肺包虫病的超声显象诊断

Ultrasonographic Diagnosis of Lung Hydatidosis

本文报告26例肺包虫病的超声显象检查,全部病例经手术病理证实。肺包虫病根据其声象图特征结合病理分为四型。即Ⅰ型(单纯囊型),Ⅱ型(多子囊型),Ⅲ型(继发症型),Ⅳ型(多型型)。超声诊断符合手术病理者26/28例,占92.8％。3例漏诊,1例位于右肺上叶背侧,因受胸椎与肩胛骨影响未显示,1例病变在右肺中叶背侧纵隔面,受胸椎、肩胛骨阻挡及肺泡气体影响显示不清,另1例为左肺底,虽经右侧位以脾为透声窗向膈面探查(可能于受胃肠道氯气影响有关)仍然显示不满意。误诊2例,1例肺结核瘤呈类圆形暗区误认为肺包虫囊肿,1例胸膜腔包虫病病灶显示为椭圆形囊性肿块向肺内突出而使定位判断错误。 超声波遇到肺组织产生多次反射,使位于肺组织深层未贴近胸膜脏层的占位病变不能显示。当肺包虫囊肿的某一部分贴近肺表面即可使超声波透过而显示病变的切面图象。超声显象有助于显示肺包虫囊肿的部位,形态、边缘状况、内部结构及其物理特性,可为本病的诊断与鉴别诊断,为临床治疗决策提供可靠的资料。

Twenty-six cases of lung hydatidosis were positively diagnosed by ultrasonography and of them were surgically confirmed later. Lung hydatidosis could be classified into 4 types ording to their ultrasonographic and pathologic characters, that is Ⅰ. single cyst; Ⅱ. ulti-daughter cyst; Ⅲ. secondary cyst and Ⅳ. multiple cyst. The conincidence of ultrasonic gnosis with surgical confirmation was 92.8% (26/28). In this study, 3 cases missed gnosis, among which 1 didn't show for it was on the back of the right upper lobe and was d up by the ihoractic vertebrae and scapula, another didn't show clearly as it was on the ;k of the middle lobe of the right lung and was separated by the thoractic vertebrae and /ered with pulmonary alveoli, the third didn't show clearly either, because of its location at the lower part of the left lung and possible influence of chlorine in the gastrointestinal tract though diaphragmatic surface examination was done using the spleen as a sound-penetrating window. Two cases were misdiagnosed, one was a round-shaped tuberculoma of the lung, and the other was mislocated. Deep space occupying lesions in the lung tissues were difficult to be detected because of the multiple reflections of the ultrasonic wave. But section pictures of pathologic changes could be shown when a certain part of a lung hydatid cyst was close to the lung surface. In most cases, ultrasonography could be done to determine the lung hydatid cyst's location, shape, edge state, inner structure and its physical characters, therefore, it was reliable in the diagnosis and differential diagnosis of lung hydatidosis.