本文選題：基底細(xì)胞瘤 + 多形性腺瘤　； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討腮腺基底細(xì)胞瘤的臨床表現(xiàn)、常規(guī)超聲及超聲造影特征,尋求其診斷價(jià)值,獲取與腮腺多形性腺瘤及腺淋巴瘤的鑒別診斷要點(diǎn)。方法:收集2011年1月至2014年12月經(jīng)手術(shù)病理證實(shí)為腮腺基底細(xì)胞瘤及多形性腺瘤、腺淋巴瘤的患者臨床表現(xiàn)、常規(guī)超聲及超聲造影資料,分別分析基底細(xì)胞瘤在這三方面的特征及與另外兩種腫瘤的差異。臨床資料包括:年齡(≥50歲/50歲)、性別(男性/女性)、吸煙史(有/無(wú))、觸診情況(較軟/較硬)、消長(zhǎng)史(有/無(wú));常規(guī)超聲資料包括:腫瘤位置(單側(cè)/雙側(cè)、左側(cè)/右側(cè))、達(dá)深葉(有/無(wú))、最大徑(3.0cm/≥3.0cm)、邊界(清楚/不清楚)、內(nèi)部回聲(低弱回聲/混合回聲)、分葉狀改變(有/無(wú))、網(wǎng)格樣回聲(有/無(wú))、后方回聲增強(qiáng)(有/無(wú))、液性暗區(qū)(有/無(wú))、液性暗區(qū)范圍(大/小)、鈣化(有/無(wú))、周邊淋巴結(jié)(有/無(wú))、內(nèi)部血流豐富程度(Alder半定量分級(jí),0-I級(jí)/Ⅱ-Ⅲ級(jí));超聲造影資料包括:團(tuán)塊始增強(qiáng)時(shí)相(早/同步或晚增強(qiáng))、始增強(qiáng)部位(周邊先增強(qiáng)/中心先增強(qiáng)或彌漫性增強(qiáng))、達(dá)峰增強(qiáng)程度(高/低增強(qiáng))、增強(qiáng)均勻程度(均勻性/不均勻性增強(qiáng))、周邊環(huán)狀增強(qiáng)(有/無(wú))、周邊結(jié)節(jié)狀增強(qiáng)(有/無(wú))、無(wú)增強(qiáng)區(qū)(有/無(wú))、增強(qiáng)后邊界(清楚/不清楚)、增強(qiáng)后范圍(有變化/無(wú)變化)、增強(qiáng)后消退(較快/較慢)。結(jié)果:2011年1月至2014年12月納入108例患者112個(gè)病灶,其中基底細(xì)胞瘤14例患者14個(gè)病灶,多形性腺瘤59例患者61個(gè)病灶,腺淋巴瘤35例患者37個(gè)病灶。經(jīng)過(guò)對(duì)三組腫瘤臨床資料分析發(fā)現(xiàn),基底細(xì)胞瘤組發(fā)病年齡一般≥50歲,觸診質(zhì)地較軟,與多形性腺瘤組比較有顯著統(tǒng)計(jì)學(xué)差異(P0.05),與腺淋巴瘤組比較無(wú)統(tǒng)計(jì)學(xué)差異;另外,基底細(xì)胞瘤組多發(fā)于女性患者,無(wú)吸煙史及消長(zhǎng)史,與腺淋巴瘤組比較有顯著統(tǒng)計(jì)學(xué)差異(P0.05),而與多形性腺瘤組比較無(wú)統(tǒng)計(jì)學(xué)差異。分析常規(guī)超聲發(fā)現(xiàn),基底細(xì)胞瘤組全部發(fā)生于單側(cè),其中71.4%(10/14)發(fā)生于左側(cè),另外85.7%(12/14)最大徑3.0cm,35.7%(5/14)呈混合回聲,無(wú)一例顯示網(wǎng)格樣回聲,42.8%(6/14)可見(jiàn)液性暗區(qū)且液性暗區(qū)范圍較大者占28.6%(4/14),57.1%(8/14)呈現(xiàn)血流信號(hào)Ⅱ-Ⅲ級(jí);多形性腺瘤組中,全部發(fā)生于單側(cè),其中37.7%(23/61)發(fā)生于左側(cè),另外26.2%(16/61)最大徑3.0cm,3.3%(2/61)呈混合回聲,1.6%(1/61)可顯示網(wǎng)格樣回聲,18.0%(11/61)可見(jiàn)液性暗區(qū)且液性暗區(qū)范圍較大者占3.3%(2/61),16.4%(10/61)呈現(xiàn)血流信號(hào)Ⅱ-Ⅲ級(jí);腺淋巴瘤組中,59.5%(22/37)發(fā)生于左側(cè),67.6%(25/37)最大徑3.0cm,24.3%(9/37)呈混合回聲,29.7%(11/37)可顯示網(wǎng)格樣回聲,40.5%(15/37)可見(jiàn)液性暗區(qū)且液性暗區(qū)范圍較大占16.2%(6/37),32.4%(12/37)呈現(xiàn)血流信號(hào)Ⅱ-Ⅲ級(jí)�；准�(xì)胞瘤組與多形性腺瘤組在腫瘤發(fā)生位置、最大徑、內(nèi)部回聲、液性暗區(qū)及液性暗區(qū)范圍、血流信號(hào)之間具有顯著統(tǒng)計(jì)學(xué)差異(P0.05),與淋巴瘤組僅在有無(wú)網(wǎng)格樣回聲表現(xiàn)上有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。分析超聲造影發(fā)現(xiàn),基底細(xì)胞瘤組中,78.6%(11/14)呈現(xiàn)早增強(qiáng)、高增強(qiáng)模式,42.9%(6/14)可見(jiàn)“無(wú)增強(qiáng)區(qū)”,14.3%(2/14)周邊可見(jiàn)結(jié)節(jié)狀增強(qiáng),21.4%(3/14)消退較快;多形性腺瘤組中,18.0%(11/61)呈現(xiàn)早增強(qiáng)模式,27.9%(17/61)呈現(xiàn)高增強(qiáng)模式,18.0%(11/61)可見(jiàn)“無(wú)增強(qiáng)區(qū)”,無(wú)一例呈現(xiàn)周邊結(jié)節(jié)狀增強(qiáng),3.3%(2/61)消退較快;腺淋巴瘤組中,54.1%(20/37)呈現(xiàn)早增強(qiáng)模式,86.5%(32/37)呈現(xiàn)高增強(qiáng)模式,54.1%(20/37)可見(jiàn)“無(wú)增強(qiáng)區(qū)”,無(wú)一例呈現(xiàn)周邊結(jié)節(jié)狀增強(qiáng),無(wú)一例呈現(xiàn)消退較快�；准�(xì)胞瘤組與多形性腺瘤組在始增強(qiáng)時(shí)相、達(dá)峰增強(qiáng)程度、“無(wú)增強(qiáng)區(qū)”、周邊可見(jiàn)結(jié)節(jié)狀增強(qiáng)、消退情況有顯著統(tǒng)計(jì)學(xué)差異(P0.05),與腺淋巴瘤比較僅在增強(qiáng)后消退表現(xiàn)上有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:基底細(xì)胞瘤在臨床表現(xiàn)、常規(guī)超聲及超聲造影表現(xiàn)上具有一定的特征性,比如多發(fā)于年齡≥50歲女性患者,觸診較軟,左側(cè)發(fā)生,最大直徑3.0cm,可呈混合回聲,可見(jiàn)液性暗區(qū)且液性暗區(qū)范圍相對(duì)較大,血流信號(hào)較豐富,超聲造影后多呈現(xiàn)早增強(qiáng)、高增強(qiáng)模式,“無(wú)增強(qiáng)區(qū)”,周邊可見(jiàn)結(jié)節(jié)狀增強(qiáng),消退較快。掌握這些要點(diǎn)可以提高基底細(xì)胞瘤診斷的準(zhǔn)確性,同時(shí)也為外科醫(yī)生提供更準(zhǔn)確的信息。另外,基底細(xì)胞瘤這些特征與多形性腺瘤比較多有明顯差異性,鑒別兩者較為容易;與腺淋巴瘤比較,除了在發(fā)病性別、吸煙史、消長(zhǎng)史、無(wú)網(wǎng)格樣回聲、消退表現(xiàn)有一定差異性,其他均無(wú)明顯差異性,鑒別有很大困難。
[Abstract]:Objective: To explore the clinical features of parotid basilar tumor, the characteristics of conventional ultrasound and ultrasound contrast, and to seek the diagnostic value of parotid pleomorphic adenoma and adenoma. Methods: to collect the diagnosis of parotid pleomorphic adenoma and adenoma from January 2011 to 2014. The surgical pathology proved to be parotid basal cell tumor, pleomorphic adenoma, adenoma Clinical features, conventional ultrasound and ultrasound contrast data, respectively, to analyze the characteristics of the three aspects of basilar tumor and the difference with the other two types of tumors. The clinical data include: age (older than 50 years old, /50 years), sex (male / female), smoking history (/ no), palpation (soft / hard), history of extinction (or no); conventional ultrasound data including tumor location (unilateral / bilateral, left / right), maximum diameter (3.0cm/ > 3.0cm), boundary (clear / unclear), internal echo (low echo / mixed echo), lobulated (/ no), mesh like echo (/ no), posterior echo enhancement (/ no), liquid dark area (/ no), liquid dark area (large / small), calcified (/ no), peripheral lymph node (there is / no), internal blood flow abundance (Alder semi quantitative, 0-I / II - III); contrast-enhanced phase (early / synchronous or late enhancement), initial enhancement (first enhancement / center enhancement or diffuse enhancement), peak enhancement (high / low enhancement), enhancement of uniformity (uniformity / inhomogeneity enhancement) Edge ring enhancement (with / without), peripheral nodular enhancement (with / no), no enhanced area (/ no), enhanced posterior border (clear / unclear), enhanced post (change / no change), and enhanced postoperative regression (faster / slower). Results: from January 2011 to December 2014, 108 patients were included in 112 lesions, of which 14 cases of basal cell tumor were 14, pleomorphic There were 61 lesions in 59 cases of adenoma and 37 lesions in 35 cases of adenoma. After analysis of the clinical data of three groups of tumors, it was found that the onset age of the basal cell tumor group was generally more than 50 years old and the palpation was softer than that of the pleomorphic adenoma group (P0.05), and there was no statistical difference between the adenoma group and the adenoma group; in addition, the basal cell tumor was the basal cell tumor. The group was mostly in female patients, no smoking history and history of extinction. There was a significant difference between the group and the adenoma group (P0.05), but there was no statistical difference between the group and the pleomorphic adenoma group. The analysis of conventional ultrasound showed that the basal cell tumor group was all unilateral, of which 71.4% (10/14) occurred on the left side, and the other 85.7% (12/14) was 3.0cm, 35.7% (5/14). There was a mixed echo, no case of grid like echo, 42.8% (6/14) visible liquid dark area and a large range of liquid dark area accounted for 28.6% (4/14), 57.1% (8/14) showed blood flow signal II - III; in the multiform adenoma group, all occurred on one side, of which 37.7% (23/61) was born on the left, the other 26.2% (16/61) maximum diameter 3.0cm, 3.3% (2/61) mixed echo, 1 .6% (1/61) can display mesh like echo, 18% (11/61) visible liquid dark area and 3.3% (2/61) with large liquid dark area range, 16.4% (10/61) showing blood flow signal II - III; 59.5% (22/37) in adeno Lymphoma Group, 67.6% (25/37) maximum diameter 3.0cm, 24.3% (9/37) mixed echo, 29.7% (11/37) can display mesh like echo, 40.5% (15/37). There were 16.2% (6/37) and 32.4% (12/37) in the dark area of liquid and liquid dark area, and the location of the tumor in the basal cell tumor group and the pleomorphic adenoma group, the maximum diameter, the internal echo, the dark area and the dark area of the liquid, and the significant difference between the blood flow signals (P0.05), only in the lymphoma group. There were significant statistical differences in the echo performance of the grid like (P0.05). Analysis of ultrasonography showed that 78.6% (11/14) in the basal cell tumor group showed early enhancement, high enhancement pattern, 42.9% (6/14) visible "no enhancement zone", 14.3% (2/14) peripheral visible nodular enhancement, 21.4% (3/14) subsiding faster; 18% (11/61) in the pleomorphic adenoma group had an early enhancement model. 27.9% (17/61) showed a high enhancement pattern, 18% (11/61) showed "no enhancement area", no case of peripheral nodular enhancement, 3.3% (2/61) subsided faster, 54.1% (20/37) showed early enhancement pattern in adeno Lymphoma Group, 86.5% (32/37) showed high enhancement pattern, 54.1% (20/37) showed "no enhancement area", no case showed peripheral nodular enhancement, no case. One case showed a rapid regression. The basal cell tumor group and the pleomorphic adenoma group were in the initial phase, the peak enhancement degree, "no enhancement area", the peripheral nodular enhancement, the regression situation had significant statistical difference (P0.05). Compared with the adenoma, there was a statistical difference between the enhancement and the retrogression (P0.05). Conclusion: basal cell tumor is in the face. Bed performance, conventional ultrasound and ultrasound contrast show a certain characteristic, such as the age of more than 50 years of age more than 50 years old female patients, palpation soft, the left, the largest diameter, the maximum diameter, can be mixed echo, visible liquid dark area and a relatively large liquid dark area, the blood flow signal is more abundant, after ultrasound contrast in the early enhancement, high enhancement pattern "No enhancement area", the peripheral visible nodular enhancement and rapid decline. Mastery of these points can improve the accuracy of the diagnosis of basal cell tumor and provide more accurate information for the surgeon. In addition, the characteristics of basal cell tumor are much different from those of pleomorphic adenomas, which are easier to distinguish between them; compared with adenomas. Besides, there was a certain difference in the history of smoking, history of growth and decline, meshless echo, and regression in addition to the onset of sex.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R739.8;R445.1

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