發(fā)布時間：2018-02-28 15:04

  本文關(guān)鍵詞： 腮腺多形性腺瘤 Warthin’s瘤 基底細(xì)胞腺瘤 超聲診斷　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究高頻超聲對腮腺多形性腺瘤、Warthin’s瘤及基底細(xì)胞腺瘤的診斷及鑒別診斷價值,以提高診斷符合率,降低誤診率。材料和方法:本研究收集了腮腺內(nèi)良性腫瘤,共50例65個腫瘤(其中多形性腺瘤21個,Warthin’s瘤32個,基底細(xì)胞腺瘤12個),術(shù)前均在我院行超聲檢查。依據(jù)病理結(jié)果將其分為3組,A組:多形性腺瘤,B組:Warthin’s瘤,C組:基底細(xì)胞腺瘤。比較各項超聲特征(瘤體的形態(tài),內(nèi)部回聲,后方回聲,血流信號強度)診斷腮腺三種良性腫瘤的敏感性、特異性及符合率,并構(gòu)建受試者作用特征(Receiver Operating Characteristic,ROC)曲線,探究各項超聲特征對三種腮腺良性腫瘤的診斷及鑒別診斷價值。結(jié)果:1.多形性腺瘤、Warthin’s瘤、基底細(xì)胞腺瘤均可單發(fā)或多發(fā)。2.年齡及性別在三組之間存在統(tǒng)計學(xué)差異(P0.05),診斷時可做參考。3.對各型腮腺良性腫瘤形態(tài)是否規(guī)整,內(nèi)部回聲是否均勻、后方回聲有無增強在單變量分析之中有統(tǒng)計學(xué)意義(P值分別為0.001、0.036和0.010)。多形性腺瘤組中表現(xiàn)為“分葉狀”者最多(14/21);Warthin’s瘤內(nèi)部回聲多不均勻(24/32),后方回聲多增強(23/32)。4.血流信號強度在單變量分析之中有統(tǒng)計學(xué)意義(P0.05),其中多形性腺瘤以0級和I級血流信號為主(17/21);Warthin’s瘤和基底細(xì)胞腺瘤以II級和III級血流信號為主(25/32,9/12)。5.邊界是否清晰、內(nèi)部回聲性質(zhì)、平均最大徑對此三個腫瘤沒有統(tǒng)計學(xué)差異(P值分別為0.489、0.565和0.358)。6.少血供在診斷多形性腺瘤的四項超聲特征中符合率最高,為78.46%;多血供在診斷Warthin’s瘤中符合率最高,為69.23%;內(nèi)部回聲均勻在診斷基底細(xì)胞腺瘤中符合率最高,為67.69%。7.ROC及多變量觀察值的ROC結(jié)果顯示:形態(tài)不規(guī)整,后方回聲無增強,少血供對多形性腺瘤的診斷準(zhǔn)確性較高,三者聯(lián)合后診斷效果較好;形態(tài)規(guī)整,多血供對Warthin’s瘤的診斷價值較高,兩者聯(lián)合可提高診斷準(zhǔn)確性;形態(tài)規(guī)整,內(nèi)部回聲均勻,后方回聲增強、多血供單獨診斷基底細(xì)胞腺瘤沒有統(tǒng)計學(xué)意義,四項超聲特征聯(lián)合診斷基底細(xì)胞腺瘤有一定準(zhǔn)確性。結(jié)論:1.年齡及性別可以作為鑒別此三種腮腺良性腫瘤參考標(biāo)準(zhǔn)。2.形態(tài)不規(guī)整(分葉狀)在多形性腺瘤中最多見;多形性腺瘤及Warthin’s瘤內(nèi)部回聲不均勻;三個良性腫瘤中,Warthin's瘤及基底細(xì)胞腺瘤后方回聲增強多見。3.三種良性腫瘤中,Warthin’s瘤及基底細(xì)胞腺瘤以多血供為主,多形性腺瘤以少血供為主。4.各項超聲特征單獨診斷腮腺良性腫瘤有一定的價值,但對此三種腮腺良性腫瘤的鑒別診斷價值有限。應(yīng)充分掌握這三種腫瘤各自的超聲特征,多特征聯(lián)合觀察,有望提高診斷符合率。
[Abstract]:Objective: to study the value of high frequency ultrasound in the diagnosis and differential diagnosis of Warthins tumor and basal cell adenoma of parotid pleomorphic adenoma, in order to improve the diagnostic coincidence rate and reduce the misdiagnosis rate. Materials and methods: benign tumors in parotid gland were collected in this study. A total of 65 tumors (including 21 pleomorphic adenomas and 32 Warthins tumors) were found in 50 cases. Twelve basal cell adenomas were examined by ultrasonography in our hospital before operation. According to the pathological results, they were divided into 3 groups: group A: group B: pleomorphic adenoma group B: Warthins tumor group C: basal cell adenoma. The sensitivity, specificity and coincidence rate of posterior echo and blood flow signal intensity in the diagnosis of three kinds of benign tumors of parotid gland were analyzed, and the receiver Operating character curve was constructed. To explore the value of ultrasound features in the diagnosis and differential diagnosis of three kinds of parotid benign tumors. Results: 1. Pleomorphic adenoma Warthins tumor, Basal cell adenoma can be single or multiple. There are statistical differences in age and sex among the three groups (P 0.05). The diagnosis of benign parotid tumors can be made reference .3. whether the shape of various types of parotid benign tumors is regular, whether the internal echo is uniform. Enhancement of posterior echo was statistically significant in univariate analysis (P = 0.001, P = 0.036 and P = 0.010, respectively). In pleomorphic adenoma group, there were 14 / 21 / 21 Warthins tumors with abnormal internal echo and 23 / 32 / 32 / 4 posterior echo enhancement. The signal intensity was statistically significant in univariate analysis (P 0.05), in which 17 / 21 / 21 Warthinthins tumors and basal cell adenomas were characterized by grade 0 and grade I blood flow signals, and grade II and III grade 2 / 32 / 9 / 12 / 5, respectively. Whether the boundary was clear or not, There was no significant difference in the internal echo properties and the mean maximum diameter between the three tumors (P = 0.489n 0.565 and 0.358g 路6.The coincidence rate of the four ultrasound features of pleomorphic adenoma was 78.46, and that of multiple blood supply was the highest in the diagnosis of Warthin's tumor. The internal echo homogeneity was the highest in the diagnosis of basal cell adenoma, and the ROC results of 67.69k.7.ROC and multivariate observation value showed that the shape was irregular, the posterior echo was not enhanced, and the accuracy of diagnosis of pleomorphic adenoma with low blood supply was higher. After the combination of the three, the diagnostic effect is better, the shape is regular, and the diagnosis value of multiple blood supply to Warthin's tumor is higher, the combination of the two can improve the diagnostic accuracy, the shape is regular, the internal echo is homogeneous, and the echo in the rear is enhanced. Single diagnosis of basal cell adenoma with multiple blood supply has no statistical significance. Conclusion: 1. Age and sex can be used as reference criteria for differentiating these three benign parotid tumors. Shape irregular (lobular) is the most common in pleomorphic adenomas. The internal echo of pleomorphic adenoma and Warthin's tumor was not homogeneous, and the echo enhancement of Warthins tumor and basal cell adenoma was more common in the three benign tumors than that in benign tumor. 3. Among the three kinds of benign tumors, Warthins tumor and basal cell adenoma were mainly multi-blood supply. In pleomorphic adenoma, hypoglycemia is the main feature. Each ultrasonic feature has certain value in the diagnosis of parotid benign tumor alone, but the differential diagnosis value of these three kinds of benign parotid tumors is limited, so we should fully grasp the ultrasonic characteristics of these three kinds of tumors. Combined observation of multiple features is expected to improve the diagnostic coincidence rate.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R739.8

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