Diagnosis and treatment of polypoid lesions of the gallbladder:report of 194 cases

BACKGROUND: With the wide use of B-ultrasonography in recent years, the polypoid lesion of the gallbladde ( PLG) has been one of the most common diseases detected in biliary surgery. This study was to investigate the diag nostic method and operative indications of PLG. METHODS: The clinical and pathological data of 194 pa tients with PLG who had received operation at our hospita from January 1994 to September 2002 were analyzed retro spectively. Categorized data were analyzed by the chi square test. RESULTS: All the patients received preoperative B-ultra- sonography. 185 of the 194 PLG patients were diagnosed as having cholecystic polyp, and 9 adenomas. Among the 42 patients who received CT, 6 showed early gallbladder can cer. Pathologically, cholesterol polyps were mostly multi ple lesions (64.7%) with a mean diameter of3.86±2.2 mm in 136 patients. Of 16 patients with adenomas, 10 had a tumor diameter of more than 10 mm (62.5%). In 11 pa tients with gallbladder carcinoma, 7 were accompanied with gallbladder stone (63.6%). In addition, inflammatory polyps and adenomyomas were found in 25 and 6 patients respectively. CONCLUSIONS: B-ultrasonography is the most effective diagnostic method for detecting PLG. When large or irreg- ular lesions are found, CT should be performed in order to avoid missing of gallbladder carcinoma. Operative indica- tions for PLG include; a maximal tumor diameter of more than 10 mm; an over 50-year-old patient with a wide-base and a single polyp lesion; a wide-base lesion or a lesion showing a tendency to enlargement; co-existing gallbladder stone or cholecystitis; a patient without other diseases but obvious clinical features and failure of general ma- nagement ; big or long pedicels or polyps at the neck of the gallbladder for preventing the empty of the gallbladder and a history of biliary colic; and PLG with irregularly thick- ened local gallbladder wall.

DIAGNOSIS AND TREATMENT OF POLYPOID LESIONS OF THE GALLBLADDER

This article reports 56 pathologically confirmed cases of polypoid lesions of the gallbladder (PLG) that were operated on in our hospital from 1984 to 1995. The patients' ages ranged from 10 to 70 and the mean age was 43. 5, 83.9% were 30～49 years old. Gallstone could be round in 24cases. There were 36 cases of pseudotumor in this group (64.2% ), 20 of true tumor(35. 8% ) and 1of carcinopolypus. The diagnosis rate was elevated with the use or BUS. The patients with complicated gallstone and polyp in the neck of gallbladder should be operated early while asymptom patients could be followed and operated on at sultable stage.

Prevalence and risk factors of gallbladder polypoid lesions in Chinese petrochemical employees

AIM:To investigate the prevalence and risk factors of polypoid lesions of the gallbladder (PLGs) in petrochemical employees in Ningbo, Zhejiang Province, China. METHODS:All active and retired employees aged 20-90 years (n = 11098) of a refinery and chemical plant in eastern China were requested to participate in a health survey. The participants were subjected to interview, physical examination, laboratory assessments and ultrasonography. All the participants were invitedto have a physical examination after a face-to-face interview. Fasting blood samples were obtained from the antecubital vein, and the samples were used for the analysis of biochemical values. Abdominal ultrasonography was conducted. RESULTS:A total of 10461 (7331 men and 3130 women) current and former petrochemical employees attended for screening. The overall prevalence of postcholecystectomy, gallstones and PLGs was 0.9%, 5.2% and 7.4%, respectively. Compared with the increased prevalence of either gallstones or post-cholecystectomy in older persons, PLGs were more common in the middle-aged, peaking in those aged 40-59 years. Excluding the patients with gallstones, gallstones mixed with PLGs, or those who had undergone cholecystectomy, in the remaining 9828 participants, the prevalence of PLGs in men (8.9%) was significantly higher than that in women (5.5%, P < 0.001). The analyzed risk factors with increased OR for the development of PLGs were male gender (OR = 1.799, P < 0.001), age ≥ 30 years (OR = 2.699, P < 0.001) and hepatitis B surface antigen (HBsAg) positivity (OR = 1.374, P = 0.006). CONCLUSION:PLGs are not rare among Chinese petrochemical employees. Male gender, HBsAg positivity, and middle age are risk factors for developing PLGs.

Outcome of gall bladder polypoidal lesions detected by transabdominal ultrasound scanning: A nine year experience

AIM: To determine the outcome of polypoidal lesions within the gall bladder (PLG) diagnosed by trans-abdominal scanning.METHODS: A nine-year (1993-2002) retrospective casenote review of all patients who underwent ultrasound scanning after referral to a single Upper GI Surgeon at a District General Hospital was conducted. Patients who were diagnosed with a PLG were included in our study. A database was constructed and patient details, investigations including ultrasound scan (USS) findings, treatment and histology and final diagnosis were recorded. RESULTS: Twenty-three (out of 651) patients were diagnosed pre-operatively by USS to have a polyp-likegall bladder lesion (PLG). Post cholecystectomy histological examination revealed 12 gallstones, 7 cholesterol polyps, 3 adenocarcinomas within polyps and 1 normal gall bladder. The specificity of USS in the diagnosis of PLG was 92.3%. All the true polyps were malignant. Overall USS had 66.66% sensitivity and 100% specificity in the pre-operative suspicion of malignancy. Using size greater than 10 mm as measured on USS as a cut-off, we find 100% sensitivity and 86.95% specificity with a positive predictive value of 50% in the diagnosis of malignancy in PLG.CONCLUSION: A large number of PLG are in fact calculi within diseased gall bladder. In cases of gall bladder polyps more then 10 mm in size on USS further imaging (crosssectional and/or EUS) is indicated prior to surgery. This will help in the optimal management of patients and avoid histological surprises.

低频与高频超声联合诊断胆囊息肉样病变价值分析

目的探讨高频和低频超声联合检查诊断胆囊息肉样病变(PLG)的价值。方法2020年5月~2023年4月我院诊治的PLG患者64例,术前均接受低频超声和高频超声检查,行腹腔镜下胆囊切除术,术中留取组织行病理学检查。以Kappa系数评价超声诊断与组织病理学检查诊断的一致性。结果在64例PLG患者中,经组织病理学检查诊断良性病变59例和恶性病变5例;超声检查恶性病变单发、宽基底和发现有血流信号百分比分别为80.0%、80.0%和80.0%,均显著高于良性病变的44.1%、33.9%和27.1%(P<0.05);经低频超声诊断恶性病变9例(14.1%)、良性病变55例(85.9%),经高频超声诊断恶性病变8例(12.5%)、良性病变56例(87.5%),经高频/低频超声联合诊断恶性病变7例(10.9%)、良性病变57例(89.1%),三种方法诊断结果比较差异无统计学意义(P>0.05);高频/低频超声联合诊断病变良恶性的敏感度、特异度和准确率分别为100.0%、96.6%和71.4%,与组织病理学诊断结果的一致性较高(kappa=0.817)。结论鉴于高频与低频超声各有优缺点,两者联合诊断PLG病变性质可能能提高诊断的准确性,值得不断尝试。

腹腔镜下行胆囊切除术治疗胆囊息肉样病变的临床效果及应激反应分析

目的评估腹腔镜下胆囊切除术(Laparoscopic Cholecystectomy,LC)应用在胆囊息肉样病变(Polypoid Lesions of The Gallbladder,PLG)患者中的临床效果及对应激反应的影响。方法随机选取2019年12月—2022年12月三明市第一医院收治的80例PLG患者为研究对象,参照随机数表法分为对照组[40例,实施开腹胆囊切除术(Open Cholecystectomy,OC)治疗]、观察组(40例,行LC治疗)。评价两组手术相关参数、应激反应、炎症反应以及术后并发症发生率。结果与对照组相比,观察组手术相关参数更佳,差异有统计学意义(P<0.05)。术前,两组应激反应[包括血糖(Blood Glucose,BG)、皮质醇(Cortisol,Cor)、肾上腺素(Epinephrine,E)]、炎症因子[包括C反应蛋白(C-Reactive Protein,CRP)、白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-8(Interleukin-8,IL-8)]比较,差异无统计学意义(P均>0.05);术后1 d,观察组应激反应指标(BG、Cor、E)、炎症因子(CRP、IL-6、IL-8)水平低于对照组,差异有统计学意义(P均<0.05)。观察组术后并发症发生率(2.50%)低于对照组(20.00%),差异有统计学意义(χ^(2)=6.135,P=0.013)。结论对PLG患者实施LC,可以减轻应激反应、炎症反应,减少术中出血量、手术时间及术后并发症,加快术后恢复速度。

彩色多普勒超声对胆囊息肉样病变的诊断价值分析

目的分析胆囊息肉样病变应用彩色多普勒超声的诊断价值。方法选择胆囊息肉样病变患者50例,所有患者均接受彩色多普勒超声检查。以病理诊断结果作为金标准,分析彩色多普勒超声对胆囊息肉样病变的诊断符合率及影像学特点。结果彩色多普勒超声对胆固醇性息肉、胆囊腺瘤、炎症性息肉、胆囊腺肌瘤样增生、早期胆囊癌的诊断符合率分别为95.45%、83.33%、100.00%、87.50%、100.00%。胆固醇性息肉可发生于胆囊各部位,大小为≤10 mm,属多发,基底窄/有蒂,形状为结节/桑葚状,局部胆囊壁正常,无血流,显示高回声;胆囊腺瘤多发生于胆囊底部,大小为10~16 mm,属单发,基底宽,形状为团块状,局部胆囊壁增厚,无血流,显示中等回声;炎症性息肉也可发生于胆囊各部位,大小为5~13 mm,属多发,基底宽,形状不规则,局部胆囊壁毛糙,无血流,显示高回声;胆囊腺肌瘤样增生多发生于胆囊底部与颈部,大小为9~17 mm,属单发,基底正常/宽,形状为球状,局部胆囊壁正常,有血流,显示低回声/无回声;早期胆囊癌多发生于胆囊底部与颈部,大小为11~25 mm,属单发,基底宽,形状为团块,局部胆囊壁正常,有血流,显示低回声/混合回声。结论在胆囊息肉样病变患者中实施彩色多普勒超声诊断的符合率较高,结合患者的影像学特点有助于明确疾病类型,为后续治疗提供参考。

高频超声联合彩色多普勒超声检查诊断胆囊息肉样病变的价值

目的:评估高频超声联合彩色多普勒超声检查在胆囊息肉样病变(polypoid lesions of gallbladder,PLG)诊断中的应用价值。方法:选取北京电力医院在2022年4月-2023年8月收诊的108例PLG患者作为研究对象,采用高频超声(探头频率7.5-11.0MHz)与彩色多普勒超声(探头频率34.5MHz)对其进行联合检查。所有患者在入院后接受检查,并随后接受手术治疗,以手术探查和术中冰冻组织病理检查结果为金标准。结果:高频超声联合彩色多普勒超声检查在PLG良恶性鉴别诊断中表现出更高的诊断准确率、灵敏度和特异度,且对PLG不同病理组织类型的诊断符合率也优于单一检查(P<0.05);对于PLG良恶性病灶的病灶形态、病灶直径、病灶回声特点、病灶数量、胆囊壁增厚概率、病灶内有血流信号概率的比较,差异均有统计学意义(P<0.05)。结论:高频超声联合彩色多普勒超声检查是诊断PLG的有效方法,有助于早期检出PLG的良恶性,值得临床推广应用。

超声造影联合高频彩色多普勒超声检查鉴别诊断胆囊息肉样病变良恶性的效能

目的:观察超声造影联合高频彩色多普勒超声检查鉴别诊断胆囊息肉样病变良恶性的效能。方法:回顾性分析2022年3月至2023年3月该院收治的78例胆囊息肉样病变患者的临床资料,根据病理活检结果,将其分为良性组48例和恶性组30例。两组均行高频彩色多普勒超声检查和超声造影检查,比较两组高频彩色多普勒超声图像特征、超声造影参数(开始增强时间、达峰时间),以及高频彩色多普勒超声、超声造影单项及联合检查鉴别诊断胆囊息肉样病变良恶性的效能。结果:恶性组多发息肉占比、息肉有血流占比以及息肉最大直径均高于良性组,差异有统计学意义(P<0.05);恶性组开始增强时间、达峰时间均短于良性组,差异有统计学意义(P<0.05);超声造影联合高频彩色多普勒超声检查诊断恶性胆囊息肉样病变的灵敏度高于两者单项检查诊断,漏诊率低于两者单项检查诊断,差异均有统计学意义(P<0.05)。结论:超声造影联合高频彩色多普勒超声检查鉴别诊断胆囊息肉样病变良恶性的效能高于两者单项检查诊断效能。

低频联合高频超声在胆囊息肉样病变中的诊断价值分析

目的探讨低频联合高频超声在胆囊息肉样病变(PLG)中的诊断价值,以期为临床准确制定防治对策提供科学依据。方法选择93例PLG患者为调查对象,均接受低频超声、低频联合高频超声检查与手术病理检查。记录手术病理结果,统计低频超声单独检查、低频联合高频超声检查对PLG的检出结果,并以手术病理结果为PLG诊断金标准,分析低频超声、低频联合高频超声检查PLG的诊断效能,分析低频超声、低频联合高频超声诊断PLG的结果和病理结果之间一致性。结果93例PLG患者经手术病理检查发现良性PLG者77例(82.80%)、恶性PLG者16例(17.20%);低频联合高频超声检查对PLG的诊断灵敏度(93.75%)略高于低频超声单独检查(75.00%),差异无统计学意义(P>0.05);低频联合高频超声检查对PLG的诊断特异度(92.21%)、准确度(92.47%)均高于低频超声单独检查(71.43%、72.04%),差异有统计学意义(P<0.05);低频超声诊断PLG结果和手术病理结果之间一致性较差(Kappa=0.321,P=0.000),低频联合高频超声诊断PLG结果和手术病理结果之间呈高度一致性(Kappa=0.765,P=0.000)。结论低频联合高频超声用于临床诊断PLG的应用价值高,能减少误诊和漏诊,为临床制定防治对策提供准确依据。

腔内三维超声自由解剖成像技术联合腔内二维超声高分辨率血流显像技术在宫腔息肉样病变术前诊断中的价值

目的探讨腔内三维超声(transvaginal three-dimensional ultrasound,3D-TVS)自由解剖成像技术(Omniview)联合腔内二维超声(transvaginal two-dimensional ultrasound,2D-TVS)高分辨率血流显像技术(high definition live flow lmaging technique,HD-flow)在子宫内膜息肉样病变术前诊断中的价值。方法回顾性分析2022年8月至2023年7月在徐州医科大学附属徐州妇幼保健院行常规2D-TVS检查拟诊子宫内膜息肉(endometrial polyps,EPS)、子宫黏膜下肌瘤(submucosal myoma,SM)、子宫内膜增生(endometrial hyperplasia,EH)、子宫内膜癌(endometrial carcinoma,EC)的患者共172例,进一步行3D-TVS Omniview联合2D-TVS HD-flow检测,所有患者均入院进行了宫腔镜(hysteroscopic,HS)手术。HS手术病理证实EPS 90例、EH 54例、SM 12例、EC 6例,分泌期子宫内膜(secretory endometrium,SE)10例。将超声诊断结果与HS手术病理结果进行对比,分析不同检查手段的诊断效能。结果3D-TVS Omniview联合2D-TVS HD-flow对EPS和EH的诊断效能均显著高于常规2D-TVS(均P<0.05),但显著低于HS手术病理诊断(P<0.05)。3D-TVS Omniview联合2D-TVS HD-flow与常规2D-TVS对SM的诊断效能相当,差异无统计学意义(P>0.05),受试者操作特征曲线的曲线下面积(area under curve,AUC)均为0.914。3D-TVS Omniview联合2D-TVS HD-flow与HS手术病理诊断对EC的诊断效能相当(AUC均为0.917,P>0.05),且高于常规2D-TVS(AUC为0.833),但差异无统计学意义(P>0.05)。结论3D-TVS Omniview联合2D-TVS HD-flow对宫腔息肉样病变的诊断效能高于常规2D-TVS,可作为子宫内膜息肉样病变术前诊断的首选检查手段。

Non-polypoid colorectal neoplasms:Classification,therapy and follow-up

In the last years,an increasing interest has been raised on non-polypoid colorectal tumors(NPT) and in particular on large flat neoplastic lesions beyond 10 mm tending to grow laterally,called laterally spreading tumors(LST).LSTs and large sessile polyps have a greater frequency of high-grade dysplasia and local invasiveness as compared to pedunculated lesions of the same size and usually represent a technical challenge for the endoscopist in terms of either diagnosis and resection.According to the Paris classification,NPTs are distinguished in slightly elevated(0-Ⅱa,less than 2.5 mm),flat(0-Ⅱb) or slightly depressed(0-Ⅱc).NPTs are usually flat or slightly elevated and tend to spread laterally while in case of depressed lesions,cell proliferation growth progresses in depth in the colonic wall,thus leading to an increased risk of submucosal invasion(SMI) even for smaller neoplasms.NPTs may be frequently missed by inexperienced endoscopists,thus a careful training and precise assessment of all suspected mucosal areas should be performed.Chromoendoscopy or,if possible,narrow-band imaging technique should be considered for the estimation of SMI risk of NPTs,and the characterization of pit pattern and vascular pattern may be useful to predict the risk of SMI and,therefore,to guide the therapeutic decision.Lesions suitable to endoscopic resection are those confined to the mucosa(or superficial layer of submucosa in selected cases) whereas deeper invasion makes endoscopic therapy infeasible.Endoscopic mucosal resection(EMR,piecemeal for LSTs > 20 mm,en bloc for smaller neoplasms) remains the first-line therapy for NPTs,whereas endoscopic submucosal dissection in high-volume centers or surgery should be considered for large LSTs for which en bloc resection is mandatory and cannot be achieved by means of EMR.After piecemeal EMR,follow-up colonoscopy should be performed at 3 mo to assess resection completeness.In case of en bloc resection,surveillance colonoscopy should be scheduled at 3 years for adenomatous lesions ≥ 1 cm,or in presence of villous features or high-grade dysplasia patients(regardless of the size),while less intensive surveillance(colonoscopy at 5-10 years) is needed in case of single(or two) NPT < 1 cm presenting tubular features or low-grade dysplasia at histology.

Ileal polypoid lymphangiectasia bleeding diagnosed and treated by double balloon enteroscopy

Intestinal lymphangiectasia is a rare disease characterized by focal or diffuse dilated enteric lymphatics with impaired lymph drainage.It causes protein-losing enteropathy and may lead to gastrointestinal bleeding.Commonly,lymphangiectasia presents as whitish spots or specks.To our knowledge,small bowel bleeding resulting from polypoid intestinal lymphangiectasia has not been reported.Here,we report a rare case of active bleeding from the small bowel caused by polypoid lymphangiectasia with a review of the relevant literature.An 80-year-old woman was hospitalized for melena.Esophagogastroduodenoscopy could not identify the source of bleeding.Subsequent colonoscopy showed fresh bloody material gushing from the small bowel.An abdominal-pelvic contrast-enhanced computed tomography scan did not reveal any abnormal findings.Video capsule endoscopy showed evidence of active and recent bleeding in the ileum.To localize the bleeding site,we performed double balloon enteroscopy by the anal approach.A small,bleeding,polypoid lesion was found in the distal ileum and was successfully removed using endoscopic snare electrocautery.

石家庄地区表观健康人群胆囊息肉样病变的危险因素

目的:探讨石家庄地区表观健康人群胆囊息肉的发病率及相关危险因素。方法:回顾性分析石家庄地区2021年7月~2022年4月表观健康体检人群的相关资料,共纳入符合标准的体检人群为13254人,其胆囊息肉样病变患者为1733例(13.1%),按照有无胆囊息肉分为胆囊息肉组(PLG组)和非胆囊息肉组(非PLG组),并将两组临床资料进行统计分析。结果:研究表明,年龄、体重指数(BMI)、收缩压(SBP)和空腹血糖(GLU)与胆囊息肉的形成密切相关(P<0.05);经二元Logistic回归分析后证实BMI为胆囊息肉的独立危险因素。结论:BMI为本地区胆囊息肉发病的独立危险因素。

CT影像组学和机器学习预测胆囊息肉样病变性质的研究

目的探讨不同机器学习的影像组学模型预测胆固醇性胆囊息肉和腺瘤性胆囊息肉的价值。方法回顾性分析2015年9月至2022年9月我院100例经手术病理证实的胆固醇性息肉和腺瘤性息肉患者的临床及影像资料。基于术前增强CT提取的影像组学特征,训练集采用T检验和最小绝对收缩和选择算子交叉验证法进行特征筛选。然后用3种机器学习方法(人工神经网络、逻辑回归和支持向量机)构建预测模型,利用ROC曲线下面积、准确率以及F1度量值评估3种模型的预测能力,并通过验证集进行验证。结果人工神经网络算法在基于10个影像组学特征的息肉病变性质鉴别模型中预测效果最好,具有最高的曲线下面积(训练集为1;验证集为0.81)、准确率(训练集为1;验证集为0.83)及F1度量值(训练集为1;验证集为0.76)。10个影像组学特征中,基本特征1个、小波特征9个。结论基于增强CT的机器学习影像组学模型有助于预测胆固醇性胆囊息肉和腺瘤性胆囊息肉的病变性质,为两者的定性诊断及治疗方式的选择提供依据。

胆囊CEUS联合肝脏MRI检查对胆囊息肉样病变患者的诊断价值

目的:探讨胆囊超声造影(CEUS)联合肝脏核磁共振成像(MRI)检查对胆囊息肉样病变(PLG)患者的诊断价值。方法:选取122例PLG患者为研究对象,依据组织病理检测结果分为良性病变组(n=55)和恶性病变组(n=67)。比较两组患者CEUS及MRI检查结果,分析胆囊CEUS与肝脏MRI单独、联合检查对胆囊息肉良恶性病变的诊断效能。结果:CEUS检查结果显示,恶性病变组胆囊壁厚度大于良性病变组(P<0.05);胆囊壁不连续、高增强占比高于良性病变组(P<0.05);始增时间、达峰时间、消退时间短于良性病变组(P<0.05)。MRI检查结果显示,恶性病变组弥散加权成像(DWI)信号强度高于良性病变组(P<0.05);表观弥散系数(ADC)值低于良性病变组(P<0.05)。以组织病理结果为“金标准”,胆囊CEUS联合肝脏MRI诊断PLG恶性病变的敏感度、特异度、准确度分别为92.54%、90.91%、91.80%,一致性检验Kappa值为0.83。结论:胆囊CEUS联合肝脏MRI在PLG良恶性病变的鉴别诊断中具有较高的诊断效能。

高频超声联合彩色多普勒超声诊断胆囊息肉样病变价值分析

目的 分析高频超声联合彩色多普勒超声检查诊断胆囊息肉样病变的价值。方法 2019年4月~2022年4月我院诊治的胆囊息肉样病变(PLG)患者71例,使用HD11型高频超声和SONOLINE Premier型彩色多普勒超声检查,所有患者接受腹腔镜下胆囊息肉切除术,取组织行病理学检查。以后者为金标准,采用Kappa系数检验,分析高频超声联合彩色多普勒超声检查的诊断价值。结果 在71例PLG患者中,经组织病理学检查,诊断为良性病变67例,腺癌4例;高频超声联合彩色多普勒超声检查诊断为良性病变66例(98.5%),高频超声或彩色多普勒超声检查诊断分别为64例(95.5%)和63例(94.0%),无显著性差异(P>0.05);使用高频超声联合彩色多普勒超声检查诊断PLG的敏感度、特异度、准确率分别为98.5%、100.0%和98.6%,与组织病理学检查的一致性(Kappa=0.881),显著高于高频超声诊断(分别为95.5%、75.0%、94.4%,Kappa=0.571)或彩色多普勒超声检查诊断(94.0%、75.0%、93.0%,Kappa=0.510)。结论 使用高频超声联合彩色多普勒超声检查诊断和判断胆囊息肉样病变性质的准确度较高,能够指导临床作出合适的处理决定。

子宫内膜息肉样病变超声图像特征、血流动力学特点及诊断价值

目的:探究子宫内膜息肉样病变超声图像特征、血流动力学特点及诊断价值。方法:选取本院2019年1月-2022年1月收治的480例初诊提示子宫内膜息肉样病变患者,彩超检查并分析超声图像与血流动力学特点,以手术病理结果为金标准,分析超声对于宫内膜息肉样病变的诊断价值。结果:480例病理结果显示,诊断为单纯子宫内膜息肉189例(39.4%)、子宫内膜息肉合并子宫内膜癌8例(1.7%)、非子宫内膜息肉283例(59.0%);超声检查结果显示,480例中诊断为子宫内膜息肉223例(46.5%),其中分泌期子宫内膜2例、子宫黏膜下肌瘤5例、子宫内膜增生44例,误诊率51例(10.6%)。部分子宫内膜息肉息肉样病变超声图像显示中高回声结节并伴有粗大条状传入血流信号,多数患者超声图像表现为宫腔内边界清晰,内壁乳头状回声(多为强回声)向宫腔内突出,底部有蒂,基底宽呈椭圆形(或梭形);与病理检查结果对照,超声检查诊断子宫内膜息肉样病变的敏感度90.0%、特异度81.8%、准确率85.0%、阳性预测值为76.2%、阴性预测值为92.6%,Kappa为0.695。结论:子宫内膜息肉样病变的鉴别中可选用诊断效能较好的超声检查作为辅助筛查。

经腹彩超对良性胆囊息肉样病变的诊断结果与手术病理结果对比分析

目的探讨经腹彩超对良性胆囊息肉样病变的诊断价值,分析超声影像学图像,以此为临床诊断提供依据。方法选取2018年1月—2022年12月江苏省启东市中医院超声科收治的疑似胆囊息肉样病变(polypoid lesions of gallbladder,PLG)患者90例,均实施经腹彩超检查,以手术病理结果为金标准,分析超声诊断价值及临床诊断一致性。结果经手术病理检查,83例PLG患者中,有69例胆固醇息肉,腺肌症1例,腺瘤性息肉13例,经腹部彩超诊断的符合率为97.59%,经腹部彩超诊断良性PLG的灵敏度、特异度、准确度分别为96.39%、85.71%、95.56%;与手术病理相比,其一致性高(Kappa=0.726,P<0.05)。结论经腹部彩色多普勒超声对良性胆囊息肉样病变诊断符合率高,诊断价值高,可为临床诊断提供必要帮助。

高频超声联合超微血管成像对胆囊息肉样病变的诊断价值

目的 探讨高频超声(HFU)联合超微血管成像(SMI)对胆囊息肉样病变(PLG)的诊断价值。方法 选择2020年4月至2022年5月医院收治的PLG患者96例,均接受HFU、SMI检查,以手术病理诊断为金标准,分析HFU、SMI单独及联合诊断PLG的效能。结果 手术病理诊断结果显示,96例患者中恶性24例(胆囊癌13例,腺癌11例),良性72例(胆囊结石5例,炎性息肉12例,胆固醇性息肉51例,腺瘤4例)。HFU联合SMI诊断PLG的灵敏度、特异度、准确度及阳性预测值均高于HFU、SMI单独诊断,差异均有统计学意义(P<0.05);HFU、SMI单独诊断PLG的灵敏度、特异度、准确度、阳性预测值及阴性预测值比较,差异均无统计学意义(P>0.05)。结论 HFU联合SMI诊断PLG的灵敏度、特异度、准确度及阳性预测值均高均较高,可为临床诊疗方案的制订提供依据。