超声在囊型肝包虫病诊断及术前评估中的应用

Application of ultrasound in the diagnosis and preoperative evaluation of cystic hepatic echinococcosis

目的:探讨超声对囊型肝包虫病的诊断及术前评估价值。方法:回顾性分析2018年1月至2019年12月在解放军总医院第五医学中心经手术病理及血清学检查证实的59例(102个病灶)囊型肝包虫病患者资料,其中男23例、女36例;年龄13~64(42±6)岁。对其声像图表现进行分型,同时判定病灶对血管及胆管受累情况。比较超声对肝包虫病诊断与手术病理相符率,以及超声诊断肝包虫病的准确率、灵敏度及特异度。结果:59例患者共涉及102个病灶,位于肝右叶78个,左叶20个,左右叶间4个。超声显示CE1型12个,CE2型24个,CE3a型16个,CE3b型6个,CE4型34个,CE5型10个。包虫超声与手术病理分型的相符率分别为91.66%(11/12)、95.80%(23/24)、93.75%(15/16)、83.33%(5/6)、91.17%(31/34)及100.00%(10/10)。超声诊断效能分析:分型的准确率为94.12%,灵敏度为96.94%,特异度为25%。特征性的超声表现中以脑回征、多子囊征出现频率最多,囊壁均匀性增厚,双壁征,内层囊壁分离征及厚壁钙化次之。超声在显示病灶累及血管及胆管判定中与术中所见比较,差异有统计学意义(均P<0.05)。结论:超声可明确诊断囊型肝包虫病,可较好地显示此病的影像特征,对提示疾病演变过程具有重要临床意义,对判定病灶对血管及胆管受累情况有临床意义。

Objective To investigate the value of ultrasound in the diagnosis and preoperative evaluation of cystic hepatic echinococcosis.Methods The data of 59 patients(102 lesions)with cystic hepatic echinococcosis confirmed by surgical pathology and serological examination in the Fifth Medical Center of PLA General Hospital from January 2018 to December 2019 were retrospectively analyzed,including 23 males and 36 females;age13 to 64(42±6)years.The ultrasonographic manifestations were classified,and the involvement of the lesions in the blood vessels and bile ducts was determined.The coincidence rate between ultrasound diagnosis of hepatic echinococcosis and surgical pathology was compared,and the accuracy,sensitivity and specificity of ultrasounic diagnosis of hepatic echinococcosis were analyzed.Results Ultrasound showed 12 CE1 type lesions,24 CE2 type lesions,16 CE3a type lesions,6 CE3b type lesions,34 CE4 type lesions,and 10 CE5 type lesions.The coincidence rates of hydatid ultrasound and surgical pathological classification were 91.66%(11/12),95.80%(23/24),93.75%(15/16),83.33%(5/6),91.17%(31/34)and 100.00%(10/10),respectively.Ultrasound diagnostic efficiency analysis:the accuracy of classification was 94.12%,the sensitivity was 96.94%,and the specificity was 25%.Among the characteristic ultrasound manifestations,the gyrus sign and the polycystic sign were the most frequent,followed by homogeneous thickening of the cyst wall,double wall,separation of the inner cyst wall,and thick wall calcification.There were significant differences between ultrasound in the determination of lesions involving blood vessels and bile ducts and intraoperative findings(all P<0.05).Conclusion Ultrasound could clearly diagnose cystic hepatic echinococcosis,could better display the imaging characteristics of the disease,and had important clinical significances in indicating the evolution of the disease and determining the involvement of the lesions in the blood vessels and bile ducts.