超声对咽食管憩室的临床诊断价值分析

　　[摘要] 目的 探討和分析超声对于咽食管憩室的临床诊断价值。方法 回顾性分析2005年2月—2016年9月经彩超检查后，通过手术、颈部CT或者X线钡剂造影、以及胃镜证实而确诊的36例咽食管憩室患者，对其声像图特征进行总结分析。结果 36例咽食管憩室，大小都处在6 mm×4 mm～18 mm×12 mm之间，位置也都处在甲状腺左侧叶的后部。经超声声像检查发现以下特点：都位于甲状腺左侧叶的后方，9例显现蝌蚪形，其余以类圆形多见，4例较大者只能模糊的展现和食管壁的关系；让受检者做吞咽动作之后，见到24例病灶和甲，状腺之间产生了相对运动，另外12例则没有相对运动；通过探头进行加压后，20例外在形状与内部强回声形状具有显著改变，16例没有较大改变；在饮水与吞咽唾液后，26例病灶区内有气体强回声现象与唾液现象、或是病灶区内的点状强回声现象显著降低甚至彻底消除，10例没有较大改变；采用彩色多普勒技术及B-flower技术均未显示血流信号。结论 憩室内点状或斑片状强回声，周边可见半环状、声晕状低回声与食管壁相连续，饮水后内部回声改变是咽食管憩室特征性超声表现；超声结合饮水试验多切面观察可提高其诊断准确度；采用彩色多普勒技术及B-flower技术可有效区别于甲状腺结节（71%的甲状腺结节可显示其周边及或内部血流信号）。这对该病的诊断及与甲状腺结节的有效鉴别诊断会产生极大的意义。
　　[关键词] 超声检查；咽食管憩室；饮水实验
　　[中图分类号] R445 [文献标识码] A [文章编号] 1674-0742（2018）01（c）-0025-03
　　[Abstract] Objective This paper tries to investigate and analyze the clinical value of ultrasonography in the diagnosis of pharyngeal and esophageal diverticulum. Methods From February 2005 to September 2016， 36 cases of pharyngoesophageal diverticulum diagnosed by color Doppler ultrasonography after surgery， neck CT or radiography， and gastroscopy were retrospectively reviewed to summarize their sonographic features. Results 36 cases of pharyngeal esophageal diverticulum， the size was between 6 mm×4 mm～18 mm×12 mm， the location was also in the left thyroid foliage at the back. The sonographic findings revealed the following features： all located in the posterior thyroid left lobe， 9 cases showed tadpole-shaped， others were more common round-like， 4 cases of larger could only vaguely show the relationship with the esophageal wall； After the swallowing action， the seizures of 24 cases and relatives of the thyroid gland and thyroid gland were observed. In the other 12 cases， there was no relative motion. After the probe was pressurized， the external shape and internal echo shape of 20 cases were significant changed， 16 cases did not change significantly； after drinking water and swallowing saliva， there were gas hyperechoic phenomenon and saliva phenomenon in 26 cases of lesion area， or point-like hyperechoic phenomenon in lesion area was significantly reduced or even completely eliminated， 10 cases did not have large changes； using color Doppler technology and B-flower technology did not show the blood flow signal. Conclusion Diverticulum punctate or spot-like hyperechoic， around the visible semi-annular sound hypoechoic echo and esophageal wall continuous after drinking water， the internal echo is pharyngeal esophageal diverticulum characteristic ultrasound； ultrasound combined with drinking water test multi-slice observation can improve its diagnostic accuracy； using color Doppler technology and B-flower technology can be distinguished from thyroid nodules （71% of thyroid nodules can show peripheral and / or internal blood flow signals）. This diagnosis of the disease and the effective identification of thyroid nodules will have a great significance.