形似軟組織腫瘤的血腫塊

Hematomas Mimicking Soft-tissue Tumors

本研究目的為評量現今主要體血腫塊（somatic hematoma）臨床診斷評估方法與其敏感度。本研究十年（1995-2005）回溯整理，共收集四十位病例，全部病患皆曾接受過手術，且術中發現或術後病理診斷為血腫塊。腫瘤的診斷評估方式包括詳細病史詢問與理學檢查、X 光、超音波、磁振照影（magnetic resonance imaging, MRI）、電腦斷層（computed tomography, CT）、骨骼鎝掃描檢查（Technetium-99m bone scans）與杜卜勒雙重式超音波檢查（duplex ultrasonography）。在經過病史詢問與理學檢查後，依情況需要再個別安排進一步檢查，其中8 位病患只有接受詳細的病史詢問與理學檢查後接受手術、17 位病患使用1 種診斷評估工具後接受手術、10 位病患使用2 種診斷評估工具後接受手術、5 位病患使用3 種診斷評估工具後接受手術。「其手術方法包括抽吸術（aspiration）、病灶內切除術（intralesional excision）、病灶邊緣切除術（marginal excision）、清創術（debridement）、筋膜切開術（fasciotomy）與分層植皮術（split-thickness skin graft, STSG）」。全部40 位病患皆曾接受詳細的病史詢問與理學檢查，而其診斷敏感度為12.5％（5/40）；9 次接受磁振照影檢查的敏感度為56％（5/9）；6 次接受電腦斷層檢查的敏感度為50％（3/6）；6 次接受超音波檢查的敏感度為33％（2/6）。綜合前述其結果是詳細病歷詢問與理學檢查，可作為體血腫塊的初步診斷評估工具。小型或表淺的腫塊可使用超音波檢查評估。磁振照影最適合鑑別診斷四肢的血腫塊與軟組織腫瘤。電腦斷層因擷取影像時間較短暫、可應用於胸腹部檢查，但在診斷及治療上，仍應取得組織及病理檢查，才可以判定。

The purpose of this study was to evaluate the main diagnostic methods and their sensitivities of hematomas. In this 10-years retrospective review (1995-2005), we collected 40 patients of hematoma and all of them underwent operations. The diagnosis of hematomas was according to the intra-operative findings or the pathologic reports. The diagnostic methods included the detail history taking and physical examination, magnetic resonance imaging (MRI), computed tomography (CT), plain radiography, ultrasonography, Technetium-99m bone scans and duplex ultrasonography. The further image studies were arranged individually after comprehensive history taking and physical examination. Eight patients underwent surgery after detail history taking and physical examinations only. Seventeen patients underwent surgery after using one diagnostic tool. Ten patients underwent surgery after using two diagnostic tools. Five patients underwent surgery after using three diagnostic tools. The operation methods included aspiration, intralesional excision, marginal excision, debridement, fasciotomy and split-thickness skin graft(STSG). In this study, the diagnostic sensitivity of somatic hematoma in all forty patients was 12.5% (5/40) in isolated detail history taking and physical examinations, 56% (5/9) in 9 times of MRI examinations, 50% (3/6) in six times of CT scans and 33% (2/6) in six times of ultrasonography. We concluded that detail history taking and physical examinations could provide the initial diagnosis of somatic hematoma. Small or superficial mass could be detected by ultrasonography. MRI was the most diagnostic imaging modality of choice for differentiating the soft-tissue neoplasm from the somatic hematoma in extremities. CT allowed the shorter image acquisition time for taking examinations in abdomen or chest. However, biopsy with histopathological examination is needed for final validation