常规超声联合超声造影测评胆囊息肉不同径线方向大小、基底部宽度在鉴别息肉性质的初步临床研究

Pilot clinical study on predicting nature of gallbladder polyp by measuring sizes in different directions,stalk width with gray scale ultrasound and contrast-enhanced ultrasound

目的探讨常规超声联合超声造影全面测评大小≥1.0 cm的胆囊息肉样病变,不同径线方向的大小以及基底部宽度在胆固醇息肉与腺瘤鉴别诊断中的价值。方法选取2016年1月至9月在解放军总医院因胆囊息肉样病变手术的患者81例,于手术前行胆囊超声及超声造影检查,记录患者的基本临床资料、胆囊息肉在不同方向的大小、常规超声及造影图像特征。根据手术病理结果分为胆固醇息肉组与胆囊腺瘤(包括腺瘤伴恶变)组。2组患者年龄、垂直径大小、平行径大小、基底部宽度、垂直径与基底部宽度比值(垂/基)以及平行径与基底部宽度比值(平/基)、垂直径大小与平行径大小的比值(垂/平)采用t检验,2组间性别、息肉数量、息肉部位、灰阶回声强度、有无彩色血流采用χ~2检验。采用Bivariate行双变相关统计分析。结果胆固醇息肉组与胆囊腺瘤组患者的息肉多普勒血流、年龄、垂直径大小、平行径大小、基底部宽度、垂/基比较[9(15.8%)vs 9(37.5%),(37.02±10.14)岁vs(52.25±13.82)岁,(0.94±0.33)cm vs(1.27±0.79)cm,1.01±0.37 vs 1.71±0.50,(0.26±0.10)cm vs(0.58±0.51)cm,3.82±1.87 vs 2.92±1.61],差异均有统计学意义(χ~2=2.675,t=5.303、2.675、5.855、4.566、-2.536,P均<0.05),而垂/平、平/基比较,差异均无统计学意义(P均>0.05)。垂直径大小、平行径大小、基底部宽以及垂直径大小与基底部宽度比值均与胆囊息肉样病变的性质有相关关系(r=0.375、0.571、0.586、-0.342,P均<0.05)。结论通过常规超声以及超声造影全面测评息肉不同径线方向的大小、基底部宽度对于鉴别大小≥1.0 cm的胆囊息肉的性质有重要临床意义。

Objective To evaluate clinical application of measuring the sizes in different directions and stalk width of gallbladder polyp lesions（GPL） ≥ 1.0 cm for differentiation diagnosis between cholesterol polyp and adenoma by both gray scale ultrasound（US） and contrast-enhanced ultrasound（CEUS）. Methods From January to September 2016, a total of 81 patients with GPL ≥ 1.0 cm received cholecystectomy in our hospital were enrolled in this study. All participations underwent US and CEUS scanning before cholecystecomy. Patient′s clinical data, sizes in different directions, stalk width and features of US images were recorded. According to pathological findings, patients were divided into cholesterol polyp group and adenoma group. All of the clinical data, sizes, stalk width and features of US images were statistically analyzed. Patient′s age, size in vertical and parallel sizes, stalk width of GPL, ratio of vertical size to stalk width, ratio of parallel size to stalk width and ratio of vertical size to parallel size were compared with t-test. Genda, number and location of GPL, echoic level and blood flow signal were compared with the χ^2 test. Bivariate was used for relation analysis. Results There were difference in patient′s age, vasularity of GPL, size in vertical direction, size in parallel direction, stalk width, ratio of vertical size to stalk width, ratio of parallel size to stalk width [9（15.8%） vs 9（37.5%）,（37.02±10.14） years old vs（52.25±13.85） years old,（0.94±0.33）cm vs（1.27±0.79）cm, 1.10±0.37 vs 1.71±0.50,（0.26±0.10）cm vs（0.58±0.51）cm, 3.82±1.87 vs 2.92±1.61], the differences were statistically significant（χ^2=2.675, t=5.303, 2.675, 5.855, 4.566,-2.536, all P〈0.05）, but no difference in ration of vertical size to parallel size between two groups（all P〈0.05）. Bivariate realtion analysis proved that size in vertical direction, size in parallel direction, stalk width and ratio of vertical size to stalk width were related with the nature of GPL ≥ 1.0 cm（r=0.375, 0.571, 0.586,-0.342, all P〈0.05）. Conclusion Sizes in different directions and stalk width were important factors for predicting the nature of GPL ≥ 1.0 cm.