高频超声对眼睑皮脂腺癌的诊断价值探讨

Diagnostic value of high frequency ultrasound in the sebaceous gland carcinoma of eyelid

目的探讨超高频超声在眼睑皮脂腺癌（sebaceousglandcarcinomaofeyelid）诊断中的价值。方法回顾性分析经手术、病理证实的11例眼睑皮脂腺癌患者的临床及超声资料，分析在常规高频超声（13MHz）和22MHz超高频超声下眼睑皮脂腺癌各种相关超声表现。结果①常规高频超声检查，7例具有派杰样改变者的患侧皮肤与正常侧对比无明显差异，彩色多普勒示肿块呈树枝样包绕血流为主，派杰样改变者彩色血流对比健侧未见明显异常。②22MHz超高频超声扫查，9例见裂隙样极低回声，9例可分辨肿瘤浸润移行区，7例具有派杰样改变者超声可见回声略低于健侧同部位，厚度测量对比健侧略增厚约（O．6±0．1）mm，彩色多普勒示肿块呈整体丰富网篮样血流信号，细小分支血管可抵达皮下，部分见滋养血管，派杰样改变区可见丰富彩色血流信号。常规高频超声与超高频超声检查问差异有统计学意义的声像学征象为回声均匀与否、中央旁裂隙样改变、浸润边缘、浸润皮肤厚度（Y。值分别为12．571、15．231、15．231、4．701，P值均d0．05），差异有统计学意义的多普勒声像图征象为血流灌注分布区域、中央血管、滋养血管j派杰样改变区血流（Y。值分别为22．000、15．231、4．899、10．267，P值均〈0．05）。结论裂隙样极低回声是眼睑皮脂腺癌在超高频超声图像中的主要表现，22MHz超高频超声可以准确显示眼睑皮脂腺癌累及皮肤的深度范围，为临床制定治疗策略提供客观依据。

Objective To evaluate the diagnostic value of high frequency ultrasound in sebaceous gland carcinoma of eyelid （SC）. Methods The ultrasonic characteristic for 11 cases with eyelid SC were respectively analyzed by using 13 MHz high frequency ultrasound and 22 MHz ultra-high frequency ultrasound. Results Through 13 MHz high frequency ultrasound, in 7 patients who exhibited Pagetoid invasion the lid shin thickness of tumor side displays no significant alteration in a comparison with normal side. Furthermore,the color Doppler flow imaging （CDFI） evealed a branch-like blood flow surrounding the masses in all cases,but the blood flow of seven patients with Pagetoid invasion had no difference compared with the healthy side. On 22 MHz ultra-high frequency ultrasound examination,slit-like low echo was found in 9 ;transition zone of tumor infiltration can be identified in 9; the echo of tumors with Pagetoid invasion was lower than the healthy side and the skin thickness of tumors with Pagetoid invasion was thicker （0.6 ＋ 0. 1）mm than the healthy side. CDFI revealed that mesh-basket like blood flow was rich in all patients, the small branch blood vessels arrived at subcutaneous, and vasa vasorum were found in some patients. The region with Pagetoid invasion was rich in blood flow. The sonography findings on 13 MHz and 22 MHz high frequency ultrasound examination were compared with chisquare test. There were significant differences on homogeneous echo,slit-like low echo, transition zone of tumor infiltration, infiltration skin thickness, blood distribution,central blood vessels, vasa vasorum, blood flow in the region with Pagetoid invasion （x2 = 12.571,15.231,15.231,4.701,22.000,15.231,4.899,10.267, P〈0.05）.Conclusions Slit-like low echo in the mass is a main finding of eyelid sebaceous gland cercinoma on the 22 MHz ultra-high frequency ultrasound. The ultra-high frequency ultrasound can accurately reveal the skin depth infiltrated by the eyelid sebaceous gland cercinoma and this method can provide solid guidance for clinical treatment strategies.