本文選題：食管癌　切入點(diǎn)：復(fù)發(fā)　出處：《河南科技大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:1.應(yīng)用MDCT增強(qiáng)掃描總結(jié)食管癌術(shù)后吻合口復(fù)發(fā)的增強(qiáng)CT表現(xiàn);2.探討食管癌術(shù)后吻合口復(fù)發(fā)的相關(guān)影響因素。方法:回顧性分析經(jīng)胃鏡病理證實(shí)的74例食管癌術(shù)后的增強(qiáng)MDCT掃描資料,依據(jù)CT征象及病理結(jié)果分為3組,正常吻合口組28例(n1),吻合口良性增厚組22例(n2),吻合口惡性增厚組24例(n3),對(duì)比分析三組病例吻合口相關(guān)征象。其中,男性50例,女性24例;年齡44~81歲,平均63.7±7.6歲,中位年齡64.39歲。距手術(shù)間隔時(shí)間1月~8年,平均28.39±27.22月,中位時(shí)間19.27月。檢查采用Toshiba AquilionTM ONE 320排螺旋CT機(jī),先行平掃120kV,200mAs,層厚5mm,層間距5mm,后經(jīng)肘靜脈團(tuán)注對(duì)比劑(50~80ml,碘普羅胺(300mgI/ml)注射液),采用動(dòng)態(tài)觸發(fā)檢查,興趣區(qū)(refion of interest,ROI)選取氣管分叉水平降主動(dòng)脈,待ROI的CT值達(dá)200HU后延遲10s行動(dòng)脈期掃描,40s后行靜脈期掃描,所有的圖像重建1mm薄層傳遞至工作站Vitrea FX Version6.3進(jìn)行多平面重建(MPR),冠狀位、矢狀位重建厚度均為5mm。應(yīng)用SPSS19.0統(tǒng)計(jì)學(xué)軟件進(jìn)行分析,P0.05表示差異有統(tǒng)計(jì)學(xué)意義,分析吻合口良性及惡性增厚與CT表現(xiàn)特征的相關(guān)性。采用單因素方差分析的統(tǒng)計(jì)學(xué)方法對(duì)n1、n2、n3三組吻合口區(qū)管壁厚度進(jìn)行對(duì)比分析,Pearson相關(guān)分析、Spearman等級(jí)相關(guān)分析對(duì)CT特征進(jìn)行相關(guān)性分析。利用卡方檢驗(yàn)對(duì)年齡、性別、病理類型、原發(fā)腫瘤部位、分化程度、T分期、N分期及臨床分期進(jìn)行單因素分析,利用logistic進(jìn)行多因素分析。結(jié)果:1.正常吻合口組、吻合口良性增厚組及吻合口惡性增厚組管壁厚度差異有統(tǒng)計(jì)學(xué)意義(P0.05),吻合口良性增厚組及吻合口惡性增厚組管壁厚度的最具意義臨界值為17.2mm,此時(shí)敏感度為68.2%,特異度為93.3%。2.狹窄段粘膜中斷與食管癌術(shù)后吻合口惡性增厚相關(guān)性較高,r=0.58(偏心型增厚、管腔腫塊、不均勻強(qiáng)化、增厚的管壁上下緣不規(guī)則、狹窄段粘膜中斷、動(dòng)脈期強(qiáng)化幅度與吻合口惡性增厚均有一定相關(guān)性),而增厚管壁強(qiáng)化環(huán)及靜脈期強(qiáng)化幅度對(duì)吻合口良、惡性增厚的鑒別無統(tǒng)計(jì)學(xué)意義。動(dòng)脈期強(qiáng)化幅度的相關(guān)系數(shù)r=0.45,吻合口良性增厚組及吻合口惡性增厚組動(dòng)脈期強(qiáng)化幅度的最具意義臨界值為19.09Hu,此時(shí)的敏感度為72.7%,特異度為80.0%。3.N分期及臨床Ⅲ期與食管癌術(shù)后吻合口復(fù)發(fā)有關(guān),OR值分別為16.500、13.200。結(jié)論:1.增強(qiáng)MDCT對(duì)食管癌術(shù)后吻合口復(fù)發(fā)的診斷具有一定的影像特征性表現(xiàn),對(duì)食管癌術(shù)后吻合口復(fù)發(fā)的診斷具有重要意義。2.N分期及臨床Ⅲ期是食管癌術(shù)后吻合口復(fù)發(fā)的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective 1. To summarize the enhanced CT findings of anastomotic recurrence after esophageal cancer operation by using MDCT enhanced scanning. To investigate the related factors of anastomotic recurrence after esophageal cancer operation. Methods: 74 cases of esophageal carcinoma proved by gastroscopy were retrospectively analyzed. Contrast-enhanced MDCT scan data after operation, According to CT signs and pathological results, we divided into 3 groups: normal anastomosis group (n = 28), benign thickening group (n = 22) and malignant thickening group (n = 24). The median age was 64.39 years, with an average age of 63.7 鹵7.6 years. The median time from January to 8 years was 28.39 鹵27.22 months, and the median time was 19.27 months. Toshiba AquilionTM ONE 320 slice CT was used. First, 120kV of 200mAs, 5mm thick, 5mm interval, and then injected with 50 ~ 80ml of contrast agent and 300mgI / ml of iopramide through cubital vein mass. Dynamic trigger examination was used to select the descending aorta with trachea bifurcation level, and the area of interest was refion of interest. After the CT value of ROI reached 200HU, the arterial phase scan was delayed for 10 s and the venous phase scan was performed after 40 s. All the images were transferred to the workstation Vitrea FX Version6.3 for multiplanar reconstruction and coronal image reconstruction, and all the images were transferred to the workstation Vitrea FX Version6.3 for multiplanar reconstruction. The thickness of sagittal reconstruction was 5 mm. The difference was statistically significant by using SPSS19.0 statistical software to analyze the sagittal reconstruction thickness. To analyze the correlation between benign and malignant thickening of anastomotic stoma and CT features, a comparative analysis of the wall thickness of anastomotic area in n _ 1n _ 2n _ 3 group was carried out by single factor variance analysis and Spearman grade correlation analysis. Correlation analysis was carried out. Age was analyzed by chi-square test. Sex, pathological type, location of primary tumor, degree of differentiation, T stage and clinical stage were analyzed by univariate analysis and multivariate analysis by logistic. Results: 1. Normal anastomotic site group. There was significant difference in wall thickness between benign thickening group and malignant thickening group. The critical value of wall thickness in benign thickening group and malignant thickening group was 17.2 mm, and the sensitivity was 68.2 mm. The mucosal disruption of narrow segment was associated with malignant thickening of anastomotic stoma after esophagus cancer operation, and the correlation was higher (eccentricity thickening, eccentricity thickening). Lumen mass with uneven enhancement, irregular upper and lower margin of thickened wall, interrupted mucous membrane of narrow segment, enhancement amplitude of arterial phase and malignant thickening of anastomotic stoma were related to malignant thickening of anastomotic stoma. There was no statistical significance in the differentiation of malignant thickening. The correlation coefficient of enhancement amplitude in arterial phase was 0.45, the critical value of arterial enhancement in benign and malignant thickening group was 19.09 Hu. the sensitivity was 72.7%. The OR values related to anastomotic recurrence in stage 鈪，

本文編號(hào)：1605980