经胸超声在诊断纵膈肿瘤中的应用价值

The value of routine transthoracic ultrasound in the diagnosis of mediastinum tumors

目的:回顾性分析27例纵膈肿瘤的超声特征、临床表现及手术病理特点,探讨超声在发现纵膈肿瘤中的应用价值,协助临床评估与决策.方法:收集2017年1月至2020年5月,于我院行超声心动图检查发现的纵膈肿瘤患者27例,回顾分析其超声结果、临床资料,并与术中大体及术后病理相对照.结果:27例纵膈肿瘤,男性19例,女性8例,年龄12~74岁,中位年龄42岁.②病理分型:27例纵膈肿瘤中,良性肿瘤6例(22.2%),恶性肿瘤16例(59.3%),生殖细胞肿瘤5例(18.5%).良性肿瘤包括心包囊肿2例,胸腺瘤2例,支气管囊肿1例,海绵状血管瘤1例.恶性肿瘤包括纵膈型肺癌8例,淋巴瘤5例,间叶组织恶性肿瘤2例,侵袭性胸腺瘤1例.生殖细胞肿瘤包括畸胎瘤5例,卵黄囊瘤1例.③纵膈肿瘤易累及的心血管部位:肺动脉最常见(10例),其次是心脏房室腔(6例),B细胞源性淋巴瘤易向上侵及主动脉弓及分支或上腔静脉,纵膈型肺癌易向下侵及下腔静脉或肺动脉.结论:超声对于纵膈肿瘤诊断的敏感性低,但是纵膈畸胎瘤、B细胞源性淋巴瘤、纵膈型肺癌具有特异性超声表现.从而,超声作为初步筛查手段对于纵膈肿瘤做出初步诊断.并且,超声可以评估肿瘤对周围器官特别是心脏的侵犯情况,为临床进一步的诊断及治疗提供重要信息.

Objective:To review the current clinical experiences and pathological characteristics of differential diagnosis of mediastinum tumors.Methods:A totally 27 patients with mediastinum tumors,which were comfired by pathology,were retroepectively reviewed.The clinical and ultrasonographic characteristic were analyzed.The ultrasonographic performance were compared with operative and pathological result.Results:Of the 27 patients with mediastinum tumors,19 were males,and 8 females.Median age was 42 years old(range 12-74 years old).②Pathological result included 6(22.2%)benign,16(59.3%)malignant,5(18􀆰5%)germ cell tumor.Benign tumors included 2 pericardial cyst,2 thymoma,1 bronchial cyst,1 cavernous hemangipma.Maligant tumors included 8 mediastinal lung cancer,5 lymphoma,2 mesenchymal malignant tumor,1 invasive thymoma.Germ cell tumor included 5 teratoma,1 yolk sac tumor.③The pulmonary artery(n=10)was most vulnerable,followed by the atrium or ventricle(n=6).B-cell derived lymphomas were tend to invade upwards and to the aortic arch and branches or superior vena cava,while mediastinal lung cancer easily invaded down-ward to the inferior vena cava or pulmonary artery.Conclusions:Ultrasonography has low sensitivity for the di-agnosis of mediastinum tumor,but mediastinal teratoma,b-cell-derived lymphoma,and mediastinal lung cancer have specific ultrasound characteristic.Ultrasound can be used as a preliminary screening method and observe the invasion situation to the heart.