梅丽霞 韩瑞 才文雅 李竞

[摘要] 目的 探究动态三维超声造影在鉴别肝肿瘤良恶性中的应用价值。方法 方便选择2014年5月—2015年11月之间，在该院就诊的肝占位的患者50例，包括病理穿刺或手术证实的恶性组、良性组，采用动态三维超声造影，观察两组患者的占位性病灶的增强方式类型、分布以及病变血管形态，并且进行分析比较。 结果 在动态三维超声造影成像中，恶性组患者主要以整体增强和环状增强为主，而良性组主要以向心型增强为主；良性肿成像出供血血管走行较平直规则以及内部规则的小血管；恶性肿瘤显示了背部走行扭曲的小血管或血管团、走行杂乱蜿蜒的滋养血管；两组患者的内部小血管的走势形态差异有统计学意义（χ2=20.589，P<0.05）、滋养血管的走势、特点形态差异有统计学意义（χ2=11.746，P<0.05）。结论 针对肝脏占位性病变的患者，选择动态三维超声造影进行检测，可以很容易区分肿瘤良恶性图像的增强方式差别、供血血管以及内部小血管的走行、形态的特点，能够更加直观、有效的区分肝肿瘤的良恶性。

[关键词] 动态三维超声；肝肿瘤良恶性；造影剂

[中图分类号] R735.7 [文献标识码] A [文章编号] 1674-0742（2016）03（c）-0193-02

Application Research on Dynamic Three-dimensional Hysterosalpingo-contrast Sonography in Differentiating the Benign and Malignant Liver Tumors

MEI Li-xia， HAN Rui， CAI Wen-ya， LI Jing

Department of Ultrasound， Qiqihaer First Hospital， Qiqihar， Heilongjiang Province， 161000 China

[Abstract] Objective To discuss the application value of dynamic three-dimensional hysterosalpingo-contrast sonography in differentiating the benign and malignant liver tumors. Methods 50 cases of patients with focal space-occupying lesions in liver treated in our hospital from May 1， 2014 to November 1， 2015 were selected and divided into the malignant group and the benign group confirmed by pathological biopsy or operation， the enhancement method types， distributions and lesion vessel forms of occupying lesions of the two groups were observed， analyzed and compared. Results In dynamic three-dimensional hysterosalpingo-contrast sonography， the global enhancement and ring enhancement were the mains in the malignant group， while the concentric enhancement was the main in the benign group， the benign tumor imaging showed the small vessels whose trends were straight regular and internal regular， the malignant tumor imaging showed the small vessels whose dorsal trends were distorted or vascular mass， nutrient vessels whose trends were messy and winding， the differences in the trend and form of internal small vessel between the two groups were obviou（χ2=20.589， P<0.05）， the differences in the trends， characteristics and forms of the nutrient vessels between the two groups were obvious（χ2=11.746， P<0.05）， which were statistically significant. Conclusion For the patients with focal space-occupying lesions in liver， the dynamic three-dimensional hysterosalpingo-contrast sonography detection can easily distinguish the differences of the enhancement methods of benign and malignant tumor imaging and the characteristics of trends and forms of supplying blood vessels and internal small vessels， and can distinguish the benign and malignant liver tumors more intuitively and effectively.

[Key words] Dynamic three-dimensional ultrasound； Benign and malignant liver tumors； Contrast medium

肝肿瘤在临床上是指发生在肝脏部位的肿瘤性病变。同时肝脏也属于肿瘤好发部位，其中良性肿瘤比较少见，而恶性肿瘤中转移性肿瘤比较多见[1]。一般原发性肿瘤经常发生在胆管上皮、肝细胞索及血管等处。而转移性肿瘤的性质一般多为转移性癌，少数是穿衣性肉瘤。目前，超声造影可实时观察肝肿瘤在不同时相的血流变化特点，并且在这个优势基础上的三维超声造影技术，能够清晰的显示肝肿瘤血管的空间结构[2]。但是，一般的三维超声局限于静态的呈现，不可以实时的动态灌注过程，而动态三维超声则可以突破这一局限。……