应用超声鉴别颈部交感及迷走神经鞘瘤

Preoperative Monographic Diagnosis of Sympathetic and Vagus Neurilemmoma in the Neck

目的：研究颈交感、迷走神经鞘瘤的彩超诊断。材料和方法：收集２２例经临床、手术及病理确诊为颈交感１６例和迷走６例神经鞘瘤，均行彩超检查。结果：其中７例仅以肿瘤本身的声像图特征为诊断依据者，其术前作出神经鞘瘤诊断的４例，神经鞘瘤可疑、占位病变或淋巴结肿大各１例。无一例能确定神经来源。另１５例以动脉、颈内静脉与肿瘤三者间的相关位置作为彩超诊断的根据：发现１１例交感神经来源者，颈总（颈内）动脉移位并紧贴于肿瘤的前方至外方，颈内静脉移位于动脉之外后方，靠近动脉或与动脉相距３０°－９０°。４例迷走神经来源者，颈总（颈内）动脉移位于肿瘤之前内至内后方，颈内静脉与动脉相反方向移位于肿瘤外侧，动静脉相距１２０°～１８０°。结论：单纯肿瘤声像图难以区分颈神经鞘瘤，利用颈内动、静脉声像图可助诊断，其中颈内动、静脉－起被推移而相互位置不变或动、静脉相距０～９０°内时提示交感神经鞘瘤，动、静脉相距１２０°～１８０°时提示迷走神经鞘瘤。

Purpose: To analyze the ultrasonographic findings of sympathetic and vagus neurilemomas in the neck. Materials and Methods: 16 sympathetic neurilemmoma and 6 vagus neurilemmoma in the neck from 1989 to 1997 which had been confirmed by clinic, operation and pathology were all examined by altrasonography. Results: 7 cases were diagnosed only by the characteristics of ultrasonographic findings. Among them only 4(57% ) nerilemmomas had been diagnosed, but its origin couldn' t be supposed. In the other 15 cases, besides the ultrasonographic findings we diagnosed them according to their relative places among carotid arteries , internal jugular vein and the mass. 11 of them were the cervical sympa- thetic neurilemmomas showing the common or/ and internal carotid artery to be pushed from the fore to lateral surface of the tumor, and the internal jugular vein to be pushed posterolateral to the artery , abut- ting the artery at a distance of 30 to 90 degree from the artery. The rest 4 cases were vagus neurilem- momas showing the common or/ and internal carotid artery to be pushed to the medical surf are of the tumor , and the internal jugular vein to be pushed to the lateral surf are of the tumor, opposite to the artery at a distance of 120 to 180 degree. Conclusion: Neurilemmoma was diagnosed difficultly only by ultra- sonography of tumor. Altrasonography of internal carotid artery and jugular vein was helpful. Sympathetic neurilemmoma was showed that internal carotid artery and jugular vein were pushed together and their relative places were changeless, or distance between theirs was 0 to 90 degree. If distance between theirs was 120 to 180 degree , vagus neurilemmoma was showed.