作者：李颖，燕晶晶，王薇，孙金如，张彤迪，李沐涵

单位：

1.河北省直属机关第一门诊部超声科2.河北省直属机关第一门诊部内科3.河北医科大学第二医院腹部超声科4.天津中医药大学

Units：

1.Department of Ultrasound, the First Outpatient Department of Organs Directly under Hebei Province, Shijiazhuang 050051, China 2.Department of Internal Medicine, the First Outpatient Department of Organs Directly under Hebei Province, Shijiazhuang 050051, China 3.Department of Abdomen Ultrasound, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China 4.Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China

关键词：

憩室,食管; 超声检查; 动态试验;

Keywords：

Diverticulum, esophageal; Ultrasonography; Dynamic test

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.143

Funds：

摘要：

目的 分析超声检查及动态试验在颈段食管憩室中的应用价值。方法 2015年4月至2021年12月在河北省直属机关体检中心进行体检者有12 666例，回顾性选取其中通过超声检查及动态试验首次发现颈段食管憩室的8例患者为研究对象。收集患者一般资料和超声检查、动态试验、随访结果。结果 8例颈段食管憩室患者的病灶均位于甲状腺左叶后方；最大径4.20～22.80 mm；呈类圆形或椭圆形；前缘边界清，光滑平整；均未探及明确彩色血流信号。最大径<10.00 mm的病灶周边呈均质低回声，与食管壁回声一致，病灶中心合并强回声且形态各异；最大径≥10.00 mm的病灶以中等回声为主，低回声壁较最大径<10.00 mm的病灶薄，病灶内合并点状强回声及片状无回声区。加压后只有病灶最大者有形态变化（前后径线变小）。7例患者可清晰显示和食管回声一致的层次结构。7例明确病灶周边低回声后缘与食管相延续；6例吞咽口水试验阳性者的病灶最大径均<10.00 mm,1例饮水试验阳性者的病灶最大径为13.80 mm,1例口服造影剂试验阳性者的病灶最大径>20.00 mm。病灶最小者随访了5年，其病灶平均每年增长0.52 mm；其余5例病灶最大径<10.00 mm者随访了3～5年，病灶平均每年增长0.80～1.00 mm；病灶最大径为13.80 mm者随访了2年，病灶平均每年增长1.50 mm。结论 当超声检查发现位于颈段食管走行区的病灶时，如其前缘边界清晰，后缘与食管相延续，并伴有特征性的气体样强回声，结合动态试验即可诊断为颈段食管憩室。超声检查及动态试验可以准确诊断颈段食管憩室，可作为颈段食管憩室筛查和随访的首选方法。

Abstract：

Objective To analyze the application value of ultrasound and dynamic test in cervical esophageal diverticulum. Methods From April 2015 to December 2021, a total of 12 666 patients underwent physical examination in Hebei Provincial Physical Examination Center, and 8 patients with cervical esophageal diverticulum first detected by ultrasound and dynamic test were retrospectively selected as the study objects. General data, ultrasonography and dynamic test results and follow-up results of patients were collected. Results The lesions of 8 patients were located behind the left lobe of thyroid gland; their maximum diameter was 4.20-22.80 mm; they were circular or elliptic; their front boundary was clear, smooth and flat; and no clear color blood flow signal was detected in them. The periphery of the lesion with the maximum diameter < 10.00 mm showed homogeneous hypoecho, consistent with the echo of the esophageal wall, and the center of the lesion combined with strong echo of different shapes. The lesions with the maximum diameter ≥ 10.00 mm were mainly medium echo, the low echo wall was thinner than the lesions with the maximum diameter < 10.00 mm, and there were spot strong echo and flake anechoic area in the lesions. After pressure, only the largest lesion showed morphological changes (the anteriorposterior diameter became smaller) . Seven patients can clearly display a hierarchical structure consistent with esophageal echoes. The posterior margin of peripheral hypoechoic echo continued with esophagus in 7 cases. The maximum focal diameter of 6 patients positive in swallowing saliva test was < 10.00 mm, the maximum focal diameter of 1 patients positive in drinking water test was 13.80 mm, and the maximum focal diameter of 1 patient positive in oral contrast test was > 20.00 mm. The patients with the smallest lesions were followed up for 5 years, and the average annual growth of lesions was 0.52 mm. The other 5 patients whose maximum lesion diameter was < 10.00 mm were followed up for 3 to 5 years, and the average annual lesion growth was 0.80 to 1.00 mm. Patients with a maximum lesion diameter of 13.80 mm were followed up for 2 years, and the average annual lesion growth was 1.50 mm. Conclusion When ultrasound examination reveals a lesion located in the cervical esophageal transit area, if the anterior boundary is clear, the posterior edge continues with the esophagus, and is accompanied by characteristic gas like strong echoes, combined with dynamic testing, it can be diagnosed as a cervical esophageal diverticulum. Ultrasound examination and dynamic testing can accurately diagnose cervical esophageal diverticulum, and can be the preferred method for screening and follow-up of cervical esophageal diverticulum.

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