对肿瘤的超声表现与手术及病理所见进行回顾性对照分析。应用SPSS 11.5统计学软件,对超声所测与术中实测的肿瘤体积进行配对样本均数t检验,对超声所见与术中及病理所见的一致性进行Kappa检验。结果超声检查除将1例发生于肝左叶的肿瘤误诊为累及左、右两叶外,其余7例定位诊断均与术中所见相符。超声与术中所测肿瘤体积差异无统计学意义(t=-0.765,P=0.470)。超声检查对肿瘤形态的显示与术中所见具有一致性(K=1.00,P=0.005);6例巨块状及2例结节状肿瘤经超声检查均诊断正确。超声检查对肿瘤内钙化或骨化(K=0.75,P=0.028)及囊变(K=0.71,P=0.035)的显示与病理观察具有一致性;5例肿瘤内钙化或骨化超声正确诊断4例,3例肿瘤内囊变超声正确诊断2例。超声检查对肿瘤边界情况、包膜完整性及肿瘤内坏死的显示与手术及病理所见无一致性(K=0.60、-0.23、-0.26,P均>0.05)。结论超声检查可较为准确地对小儿肝母细胞瘤进行定位,且在显示肿瘤形态和肿瘤内钙化或骨化及囊变方面具有优势,有助于制定肿瘤治疗方案及疗效评价。

Objective To investigate the diagnostic value of color Doppler ultrasonography in infantile hepatoblastoma compared with the findings of surgery and pathological examination.Methods Totally 8 infants with pathologically confirmed hepatoblastoma were enrolled in this study.The clinical and ultrasonic data of all the cases were complete.The ultrasonographic findings of hepatoblastoma were comparatively analyzed with those observed of surgery and pathology.The statistic analysis was performed using SPSS 11.0 software.The tumor volumes obtained with ultrasonography and surgery were compared with the paired-temple t test,and the consistency of the tumor characteristics observed with ultrasonography,surgery and pathology were analyzed with Kappa test.Results Comparing with surgery,7 tumors were accurately located with ultrasonography,while 1 single lesion in the left lobe of liver was misdiagnosed as multiple lesions involving the left and right lobes.No statistical difference was found between the tumor volume obtained with ultrasonography and surgery（t=-0.765,P=0.470）.The tumor morphology of ultrasonography had consistency with that of surgery（K=1.00,P=0.005）.All 6 cases of massive tumor and 2 cases of nodular tumor were diagnosed correctly with ultrasonography.There was consistency of calcification or ossification（K=0.75,P=0.028） and cyst（K=0.71,P=0.035） in tumors between ultrasonography and pathology.Four of 5 cases with calcification or ossification as well as 2 of 3 cases with cyst were diagnosed correctly with ultrasonography.There was no consistency in displaying the boundary,capsule and necrosis in tumors between ultrasonography,surgery and pathology（K=0.60,-0.23,-0.26,all P〉0.05）.Conclusion Ultrasonography is an effective method for illustrating the localization and the shape of hepatoblstoma,as well as the calcification or ossification and cyst in tumors.It would be helpful in determining the strategy of treatment and evaluating the prognosis of patients with hepatoblstoma.