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摘要:
目的 探讨灰阶超声和彩色多普勒在鳃裂囊肿和鳃裂瘘管诊断中的应用价值。 方法 回顾性分析北京协和医院2010年1月至2014年1月收治的19例鳃裂囊肿和鳃裂瘘管患者的临床资料及超声图像资料, 对照手术及病理结果, 分析其超声图像特征。 结果 鳃裂囊肿共14例, 包括第一鳃裂囊肿5例, 第二鳃裂囊肿9例; 鳃裂瘘管共5例, 包括第一鳃裂瘘管1例, 第二鳃裂瘘管2例, 第三鳃裂瘘管1例, 第四鳃裂瘘管1例。13例(92.8%)鳃裂囊肿超声表现为形态规则的圆形、类圆形或椭圆形, 仅1例形态不规则; 12例(85.7%)边界清晰, 2例(14.3%)边界不清; 7例(50%)呈无回声, 其中2例内部多数点状回声漂浮, 挤压时可移动; 2例(14.3%)为囊实性; 4例(28.6%)为实性不均质低回声; 彩色多普勒显示4例(28.6%)周边条状血流, 10例(71.4%)未见血流信号。4例(80%)鳃裂瘘管超声表现为条状或不规则低回声, 2例(40%)显示瘘管回声; 1例(20%)为片状低回声, 形状不规则; 3例(60%)为实性, 2例(40%)为囊实性; 彩色多普勒显示2例(40%)内部可见条状血流, 1例(20%)边缘条状血流, 2例(40%)未见血流信号。 结论 鳃裂囊肿和鳃裂瘘管具有典型的超声成像特征, 可为临床提供不可或缺的诊断信息。 Abstract:Objective To investigate the value of gray-scale and color Doppler ultrasound in the diagnosis of brachial cleft cysts and brachial cleft fistulas. Methods The sonographic and clinical records of 19 patients with pathologically proven brachial cleft cysts and brachial cleft fistulas between January 2010 and January 2014 were retrospectively reviewed and the sonographic characteristics of the brachial cleft abnormalities were analyzed. Results Fourteen cases were diagnosed as brachial cleft cysts (5 were First, 9 were Second), 5 cases were diagnosed as brachial cleft fistulas (1 was First, 2 were Second, 1 was Third, 1 was Fourth). On the ultrasound, the brachial cleft cysts manifested as round or oval in 92.8% (13/14), and 85.7%(12/14) had a sharp border; 50.0%(7/14) were echo-free, and floating echo points could be found in 2 of them. Also, 14.3%(2/14) had solid cysts with small cystic structure, and 28.6% (4/14) had purely heterogeneous solid cysts. Color Doppler flow imaging(CDFI) showed 28.6%(4/14) were peripherally vascularized and 71.4%(10/14) were not vascularized. In the 5 patients with brachial cleft fistulas, 4(80%) had hypo-echoic strips or irregular shape, 2(40%) showed the fistula, 3(60%) were solid, and 2(40%) were mixed solid and cyst. CDFI showed 2(40%) were inner-part vascularized, 1(20%) was peripherally vascularized, and 2(40%) were not vascularized. Conclusion Brachial cleft cysts and brachial cleft fistulas have typical ultasound manifestations, which can guide the preoperative diagnosis of these diseases. -
Key words:
- brachial cleft abnormality /
- branchioma /
- fistula /
- ultrasound /
- diagnosis
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图 1 女，18岁，发现左侧下颌下方肿块2个月
超声：左上颈部囊性包块5 cm×3 cm，边界清，形态规则，内部可见多数点状回声，压之漂浮；手术：分离并完整切除肿物，切开肿物，囊内壁不光滑；病理：包膜完整，内为黄色干酪样分泌物，符合第二鳃裂囊肿
图 2 男，60岁，发现左耳前肿物1年余
超声：左侧腮腺内见2.0 cm×1.1 cm混合回声，边界清，大部分为无回声，内见强回声光点，无血流信号；手术：肿物位于腮腺浅叶内，完整切除；病理：腮腺囊肿，伴出血，符合第一鳃裂囊肿
图 3 女，28岁，发现左耳前肿物2个月
超声：右侧腮腺下极前方皮下软组织内可见低回声，0.6 cm×0.5 cm，边界尚清晰，内部回声欠均，可见点状强回声，其后方与腮腺关系密切，可见尾样条状低回声向后方斜行，范围0.3 cm×0.05 cm，呈“蝌蚪征”(箭头)；彩色多普勒：低回声边缘条状血流信号；手术：完整切除肿物、深部瘘管及周围部分腮腺组织；病理：符合瘘管伴感染，局灶坏死伴脓肿形成，内可见管样结构，一侧附有少许黏膜，切面可见管腔，符合第一鳃裂瘘管
图 4 女，9岁，左颈部肿物3年，近期突然增大
超声:左颈中部软组织内见低回声4.1 cm×3.0 cm× 2.4 cm，最浅表处距体表 0.3 cm，后方达甲状软骨左侧，形态不规则，沿肌间隙走行分布，靠近梨状窝处可见低回声条状瘘管回声(箭头); 彩色多普勒:内部条状血流；手术：瘘管于甲状腺上极穿入梨状窝尖相通，分离并切除瘘管；病理：符合第三鳃裂瘘管
表 1 19例鳃裂异常患者的临床资料
病理诊断 性别
(男/女，例)位置
(左侧/右侧，例)手术次数
(次/例)第一鳃裂囊肿 3/2 1/4 1/3，2/2 第二鳃裂囊肿 4/5 4/5 1/6，2/3 第一鳃裂瘘管 0/1 1/0 1/1 第二鳃裂瘘管 1/1 0/2 1/1，2/1 第三鳃裂瘘管 0/1 1/0 4/1 第四鳃裂瘘管 0/1 1/0 3/1 
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表 2 不同类型鳃裂囊肿和鳃裂瘘管的超声表现及定位诊断和误诊病例
诊断 部位 大小
(cm)形态 边界 回声水平 内部结构 彩超 定位
(例)误诊 第一鳃裂
囊肿腮腺内、耳后、
耳下0.8×0.5~
5.8×2.7圆形、类圆形、
椭圆形4/5清,
1/5欠清低回声、无
回声无回声内多量点状
回声无或边缘少许
多条状血流5/5 2/5例考虑淋巴
结肿大第二鳃裂
囊肿颌下、胸锁乳突
肌前缘、后方1.0×0.8~
9.5×8.58/9类圆形、椭圆
形，1/9不规则8/9清，
1/9欠清低回声、无
回声部分无回声内细密
光点无或边缘少许多条状血流 9/9 2/9例考虑淋巴
结肿大第一鳃裂
瘘管乳突下方、下颌
骨后方3.2×2.0 条状、不规则 不清 低回声 实性 内部短条状
血流1/1 1/1例考虑炎性
病变第二鳃裂
瘘管胸锁乳突肌与带
状肌之间、皮下3.0×0.5~
11.0×2.0管状、不规则 不清 低回声 1/2实性、1/2囊
性内部细密光点未见血流信号 2/2 1/2例考虑炎性
病变第三鳃裂
瘘管左颈中部、甲状
腺上极2.0×1.9 大片状 不清 低回声，气
体强回声实性 内部条状血流 1/1 1/1例考虑瘘合
并急性甲状腺炎第四鳃裂
瘘管左颈前皮下 1.3×0.5 不规则条状 不清 低回声 囊实性 边缘 1/1 1/1例考虑炎性
病变
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