本文選題：腎癌 + 病理分型　； 參考：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:回顧分析四種不同病理組織類型的腎癌的術(shù)前CT影像學(xué)資料,總結(jié)四種腎細(xì)胞癌亞型的CT影像學(xué)表現(xiàn),旨在術(shù)前對不同病例分型的腎細(xì)胞癌有較為準(zhǔn)確的初步診斷,進而對臨床治療方案等起到一定的指導(dǎo)作用。方法:收集從2011年7月到2016年7月,經(jīng)寧夏醫(yī)科大學(xué)總醫(yī)院泌尿外科行手術(shù)治療,且術(shù)后病理明確診斷為腎癌的病例,選取其中透明細(xì)胞癌50例;乳頭狀癌15例;嫌色細(xì)胞癌10例;多房囊性腎癌6例。對每種腎癌亞型發(fā)病年齡、臨床特征及性別差異進行統(tǒng)計;并對四種腎癌亞型CT圖像進行不同分期的CT值、強化幅度以及強化形式的統(tǒng)計分析;觀察不同病理類型腫瘤內(nèi)部的變化,包括鈣化、壞死囊變等,明確有無統(tǒng)計學(xué)差異。結(jié)果:1、所收集到的四種腎癌在臨床表現(xiàn)方面,典型的“腎癌三聯(lián)征”比例都較少,且差異在四種腎癌間無明顯統(tǒng)計學(xué)意義(P0.05)。在有臨床癥狀的患者中,以血尿、腰痛、腹部包塊中一種或兩種主訴就診的患者的比例較典型三聯(lián)征患者高,部分患者表現(xiàn)為副瘤綜合征;而臨床無癥狀患者的比例較高,通常為體檢發(fā)現(xiàn),或是因其它疾病就診過程中發(fā)現(xiàn)腎臟占位性病變。2、四種腎癌在性別比較中差異無統(tǒng)計學(xué)意義(P0.05)。3、在CT平掃中,四種腎癌均為低密度影,其中乳頭狀癌及嫌色細(xì)胞癌密度較透明細(xì)胞癌高,經(jīng)統(tǒng)計分析后有統(tǒng)計學(xué)意義(P0.05)。4、進行增強掃描后,透明細(xì)胞癌表現(xiàn)出典型的“快進快出”特征,在動脈期其強化最快,強化幅度最高,與其它三種腎癌具有統(tǒng)計學(xué)意義(P0.05);實質(zhì)期,透明細(xì)胞癌強化較前下降,但仍高于其他三類腎癌,差異具有統(tǒng)計學(xué)意義(P0.05)。在排泄期,四種腎癌亞型的CT值較前均呈下降趨勢,但透明細(xì)胞癌仍最高,差異有統(tǒng)計學(xué)意義(P0.05)。5、在強化形式上,透明細(xì)胞癌主要以不均勻強化為主,而乳頭狀癌及嫌色細(xì)胞癌均勻強化占優(yōu)勢,多房囊性腎癌囊壁及囊內(nèi)分隔強化明顯。進行統(tǒng)計分析后差異有統(tǒng)計學(xué)意義。透明細(xì)胞癌較乳頭狀癌及嫌色細(xì)胞癌更容易出現(xiàn)囊變壞死,而多房囊性腎癌本身以囊變?yōu)樘卣鳌＝Y(jié)論:1、不同腎癌亞型因病理組織學(xué)基礎(chǔ)不同,在CT影像學(xué)方面具有可觀察并具有統(tǒng)計學(xué)意義的的差異。2、透明細(xì)胞癌在動脈期的明顯強化仍然是此類腎癌的特征性改變。3、CT因高分辨率、對不同組織有較準(zhǔn)確成像以及操作方便,目前仍是診斷腎癌的首選檢查手段。
[Abstract]:Objective: To review and analyze the preoperative CT imaging data of four different pathological types of renal cell carcinoma and to sum up the CT imaging findings of the four subtypes of renal cell carcinoma. The purpose of this study was to make a more accurate preliminary diagnosis of renal cell carcinoma in different cases and to guide the clinical treatment. Methods: collect from 7 in 2011. From month to July 2016, 50 cases of transparent cell carcinoma, 15 cases of papillary carcinoma, 10 cases of chromophobe cell carcinoma and 6 cases of multilocular cystic renal carcinoma were selected by surgical treatment in the Department of Urology, General Hospital of Ningxia Medical University, and the postoperative pathology was clearly diagnosed as renal carcinoma. Four types of renal carcinoma subtype CT images were analyzed by statistical analysis of CT values, intensification amplitude and intensification forms in different stages. The changes of internal changes in different pathological types, including calcification and necrotic cystic change, were clearly observed. Results: 1, the clinical manifestations of four types of renal carcinoma collected, the typical "renal carcinoma triple syndrome" ratio There was less significant difference between the four types of renal carcinoma (P0.05). Among the patients with clinical symptoms, the proportion of one or two cases in the patients with hematuria, lumbago, and abdominal mass was higher than that of the typical triad, and some of the patients showed paraneoplastic syndrome; and the proportion of the patients with clinical symptoms was higher, usually a physical examination. The renal space occupying lesion.2 was found in the process of other diseases, and there was no significant difference (P0.05).3 in the sex comparison between the four types of renal carcinoma. In the CT plain scan, the four kinds of renal carcinoma were low density shadow, and the papillary and chromophobe cell carcinoma density was higher than that of the transparent cell carcinoma, and the statistical significance (P0.05).4 was statistically significant after the statistical analysis. After strong scan, the clear cell carcinoma showed a typical "fast forward and fast out" feature. In the arterial phase, the enhancement was the fastest and the most enhanced, with the other three types of renal cancer (P0.05). In the substance phase, the enhancement of the clear cell carcinoma was lower than that of the other three types of renal cancer, but the difference was statistically significant (P0.05). In the excretory period, four kinds of cancer were found. The CT value of the subtype of renal carcinoma is declining, but the clear cell carcinoma is still the highest, and the difference is statistically significant (P0.05).5. In the intensification form, the main type of clear cell carcinoma is uneven enhancement, while the papillary carcinoma and the chromophobe cell carcinoma are predominant, and the cystic wall and the intraductal septum of the multilocular cystic renal cell carcinoma are obviously strengthened. There is a statistically significant difference in the post difference between the papillary and chromophobe cell carcinoma, and the multiple cystic renal cell carcinoma itself is characterized by cystic degeneration. Conclusion: 1, the different subtypes of renal carcinoma are different from the histopathology based on the CT imaging and have a statistically significant difference in.2, transparent cell carcinoma. The obvious enhancement in the arterial phase is still the characteristic change of.3 in this kind of renal carcinoma. CT is the first choice for diagnosis of renal cancer because of its high resolution, accurate imaging of different tissues and convenient operation.

【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.11;R730.44

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相關(guān)期刊論文 前1條

1 傅長根,張雪斌;腎癌的血管造影診斷與其他相關(guān)影像學(xué)檢查的比較研究[J];江蘇醫(yī)藥;1998年08期

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本文編號：1830993