协和医学杂志

2017, v.8(01) 14-19

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术前超声检查对软组织肿瘤相关性低磷骨软化症诊断及术前定位的指导价值
Value of Preoperative Ultrasound in the Diagnosis and Localization of Soft-tissue Tumor-associated Hypophosphatemic Osteomalacia

汪培英;姜玉新;朱沈玲;刘如玉;夏宇;朱庆莉;齐振红;蔡胜;李建初;刘真真;赵瑞娜;赖兴建;张青;张波;
WANG Pei-ying;JIANG Yu-xin;ZHU Shen-ling;LIU Ru-yu;XIA Yu;ZHU Qing-li;QI Zhen-hong;CAI Sheng;LI Jian-chu;LIU Zhen-zhen;ZHAO Rui-na;LAI Xing-jian;ZHANG Qing;ZHANG Bo;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;Department of Medical Imaging,Electricity Worker Hospital of Guizhou Power Grid Co.,LTD.;

摘要(Abstract):

目的探讨术前超声诊断对软组织肿瘤相关性低磷骨软化症病变手术定位切除的指导价值及良恶性病灶成像特征。方法回顾分析北京协和医院2005年1月至2016年6月收治的63例软组织肿瘤相关性低磷骨软化病患者的临床资料及术前超声图像资料,对照手术及病理结果,分析超声图像特征,比较良恶性超声特征差异。结果 63例患者的65个病变全部在术前超声定位下完整切除,病理结果均为磷酸盐尿性间叶组织肿瘤,其中良性病灶56个,中位最大径2.3 cm(1.6~3.3 cm),恶性病灶9个,中位最大径3.0 cm(2.5~5.5 cm),两者差异无统计学意义(P>0.05)。恶性结节钙化和血流信号丰富的比例高于良性结节,差异有统计学意义(100%/62.5%和66.7%/28.57%,P均<0.05)。其他征象如形态、边界、边缘特征、内部回声、回声水平、均匀性差异均无统计学意义(P均>0.05)。良恶性结节的成像模式具有差异(P=0.009),恶性病变66.7%为Ⅰ类,33.3%为Ⅱ类;良性病变80.3%为Ⅱ类和Ⅲ类。结论术前超声定位可以帮助手术完整切除软组织肿瘤相关性低磷骨软化病变,部分超声特征及成像模式对于鉴别良恶性病灶有帮助。
Objective To study the role of preoperative ultrasound in the targeted removal of soft-tissue tumor-associated hypophosphatemic osteomalacia,and to explore ultrasound features of benign and malignant lesions. Methods We reviewed the sonographic and clinical records of 63 patients with soft-tissue tumor-induced hypophosphatemic osteomalacia who were treated at Peking Union Medical College Hospital between January 2005 and June 2016. Compared with surgical and pathological results,we retrospectively analyzed the ultrasonic features of benign and malignant lesions. Results All 65 lesions in the 63 patients were removed completely and successfully as guided by preoperative localization with ultrasound. Pathology identified them all as phosphaturic mes-enchymal tumors,including 56 benign lesions and 9 malignant lesions. The median maximum diameter of the benign group was 2. 3( 1. 6- 3. 3) cm,and that of the malignant group was 3. 0( 2. 5- 5. 5) cm,there was no statistically significant difference between the two groups( P > 0. 05). The malignant lesions were more likely to be of calcificacion and rich blood flow signals than benign lesions( 100%/62. 5%,66. 7%/28. 57%,both P < 0. 05).Other features such as shape,margin,border,structure,echogenicity and echo uniformity were found with no statistically significant difference( all P > 0. 05). The ultrasound pattern was different between benign and malignant lesions( P = 0. 009),and 66. 7% of the malignant lesions were in classⅠ,33. 3% were in classⅡ,while 80. 3% of the benign lesions were in classes Ⅱ and Ⅲ. Conclusions Ultrasonic preoperative localization could help guide complete resection of soft-tissue tumor-associated hypophosphatemic osteomalacia. Some specific ultrasound features and imaging patterns may be useful to differentiate malignant and benign lesions.

关键词(KeyWords): 软组织肿瘤相关性低磷骨软化症;超声;定位
soft-tissue tumor-associated hypophosphatemic osteomalacia;ultrasound;localization

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作者(Author): 汪培英;姜玉新;朱沈玲;刘如玉;夏宇;朱庆莉;齐振红;蔡胜;李建初;刘真真;赵瑞娜;赖兴建;张青;张波;
WANG Pei-ying;JIANG Yu-xin;ZHU Shen-ling;LIU Ru-yu;XIA Yu;ZHU Qing-li;QI Zhen-hong;CAI Sheng;LI Jian-chu;LIU Zhen-zhen;ZHAO Rui-na;LAI Xing-jian;ZHANG Qing;ZHANG Bo;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;Department of Medical Imaging,Electricity Worker Hospital of Guizhou Power Grid Co.,LTD.;

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