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目的分析恶性腹膜间皮瘤(peritoneal malignant mesothelioma,PMM)的超声声像图特征,探讨超声对PMM的诊断价值及误、漏诊原因。方法对经手术及超声引导下组织活检证实的7例PMM声像图及其中4例彩色多普勒血流特点进行分析。结果PMM的声像图表现为:①壁层腹膜不规则非均匀性增厚,或类似结节样、凹凸不平的丘状隆起病灶;②腹腔内网膜、肠系膜及肝、脾等表面结节样肿块;③较大结节肿块内、不规则增厚或结节状、丘状腹膜病灶内有丰富的血流信号。误、漏诊的原因主要是对本病的认识不清,对由其病理变化而产生的相应超声影像学改变不了解,而低频常规探头近场显示不佳及肠腔的不同程度梗阻也影响了病灶的显示。结论在腹部常规探头检查的基础上,应用高频超声探头及彩色多普勒超声显像可较好地显示PMM的腹膜病灶。符合上述超声表现,同时结合临床症状、体征可作出PMM的初步诊断。在超声引导下对病灶进行组织活检,其病理组织学及免疫组化检查可确诊。
Objective To analyze the ultrasonographic features of peritoneal malignant mesothelioma (PMM) and investigate the diagnostic value of ultrasonography for PMM and its causes of misdiagnosis and missed diagnosis. Methods Seven cases of PMM sonography confirmed by operation and ultrasound-guided tissue biopsy and four cases of color Doppler flow characteristics were analyzed. Results PMM sonography showed: ① parietal irregular peritoneal irregularity thickening, or similar nodular, uneven mound bulge lesions; ② intra-abdominal omentum, mesentery and liver, spleen and other surface nodules Like mass; ③ larger nodular mass, irregular thickening or nodular, mound-like peritoneal lesions have a rich blood flow signal. Misdiagnosis and missed diagnosis mainly due to unclear understanding of the disease, caused by its pathological changes caused by the corresponding ultrasound imaging changes do not understand, and low-frequency conventional probe near field display poor and varying degrees of intestinal obstruction also affected Display of lesions. Conclusion On the basis of conventional abdominal examination, high frequency ultrasound probe and color Doppler ultrasound imaging can better show peritoneal lesions of PMM. Meet the above ultrasound performance, combined with clinical symptoms and signs can make a preliminary diagnosis of PMM. Ultrasound-guided tissue biopsy of the lesion, the histopathology and immunohistochemistry can be diagnosed.