發(fā)布時間：2018-03-10 05:33

  本文選題：多層計算機(jī)體層攝影術(shù)　切入點(diǎn)：卵巢癌　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:本文通過回顧性分析確診為原發(fā)性卵巢癌的50名患者的影像學(xué)資料,將患者原發(fā)灶、周圍侵犯及遠(yuǎn)處轉(zhuǎn)移的影像學(xué)表現(xiàn)進(jìn)行綜合、客觀的統(tǒng)計學(xué)處理,評價多層螺旋CT平掃及增強(qiáng)對卵巢癌術(shù)前分期的診斷價值,探討其對原發(fā)性卵巢癌分期的臨床應(yīng)用價值。方法:搜集2015年1月至2017年1月在我院就診、接受全面手術(shù)分期并行多層螺旋CT全腹平掃+增強(qiáng)掃描的原發(fā)性卵巢癌患者50名。請2名有經(jīng)驗(yàn)的放射科醫(yī)師進(jìn)行影像圖像分析,做出影像分期診斷。主要觀察內(nèi)容有腫瘤原發(fā)灶位置、形態(tài)及與周圍組織關(guān)系、各個部位腹膜轉(zhuǎn)移、淋巴結(jié)轉(zhuǎn)移、遠(yuǎn)處轉(zhuǎn)移等,將具體結(jié)果與手術(shù)病理結(jié)果進(jìn)行對照,分別計算CT對卵巢癌原發(fā)灶、子宮輸卵管侵犯、其他盆腔組織侵犯、腹膜轉(zhuǎn)移、淋巴結(jié)轉(zhuǎn)移、腹水以及遠(yuǎn)處轉(zhuǎn)移診斷的準(zhǔn)確性、敏感性及特異性,使用spss19.0軟件計算CT分期與手術(shù)分期的吻合系數(shù)及CT診斷總分期的ROC曲線總面積,對CT分期和手術(shù)分期的吻合度和CT總分期的診斷價值進(jìn)行統(tǒng)計學(xué)分析。結(jié)果:術(shù)后病理證實(shí)50例原發(fā)性卵巢癌患者中卵巢漿液性癌36例,卵巢粘液性癌4例,子宮內(nèi)膜樣癌2例,透明細(xì)胞癌2例,顆粒細(xì)胞癌3例,卵巢甲狀腺腫類癌1例,卵巢癌肉瘤1例,支持-間質(zhì)細(xì)胞瘤1例。手術(shù)病理分期I期9例,II期6例,III期27例,IV期8例。CT術(shù)前分期I期8例,II期7例,III期28例,IV期6例。多層螺旋CT對單雙側(cè)判斷、子宮輸卵管侵犯、其他盆腔組織侵犯、腹膜轉(zhuǎn)移、淋巴結(jié)轉(zhuǎn)移、腹水及遠(yuǎn)處轉(zhuǎn)移診斷的準(zhǔn)確性為84%~100%,敏感性為50%~100%,特異性為75%~100%。CT分期與手術(shù)分期的吻合系數(shù)為κ=0.746,p0.001,吻合度較強(qiáng)且具有統(tǒng)計學(xué)意義;CT診斷總分期ROC曲線下面積為0.925,p0.001,診斷價值較高且具有統(tǒng)計學(xué)意義。結(jié)論:多層螺旋CT是卵巢癌術(shù)前分期的有效檢查方法,對卵巢癌患者術(shù)前評估有重要臨床應(yīng)用價值,對手術(shù)分期有一定補(bǔ)充作用,可以有效預(yù)防手術(shù)分期不足及過度分期現(xiàn)象。
[Abstract]:Objective: to analyze retrospectively the imaging data of 50 patients with primary ovarian cancer, and to analyze the imaging findings of primary tumor, peripheral invasion and distant metastasis. To evaluate the diagnostic value of multislice spiral CT scan and enhancement in preoperative stage of ovarian cancer, and to evaluate its clinical value in staging of primary ovarian cancer. Methods: from January 2015 to January 2017, the patients were treated in our hospital. A total of 50 patients with primary ovarian cancer underwent staging and enhanced multislice spiral CT scanning. Two experienced radiologists were asked to perform image analysis. Imaging staging diagnosis was made. The main contents were the location of primary tumor, morphology and relationship with surrounding tissues, peritoneal metastasis, lymph node metastasis, distant metastasis and so on. The specific results were compared with the results of surgery and pathology. The accuracy, sensitivity and specificity of CT in the diagnosis of primary ovarian cancer, hysteropian tube invasion, other pelvic invasion, peritoneal metastasis, lymph node metastasis, ascites and distant metastasis were calculated. Spss19.0 software was used to calculate the coincident coefficient between CT staging and operative staging, and the total area of ROC curve in CT diagnosis of the total stage. Results: there were 36 cases of ovarian serous carcinoma and 4 cases of ovarian mucinous carcinoma. There were 2 cases of endometrial carcinoma, 2 cases of clear cell carcinoma, 3 cases of granular cell carcinoma, 1 case of ovarian goiter carcinoid and 1 case of ovarian cancer sarcoma. One case of Sertoli stromal cell tumor, 9 cases of stage I, 6 cases of stage II, 27 cases of stage III, 8 cases of stage IV, 8 cases of stage I before CT staging, 7 cases of stage II, 7 cases of stage III, 6 cases of stage IV. Multi-slice spiral CT was used to judge unilateral bilateral, hysterosalpinx invasion. Other pelvic invasion, peritoneal metastasis, lymph node metastasis, The accuracy of diagnosis of ascites and distant metastases was 84 / 100, the sensitivity was 50 / 100, the specificity was 75 / 100. the coefficient of anastomosis between CT staging and surgical staging was 0.746p0.001, the area under the ROC curve of CT was 0.925 / p0.001, and the diagnostic value was 0.925p0.001. Conclusion: multislice spiral CT is an effective method for preoperative staging of ovarian cancer. It has important clinical application value for preoperative evaluation of ovarian cancer, and has certain supplementary effect on surgical staging, which can effectively prevent the insufficiency of surgical staging and the phenomenon of excessive staging.
【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】：R737.31;R730.44

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