彩超对肝内三种常见强回声病灶的鉴别与诊断研究

Differentiation and Diagnosis of Three Common Strong Echo Lesions in Liver by Color Doppler Ultrasound

目的观察彩色多普勒超声检查对三种不同肝部强回声病灶(胆管结石、肝内钙化灶、肝内胆管积气)的鉴别诊断。方法对我院2017年9月~2018年3月收治的肝内胆管结石20例和肝内钙化灶40例、肝内胆管积气20例患者的相关资料和超声资料进行分析,比较三种不同肝部强回声病灶的彩超结果。结果 20例肝内胆管结石患者中,肝左右叶同时发病的有6例,左叶占30.00%,右叶占40.00%,彩超声像图显示为结石沿着肝内胆管分布,呈簇状,结石通常为多发,表现为斑点状或条索状、团状以及不规则形,超声检查会出现高强回声,后部通常伴有明显的回声影,肝内胆管存在不同程度扩张,和门静脉分支呈现"平行管"特征。40例肝内钙化灶患者中,肝左叶有患者20例,位于肝右叶患者17例,肝左右叶同时存在患者有3例,彩超检查可以表现为强回声,可见大小不一,形态为团状或斑块状的影像,通常为单发,可分布于肝内的多处,肝内胆管不存在无明显扩张。在20例肝内胆管积气患者中,有6例患者伴有胆道手术病史,彩超声像图可体现出肝内胆管内有强回声出现,体位发生改变时,其形态和位置均会有变化,如发生的强回声位于肝内胆管的前壁处,后方会伴有"彗尾征"图像。结论彩超可以实现多角度和多切面的扫描检查,结合不同的声像图信息,可以诊断肝内胆管结石、肝内钙化灶、肝内胆管积气,在临床诊断具有非常重要的作用。

Objective To observe the differential diagnosis of three kinds of liver hyperechoic lesions（intrahepatic cholelithiasis,intrahepatic calcification,intrahepatic bile duct gas accumulation）by color Doppler ultrasonography. Methods From September 2017 to March 2018,20 cases of intrahepatic cholelithiasis,40 cases of intrahepatic calcification and 20 cases of intrahepatic bile duct gas accumulation were analyzed.The results of color Doppler ultrasound were compared among three kinds of liver hyperechoic lesions.Results Among the 20 cases of intrahepatic cholelithiasis,6 cases occurred simultaneously in the left and right lobes of the liver,with left lobe accounting for 30.00% and right lobe 40.00%.The color Doppler sonography showed that the stones distributed along the intrahepatic bile duct,and the stones were usually multiple.The findings were speckled or striped, lumped or irregular,high echo in ultrasound,obvious echo in posterior part,dilatation of intrahepatic bile duct in varying degrees,and ＂parallel tube＂ in portal vein branch.Among the 40 patients with intrahepatic calcification,there were 20 patients with left hepatic lobe,17 patients with right hepatic lobe,and 3 patients with left and right hepatic lobe.The color Doppler ultrasound examination showed strong echoes,and the size was different.The lumps or plaques are usually single-shot and can be distributed in multiple places in the liver.There is no obvious expansion in the intrahepatic bile duct.Among the 20 patients with intrahepatic biliary tract,6 patients had a history of biliary surgery.The color ultrasound image showed strong echoes in the intrahepatic bile duct.When the position changed, the shape and position changed.If a strong echo occurs,it is located at the anterior wall of the intrahepatic bile duct,the rear will be accompanied by an image of the ＂Iris sign＂.Conclusion Color Doppler ultrasound can be used to detect multi-angle and multi-section scanning.Combined with different sonographic information,it can be used to diagnose intrahepatic cholelithiasis,calcification focus and accumulation of gas in intrahepatic bile duct,which plays an important role in clinical diagnosis.