摘 要 目的：采用二维声像图和彩色多普照勒血流显像（CDFI）对33例腮腺恶性肿瘤进行研究，探讨其超声诊断依据。方法： 除按常规方法观察觉肿瘤外，注重在检查中利用探头按压、推移肿瘤，借此感知其质地和活动度、有无压缩改变。并作同侧颈深 上淋巴结检查间接协助诊断。结果：声像图显示肿瘤质地坚硬25例、活动度无或欠佳239例误诊者进行了分析。结论：超声诊断主要以二维像图的特点你综合分析，肿瘤质地和活动度以及颈深上淋巴结有无转移在诊断时有一定的价值。CDFI能在志像图上提供肿瘤的血管分布和血流的信息。
关键词 腮腺恶性肿瘤 声像图特点 颈深上淋巴结转移 彩色多普勒血流显像
Ultrasonographic Study on Malignant Tumors in the Parotid Gland
Lu Linguo, Yan Shan, Xu Qiuhua
Dept. Ultrasound, The Ninth people’s Ho ital, Shanghai Second Medical University, Shanghai 200011 chia
A TRACT Objective: The purpose of this research is to study 33 cases of malignant tumors in the parotid gland with two-dime ional ultrasonography (2-D) and color Ko ler flow imaging (CDFI) and to evaluate the diagnostic evidences of malignant tumors. Methods: In addition to routine o ervation, the research emphasized to pre tumors with the tra ducer during examination to o erve the hardne , mobility and dime ional changes. Besides, the nodi lymphatici cervicales profundi superiores of the e ilateral side were also examined to a ist the diagnosis. Results: Ultrasound image showed that the cases of tumors were 25 in hardne , 23 in le mobility, 11 in metastasing to the nodi lymphatici cervicales profundi superiores of the e ilateral side (9/11 confirmed by pathology). The accuracy rate for the diagnosis of parotid malignant tumor was 73%. Analyses were also done on 9 misdiagnosed cases. Conclusio : The diagnosis of ultrasound depends mainly on 2-D. Besides, tumor hardne , mobility and metastasis of the nodi lymphatici cervicales profundi superiores of the e ilateral side can a ist the diagnosis. CDFI can provide the information of the ve el distribution and blood flows of tumors.
KEY WORDS Malignant tumor in the parotid gland Features of ultrasonography Metastasis of the nodi lymphatici cervicales profundi superiores CDFI
腮腺恶性肿瘤报道较少，病种较多，声像图常具有其共性和特性。本文旨在运用二维声像对其进行研究分析，利用肿瘤的物理特性及远处转移，试图归纳总结出腮腺恶性肿瘤的声像图共性，探讨其超声诊断依据。
资料与方法
从1997~1999年在我院口腔外科住院患者，经手术和病理证实为腮腺恶性肿瘤者33例，男16例，女17例，年龄5~82岁，平均50岁。仪器为LOGIQ700和AI-4。探头频率10MHz，彩色频率7.5MHz 。检查方法和观察肿瘤指标见参考文献[1]，并注重在超声检测下，用探头按压、推移肿瘤进一步观察其质地和活动度；以及作同侧颈深上淋巴结扫查。在理想的灰阶图上用CDFI观察病灶部位血流情况，脉冲多普勒取样角度<60度。
结 果
腮腺恶性肿瘤最大只为48mm×28mm×47mm,最小只为7mm×6mm×5mm,多数肿瘤大小为20～30mm。声像图示：内部回声均呈低回声；实质不均匀18例，囊实混合型15例；多发5例，单发28例；肿瘤的声像图特点见表1.显示同侧颈深上淋巴结肿在呈转移灶声像图11例（其中9例经病理证实）；1例转移灶灶超漏诊。超声诊断：恶性肿瘤11例，恶性肿瘤可能13例，良性肿瘤9例，诊断正确率73％。
表1 33例腮腺恶性肿瘤声像图特点（单位： 例）
内部回声 境界 形态 形态 活动度
病种 例数
欠 不 清 欠 不 圆或 欠 不 中 硬 佳 欠 不
均 均 晰 清 清 椭圆形 规则 规则 佳 佳
粘液表皮样癌 7 7 2 3 2 4 3 1 6 3 2 2
腺泡细胞癌 5 3 2 1 2 2 1 4 2 3 1 1 3
恶性多形性腺瘤 4 1 3 3 1 1 2 1 2 2 3 1
恶性淋巴上皮病 3 3 1 2 2 1 3 1 2
未、低分化癌 5 5 1 3 1