彩色多普勒超声对甲状腺病变的诊断与病理结果的研究
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摘要
目的:探讨彩色多普勒超声对甲状腺病变诊断与病理结果的研究。
方法:1.研究对象2007年7月—2008年12月期间来我院就诊的甲状腺患者中,对较常见的甲状腺疾病198例患者进行临床随访证实,其中良性121例(慢性淋巴细胞性甲状腺炎41例,结节性甲状腺肿36例,腺瘤44例);甲状腺癌61例(乳头状癌28例,髓样癌8例,未分化癌7例,滤泡癌12例,淋巴瘤6例),男性91例,女性107例,年龄25～70岁。2.方法检查前患者无需特殊准备,对女性戴有项链的患者,于检查前取下,妥善保存,对穿高领上衣的患者,应脱去以便充分暴露颈前部位进行检查;常规二维纵横扫查,观察肿物生长部位、大小及声像图特征,再行彩色多普勒血流显像(CDFI)检查,观察并记录肿物内部回声及周边血流显示和分布情况;超声检查时患者采取仰卧位,充分暴露颈部,扫查时探头不对皮肤加压,以免肿瘤血管受压而影响血流参数。通过纵切面、横切面和斜切面时平行移动探头以全面了解肿瘤的大小、形态、内部结构;将198例甲状腺病变的患者进行分病种、类别做超声表现与病理结果等详细分析、对比、鉴别、研究。3.测量指标采用彩色多普勒(CDFI)和能量多普勒显像(CDF)观察甲状腺病变内血流分布状态及类型,测量收缩期峰值流速(Vmax)、舒张期峰值流速(Vmin);经过近一年半时间对所有患者进行跟踪随访,计算阻力指数(RI)进行分析、观察甲状腺病灶的二维图像及彩色多普勒血流分布、PW、RI及Vmax方面是具有显著性差异的(P＜0.05)。
结果:1.121例甲状腺良性结节的患者中,男性54例,女性67例,其中结节性甲状腺肿患者36例,甲状腺腺瘤患者44例,慢性淋巴细胞性甲状腺炎(桥本病)患者41例,所有病例手术后病理结果显示:彩色多普勒超声诊断符合率达92.6%,误差率达7.4%;61例甲状腺恶性结节的患者中,男性29例,女性32例,其中甲状腺乳头状癌28例,甲状腺滤泡样癌12例,甲状腺髓样癌8例,甲状腺未分化癌7例,甲状腺淋巴瘤6例,所有病例手术后与病理结果对比显示:彩色多普勒超声诊断符合率达88.5%,误差率达11.5%;16例甲状腺良恶性共同存在的患者中,男性7例,女性9例,病例手术后与病理结果对比显示:彩色多普勒超声诊断符合率达87.5%,误差率达12.5%。
2.经统计学处理证明通过彩色多普勒超声可以对甲状腺病变作出准确的诊断,并与病理结果比较的相关系数达0.89,由此得出彩色多普勒超声做为甲状腺病变的诊断方法具有一定的临床意义。
结论:1.彩色多普勒超声是一种非侵入性、无放射性及有效性等多个特点且价格低廉的检查手段,同时与其它方法相结合,将对早期临床诊断有决定性帮助,是除手术之外唯一可在术前观察结节大小、形状、性质及血流情况的检查手段。2.对颈部及锁骨上淋巴结转移,超声可以提示有无肿大淋巴结,对肥胖患者,触诊困难时,超声可以准确提供淋巴结大小及位置。3.彩色多普勒超声的二维声像图的表现以及CDFI的特点与病理诊断结果相符合,证明彩色多普勒超声做为甲状腺病变的诊断方法具有一定的临床意义。
Objective: Discusses colored Doppler supersonic to the thyroid gland pathological change diagnosis and the pathology result research。
Methods: 1. object of study in July, 2007 - December, 2008 period comesmy courtyard seeing a doctor in the thyroid gland patient, carries on the clinical revisit to the common thyroid gland disease 198 example patients to confirm, benign 121 examples (chronic lymph cellularity thyroiditis 41 examples, nodular goiter 36 examples, adenoma 44 examples); Thyroid cancer 61 examples (papilliform tumor 28 examples, marrow type cancer 8 examples, undifferentiation cancer 7 examples, follicle cancer 12 examples, lymphoma 6 examples), masculine 91 examples, feminine 107 examples, age 25-70 years old. 2. method Before the inspection, the patient does not need to prepare specially, wears to the female has necklace' s patient, takes down before the inspection, the preserve well, to puts on the high-necked coat' s patient, should take off before in order to expose the neck, the spot to carry on the inspection fully; The convention two-dimensional vertical sweeps away looks up, the observation goitre growth spot, the size and the acoustic image chart characteristic, colored Doppler the blood stream developing (CDFI) inspection, observes and records the goitre interior echo and the peripheral blood stream demonstration and the distributed situation again; When supersonic inspection the patient adopts the supine decubitus, exposes the pate fully, sweeps Zha Shi probe head not to skin compression, in order to avoid the tumor blood vessel bearing affects the blood stream parameter. Through when longitudinal section, cross section and bevelling surface parallel motion probe head by thorough understanding tumor size, shape, internal structure; Carries on 198 example thyroid gland pathological change's patient divides sickness to plant, the category to make the supersonic performance and the pathology result and so on multianalysis, the contrast, the distinction, the research. the 3. survey target uses colored Doppler (CDFI) and energy Doppler in the developing (CDF) observation thyroid gland pathological change the blood stream distribution condition and the type, survey systole peak value speed of flow (Vmax), relaxing period peak value speed of flow (Vmin); Carries on the track revisit after near one-and-a-half years time to all patients, computation drag index (RI) carries on the analysis, the observation thyroid gland infection's two-dimensional picture and the colored Doppler blood stream distribution, PW, RI and the Vmax aspect has the significance difference (P < 0.05).
Results: 1. in 121 example thyroid gland benign tubercle patient,masculine 54 examples, feminine 67 examples, nodular goiter patient 36 examples, thyroid gland adenoma patient 44 examples, chronic lymph cellularity thyroiditis (chronic lymphocytic thyroiditis) patient 41 examples, after all case surgery, the pathology result showed: Colored Doppler the ultrasound diagnosis coincidence rate reaches 92.6%, the error coefficient reaches 7.4%; in 61 example thyroid gland malignant tubercle patient, masculine 29 examples, feminine 32 examples, thyroid gland papilliform tumor 28 examples, thyroid follicle type cancer 12 examples, thyroid gland marrow type cancer 8 examples, thyroid gland undifferentiation cancer 7 examples, thyroid gland lymphoma 6 examples, after all case surgery, demonstrated with the pathology result contrast: The colored Doppler ultrasound diagnosis coincidence rate reaches 88. 5%, the error coefficient reaches 11.5%; 16 example thyroid gland good malignancy coexists in patient, masculine 7 examples, feminine 9 examples, after case surgery, demonstrated with the pathology result contrast: The colored Doppler ultrasound diagnosis coincidence rate reaches 87. 5%, the error coefficient reaches 12. 5%.2. passes through statistics processing proof supersonic to be possible to make the accurate diagnosis through colored Doppler to the thyroid gland pathological change, and reaches 0. 89 with the pathology result comparison correlation coefficient, from this obtains colored Doppler supersonic to do for the thyroid gland patho logical change' s diagnosis method has certain clinical significance.
Conclusion: 1. colored Doppler supersonic is one kind of non-invasive,does not have the radioactivity and valid and so on many characteristics and the low in price the inspection method, simultaneously unifies with other methods, will have the decisive help to the early clinical diagnosis, is may observe the tubercle size, the shape, the nature and the blood stream situation inspection method only except the surgery outside before the technique. 2. to the pate and the collar bone the lymph node shift, whether there is supersonic prompt the tumescent lymph node, when to obese patient, palpation difficulty, supersonic may provide the lymph node size and the position accurately. 3. the colored Doppler's supersonic two-dimensional acoustic image chart' s performance as well as the CDFI characteristic and the pathological diagnosis result tallies, proved that colored Doppler supersonic does for the thyroid gland tubercle diagnosis method has certain clinical significance.
方法:1.研究对象2007年7月—2008年12月期间来我院就诊的甲状腺患者中,对较常见的甲状腺疾病198例患者进行临床随访证实,其中良性121例(慢性淋巴细胞性甲状腺炎41例,结节性甲状腺肿36例,腺瘤44例);甲状腺癌61例(乳头状癌28例,髓样癌8例,未分化癌7例,滤泡癌12例,淋巴瘤6例),男性91例,女性107例,年龄25～70岁。2.方法检查前患者无需特殊准备,对女性戴有项链的患者,于检查前取下,妥善保存,对穿高领上衣的患者,应脱去以便充分暴露颈前部位进行检查;常规二维纵横扫查,观察肿物生长部位、大小及声像图特征,再行彩色多普勒血流显像(CDFI)检查,观察并记录肿物内部回声及周边血流显示和分布情况;超声检查时患者采取仰卧位,充分暴露颈部,扫查时探头不对皮肤加压,以免肿瘤血管受压而影响血流参数。通过纵切面、横切面和斜切面时平行移动探头以全面了解肿瘤的大小、形态、内部结构;将198例甲状腺病变的患者进行分病种、类别做超声表现与病理结果等详细分析、对比、鉴别、研究。3.测量指标采用彩色多普勒(CDFI)和能量多普勒显像(CDF)观察甲状腺病变内血流分布状态及类型,测量收缩期峰值流速(Vmax)、舒张期峰值流速(Vmin);经过近一年半时间对所有患者进行跟踪随访,计算阻力指数(RI)进行分析、观察甲状腺病灶的二维图像及彩色多普勒血流分布、PW、RI及Vmax方面是具有显著性差异的(P＜0.05)。
结果:1.121例甲状腺良性结节的患者中,男性54例,女性67例,其中结节性甲状腺肿患者36例,甲状腺腺瘤患者44例,慢性淋巴细胞性甲状腺炎(桥本病)患者41例,所有病例手术后病理结果显示:彩色多普勒超声诊断符合率达92.6%,误差率达7.4%;61例甲状腺恶性结节的患者中,男性29例,女性32例,其中甲状腺乳头状癌28例,甲状腺滤泡样癌12例,甲状腺髓样癌8例,甲状腺未分化癌7例,甲状腺淋巴瘤6例,所有病例手术后与病理结果对比显示:彩色多普勒超声诊断符合率达88.5%,误差率达11.5%;16例甲状腺良恶性共同存在的患者中,男性7例,女性9例,病例手术后与病理结果对比显示:彩色多普勒超声诊断符合率达87.5%,误差率达12.5%。
2.经统计学处理证明通过彩色多普勒超声可以对甲状腺病变作出准确的诊断,并与病理结果比较的相关系数达0.89,由此得出彩色多普勒超声做为甲状腺病变的诊断方法具有一定的临床意义。
结论:1.彩色多普勒超声是一种非侵入性、无放射性及有效性等多个特点且价格低廉的检查手段,同时与其它方法相结合,将对早期临床诊断有决定性帮助,是除手术之外唯一可在术前观察结节大小、形状、性质及血流情况的检查手段。2.对颈部及锁骨上淋巴结转移,超声可以提示有无肿大淋巴结,对肥胖患者,触诊困难时,超声可以准确提供淋巴结大小及位置。3.彩色多普勒超声的二维声像图的表现以及CDFI的特点与病理诊断结果相符合,证明彩色多普勒超声做为甲状腺病变的诊断方法具有一定的临床意义。
Objective: Discusses colored Doppler supersonic to the thyroid gland pathological change diagnosis and the pathology result research。
Methods: 1. object of study in July, 2007 - December, 2008 period comesmy courtyard seeing a doctor in the thyroid gland patient, carries on the clinical revisit to the common thyroid gland disease 198 example patients to confirm, benign 121 examples (chronic lymph cellularity thyroiditis 41 examples, nodular goiter 36 examples, adenoma 44 examples); Thyroid cancer 61 examples (papilliform tumor 28 examples, marrow type cancer 8 examples, undifferentiation cancer 7 examples, follicle cancer 12 examples, lymphoma 6 examples), masculine 91 examples, feminine 107 examples, age 25-70 years old. 2. method Before the inspection, the patient does not need to prepare specially, wears to the female has necklace' s patient, takes down before the inspection, the preserve well, to puts on the high-necked coat' s patient, should take off before in order to expose the neck, the spot to carry on the inspection fully; The convention two-dimensional vertical sweeps away looks up, the observation goitre growth spot, the size and the acoustic image chart characteristic, colored Doppler the blood stream developing (CDFI) inspection, observes and records the goitre interior echo and the peripheral blood stream demonstration and the distributed situation again; When supersonic inspection the patient adopts the supine decubitus, exposes the pate fully, sweeps Zha Shi probe head not to skin compression, in order to avoid the tumor blood vessel bearing affects the blood stream parameter. Through when longitudinal section, cross section and bevelling surface parallel motion probe head by thorough understanding tumor size, shape, internal structure; Carries on 198 example thyroid gland pathological change's patient divides sickness to plant, the category to make the supersonic performance and the pathology result and so on multianalysis, the contrast, the distinction, the research. the 3. survey target uses colored Doppler (CDFI) and energy Doppler in the developing (CDF) observation thyroid gland pathological change the blood stream distribution condition and the type, survey systole peak value speed of flow (Vmax), relaxing period peak value speed of flow (Vmin); Carries on the track revisit after near one-and-a-half years time to all patients, computation drag index (RI) carries on the analysis, the observation thyroid gland infection's two-dimensional picture and the colored Doppler blood stream distribution, PW, RI and the Vmax aspect has the significance difference (P < 0.05).
Results: 1. in 121 example thyroid gland benign tubercle patient,masculine 54 examples, feminine 67 examples, nodular goiter patient 36 examples, thyroid gland adenoma patient 44 examples, chronic lymph cellularity thyroiditis (chronic lymphocytic thyroiditis) patient 41 examples, after all case surgery, the pathology result showed: Colored Doppler the ultrasound diagnosis coincidence rate reaches 92.6%, the error coefficient reaches 7.4%; in 61 example thyroid gland malignant tubercle patient, masculine 29 examples, feminine 32 examples, thyroid gland papilliform tumor 28 examples, thyroid follicle type cancer 12 examples, thyroid gland marrow type cancer 8 examples, thyroid gland undifferentiation cancer 7 examples, thyroid gland lymphoma 6 examples, after all case surgery, demonstrated with the pathology result contrast: The colored Doppler ultrasound diagnosis coincidence rate reaches 88. 5%, the error coefficient reaches 11.5%; 16 example thyroid gland good malignancy coexists in patient, masculine 7 examples, feminine 9 examples, after case surgery, demonstrated with the pathology result contrast: The colored Doppler ultrasound diagnosis coincidence rate reaches 87. 5%, the error coefficient reaches 12. 5%.2. passes through statistics processing proof supersonic to be possible to make the accurate diagnosis through colored Doppler to the thyroid gland pathological change, and reaches 0. 89 with the pathology result comparison correlation coefficient, from this obtains colored Doppler supersonic to do for the thyroid gland patho logical change' s diagnosis method has certain clinical significance.
Conclusion: 1. colored Doppler supersonic is one kind of non-invasive,does not have the radioactivity and valid and so on many characteristics and the low in price the inspection method, simultaneously unifies with other methods, will have the decisive help to the early clinical diagnosis, is may observe the tubercle size, the shape, the nature and the blood stream situation inspection method only except the surgery outside before the technique. 2. to the pate and the collar bone the lymph node shift, whether there is supersonic prompt the tumescent lymph node, when to obese patient, palpation difficulty, supersonic may provide the lymph node size and the position accurately. 3. the colored Doppler's supersonic two-dimensional acoustic image chart' s performance as well as the CDFI characteristic and the pathological diagnosis result tallies, proved that colored Doppler supersonic does for the thyroid gland tubercle diagnosis method has certain clinical significance.
引文
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[1].杨松玉.甲状腺瘤的高频声像图及彩超的诊断分析[J].中国超声诊断杂志,2002,3(2):150 2 151.
[2].Hou MF,Chuang HY,Yang FO.el al Comparison ofmammography,Sonography and physical examination for screening women at high risk of breat cancer in Tanwan[J].Ultrasound McdBiol,2002;28(4):415-420
[3].Liferman L,Morris EA,LeeMJY,elal Breast Lesfons detect on MR imaging:Features and positive predictive value[J].AM J Roentgenol,2002;179(1)171-178
[4].Goritgmann N.Koischnitz D.Rettenbacher T.Sonography of the thyroidand parathyroid glands.Radiol Clin NAm,2000,38:1131-1145
[5].李治安主编1临床超声影像学[M]1北京:人民卫生出社,2003:1259-12601
[6].Bassett LW.Mamographic analysis of calcifications.Radiol Clin North Am,1992,30(1):93-105
[7].Rarssch P.Nowels K,Jeffrey RB.Ultrasonographically gridedthyroid biopsy.A review with emphasis on technique.J ultrasoundMed,2001,20:79-85
[8].吴在德1外科学.5版1北京:人民卫生出版社,2001.342
[9].陈敏,朱世亮,周世崇,等.高频超声在甲状腺癌诊断和鉴别诊断中的应用:附380例病例分析.中华医学超声杂志,2006,3(3):161
[10].王怡,闻恽,唐天雪.甲状腺结节超声图像特征.中国超声医学杂志,1998,14(11):18-20
[11].孔金金,邢淑珍,秦卫,等.不典型甲状腺癌彩色超声误诊分析[J].中国医学影响技术,2002,18(7):651 2 653.
[12].陈文,张武,苗立英,等.甲状腺恶性肿瘤的二维及彩色多普勒超声征象及其临床意义.中国超声医学杂志,2000,16(7):495-497
[13].于铭,王全华,王建宏,等.二维超声多普勒超声在结节性甲状腺肿诊断 中的应用.中国超声医学杂志,2000,16(8):599-601
[14].侯锐,刘成国,王宝刚,甲状腺肿瘤超声图像特征与病理对照分析,中国超声医学杂志,1997,11(5):45247
[15].秦茜淼,茅蓉,戴训芦,等.甲状腺癌的高频声像图中钙化的意义.中国超声医学杂志,2000,16(2):139-141
[16].吕珂,蒋玉新,张缙熙,等.甲状腺结节的超声诊断研究.中华超声影像学杂志,2003,12(5):285-288
[17].Hatabu H,Kasagi K,Yamamo to K,et allU ndifferentiated carci2noma of the thyroid gland:sonograph ic findingsIClinical Radio lo2gy,1992,45(5):3072310
[18].James C,Starks M,Macgi Uivray DC,et al.The use of imagingstudies in the diagnosis and management of thyroid cancer and hy2perpaka thyroidism[J]1Surg Oncel Clin N Am,1999,8(1):1451
[19].Rago T,V itti P,Ch iovato L,et allRo le of conventional ultrason2ography and co lo r flow Doppler sonography in predicting malig2nancy in "cold" thyroid nodulesIEur J Endocrino l,1998,138(1):41246
[20].胡小涛,胡淑芳1甲状腺肿块的超声诊断进展[J]1 医学综述,2002,8(3):1681
[21].吴白云,郑宗英,邹利芝1 甲状腺癌超声诊断及其误诊分析,中国超声医学杂志,1997,13(5):51253
[22].刘洪枫,唐伟松,杨志英1 甲状腺钙化性病灶与甲状腺癌1 中国医学科学院学报,2003,25(5):6262629
[23].刘召芬,程红英,江森,等1 彩色多普勒血流显像与多普勒频移曲线对卵巢肿瘤的鉴别诊断1 中华超声影像学杂志,2000,9(9):572
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[28].洪杰,樊静1 甲状腺结节的超声声像图特征及良恶性鉴别诊断[J]1 临床超声医学杂志,2002,2(1):531
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[1].杨松玉.甲状腺瘤的高频声像图及彩超的诊断分析[J].中国超声诊断杂志,2002,3(2):150 2 151.
[2].Hou MF,Chuang HY,Yang FO.el al Comparison ofmammography,Sonography and physical examination for screening women at high risk of breat cancer in Tanwan[J].Ultrasound McdBiol,2002;28(4):415-420
[3].Liferman L,Morris EA,LeeMJY,elal Breast Lesfons detect on MR imaging:Features and positive predictive value[J].AM J Roentgenol,2002;179(1)171-178
[4].Goritgmann N.Koischnitz D.Rettenbacher T.Sonography of the thyroidand parathyroid glands.Radiol Clin NAm,2000,38:1131-1145
[5].李治安主编1临床超声影像学[M]1北京:人民卫生出社,2003:1259-12601
[6].Bassett LW.Mamographic analysis of calcifications.Radiol Clin North Am,1992,30(1):93-105
[7].Rarssch P.Nowels K,Jeffrey RB.Ultrasonographically gridedthyroid biopsy.A review with emphasis on technique.J ultrasoundMed,2001,20:79-85
[8].吴在德1外科学.5版1北京:人民卫生出版社,2001.342
[9].陈敏,朱世亮,周世崇,等.高频超声在甲状腺癌诊断和鉴别诊断中的应用:附380例病例分析.中华医学超声杂志,2006,3(3):161
[10].王怡,闻恽,唐天雪.甲状腺结节超声图像特征.中国超声医学杂志,1998,14(11):18-20
[11].孔金金,邢淑珍,秦卫,等.不典型甲状腺癌彩色超声误诊分析[J].中国医学影响技术,2002,18(7):651 2 653.
[12].陈文,张武,苗立英,等.甲状腺恶性肿瘤的二维及彩色多普勒超声征象及其临床意义.中国超声医学杂志,2000,16(7):495-497
[13].于铭,王全华,王建宏,等.二维超声多普勒超声在结节性甲状腺肿诊断 中的应用.中国超声医学杂志,2000,16(8):599-601
[14].侯锐,刘成国,王宝刚,甲状腺肿瘤超声图像特征与病理对照分析,中国超声医学杂志,1997,11(5):45247
[15].秦茜淼,茅蓉,戴训芦,等.甲状腺癌的高频声像图中钙化的意义.中国超声医学杂志,2000,16(2):139-141
[16].吕珂,蒋玉新,张缙熙,等.甲状腺结节的超声诊断研究.中华超声影像学杂志,2003,12(5):285-288
[17].Hatabu H,Kasagi K,Yamamo to K,et allU ndifferentiated carci2noma of the thyroid gland:sonograph ic findingsIClinical Radio lo2gy,1992,45(5):3072310
[18].James C,Starks M,Macgi Uivray DC,et al.The use of imagingstudies in the diagnosis and management of thyroid cancer and hy2perpaka thyroidism[J]1Surg Oncel Clin N Am,1999,8(1):1451
[19].Rago T,V itti P,Ch iovato L,et allRo le of conventional ultrason2ography and co lo r flow Doppler sonography in predicting malig2nancy in "cold" thyroid nodulesIEur J Endocrino l,1998,138(1):41246
[20].胡小涛,胡淑芳1甲状腺肿块的超声诊断进展[J]1 医学综述,2002,8(3):1681
[21].吴白云,郑宗英,邹利芝1 甲状腺癌超声诊断及其误诊分析,中国超声医学杂志,1997,13(5):51253
[22].刘洪枫,唐伟松,杨志英1 甲状腺钙化性病灶与甲状腺癌1 中国医学科学院学报,2003,25(5):6262629
[23].刘召芬,程红英,江森,等1 彩色多普勒血流显像与多普勒频移曲线对卵巢肿瘤的鉴别诊断1 中华超声影像学杂志,2000,9(9):572
[24].Wunderbanldinger P,Harlsinghani MG,Hahn PF,et al.CysticLymph node metastases in papillary thyroid carcinoma[J]1American Journal of Roentgenography,2002,178(2):6931
[25].Chen Sc,Cheng Yc,Su Ch,el al Analysis of sonography features for differentiation of benign and malignamt breast treat tumors of differentsizes[J].Ultrasound Obsterics Gynecol,2004;23(2)188-193
[26].王怡,闻辉,唐天雪甲状腺结节超声图像特征,中国超声医学杂志,1998,14(11):18-20
[27].龚新环,金亚萍1 甲状腺病变的超声诊断探讨[J]1 中国超声医学杂志,1996,12(1):451
[28].洪杰,樊静1 甲状腺结节的超声声像图特征及良恶性鉴别诊断[J]1 临床超声医学杂志,2002,2(1):531
[29].Koike E,Noguchi S,Yamashita H,et al.Ult rasonographiccharacteristics of thyroid nodules:Prediction of malignancy.ArchSurg,2001,136:3342337.
[30].Chodayu T,Harukif,Naokon,etallThyroid nodules:Re-evalua2tion with ultrasound[J]1J Clin Ultrasond,1995,23:179-1841
[31].Chodayu T,Haruki F,Naoko N,et al.Thyrold nodules:Re-evaluation With ultyasound[J].J clin ultrasound,1995,23:179-184
[32].张武1 拓宽视野成像新技术:全景超声成像及其临床应用,引进国外医药技术与设备,1999,5(1):42