采用彩色多普勒超声评估肺周病灶的血流模式，比较良恶性病灶血流模式的差异。

选择西安市胸科医院2020年6月至2021年7月经CT影像学检查诊断肺周病灶的患者87例，均经病理学确诊。应用彩色多普勒超声对肺周病灶血流模式进行探查并分型，归纳为4种类型：A型为肋间动脉向肺部病灶供血并肺内静脉树枝状回流；B型为肋间动脉向肺部病灶供血但无肺内树枝状静脉回流；C型未见肋间动脉向肺部病灶供血但可见肺内静脉树枝状回流；D型既无肋间动脉供血也无肺内静脉树枝状回流。采用χ²检验比较良恶性病灶血流模式的差异，并采用受试者操作特征（ROC）曲线分析血流模式对判断病灶良恶性的价值。

87例肺周病灶其血流模式分别为A型19例（良性18例，恶性1例），B型6例（良性2例，恶性4例），C型42例（良性41例，恶性1例），D型20例（良性4例，恶性16例），其中良性病灶65例（74.7%），恶性病灶22例（25.3%）。对比良、恶性病灶血流模式发现，良性组肺内静脉树枝状回流构成比高于恶性组（90.8% vs 19.1%），差异具有统计学意义（χ²=53.332，P＜0.001），肺内静脉树枝状回流判断肺周病灶良恶性的敏感度为90.8%，特异度为97.9%，曲线下面积为0.908（95% CI：0.837~0.979，P＜0.001）。存在肋间动脉向恶性病灶供血的患者术中出血量［510.0（477.5，730.0）ml］较无肋间动脉供血的恶性病灶患者术中出血量［400.0（350.0，450.0）ml］显著增加，差异具有统计学意义（Z=2.627，P=0.009）。

良恶性肺周病灶血流模式存在差异，肺内静脉树枝状回流是肺周病灶的良性特征。肋间动脉向恶性病灶供血可增加恶性病灶患者术中出血的风险，需要临床加以密切关注。

To evaluate the blood flow patterns of peripulmonary lesions by color Doppler ultrasound and compare the differences of blood flow patterns between benign and malignant lesions.

From June 2020 to July 2021, a total of 87 inpatients with peripulmonary lesions diagnosed by CT imaging examination were enrolled at Xi'an Chest Hospital, and all patients were confirmed by pathological diagnosis. The blood flow patterns of peripulmonary lesions were detected and classified using Colour Doppler ultrasound, which were divided into four types: type A, the presence of both intercostal artery blood supply patterns and dendritic reflux patterns of intrapulmonary veins in peripulmonary lesions; type B, the presence of intercostal artery blood supply pattern of peripulmonary lesions, but the absence of dendritic reflux of intrapulmonary veins; type C, the absence of intercostal artery blood supply pattern of lesions, but the presence of dendritic reflux pattern of intrapulmonary veins; type D, the absence of both intercostal artery blood supply pattern and dendritic reflux pattern of intrapulmonary veins in peripulmonary lesions. The differences of blood flow patterns between benign and malignant lesions were compared, and the value of blood flow patterns in distinguishing benign and malignant lesions was assessed by ROC curve analysis.

The blood flow patterns of 87 peripulmonary lesions were: type A in 19 cases, type B in 6, type C in 42, and type D in 20, of which 65 were benign (74.7%) and 22 were malignant (25.3%). By comparing the blood flow patterns of benign and malignant lesions, it was found that the dendritic reflux of intrapulmonary veins was the benign feature of peripulmonary lesions, and its constituent ratio was higher in the benign group than in the malignant group (90.8% vs 19.1%, χ²=53.332, P＜0.001); the sensitivity, specificity, and area under the curve of this pattern were 90.8%, 97.9%, and 0.908 (95% CI: 0.837-0.979, P＜0.001), respectively. Intraoperative bleeding volume [510.0 (477.5730.0) ml] was significantly increased in patients with intercostal artery supply to the malignant lesion [400.0 (350.0, 450.0) ml] than patients without (Z=2.627, P=0.009).

There are differences in blood flow patterns between benign and malignant peripulmonary lesions. The dendritic reflux pattern of intrapulmonary veins is a benign feature of peripulmonary lesions. The blood supply pattern of intercostal arteries in patients with malignant lesions increases the risk of intraoperative bleeding, which requires close clinical attention.