本文選題：肝細(xì)胞癌 + 細(xì)胞分化程度�。� 參考：《第三軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：研究背景肝細(xì)胞癌(Hepatocellular carcinoma,HCC)是起源于肝細(xì)胞的惡性腫瘤,占原發(fā)性肝臟惡性腫瘤的80%-90%。在世界范圍內(nèi),HCC的發(fā)病率男性居第五位,女性居第九位,死亡率男性居第二位,女性居第六位。超聲造影(Contrast-enhanced ultrasound,CEUS)在肝臟病變的診斷中應(yīng)用廣泛,診斷HCC的敏感性和特異性與增強(qiáng)CT(Computed Tomography,計(jì)算機(jī)斷層攝影技術(shù))和增強(qiáng)MRI(Magnetic Resonance Imaging,磁共振成像)相當(dāng)。不同患者HCC超聲造影增強(qiáng)模式間有差異,但影響增強(qiáng)模式的因素尚不清楚。有研究報導(dǎo)高分化HCC與中-低分化HCC間超聲造影增強(qiáng)模式有差別,但中分化HCC與低分化HCC間是否有差異尚不清楚。此外,病灶大小及肝臟背景是否會對HCC超聲造影增強(qiáng)模式產(chǎn)生影響尚不清楚。目的(1)進(jìn)一步分析細(xì)胞分化程度對HCC超聲造影增強(qiáng)模式的影響,尤其是中分化HCC和低分化HCC間的差異;(2)分析病灶大小對HCC超聲造影增強(qiáng)模式的影響;(3)分析肝臟背景對HCC超聲造影增強(qiáng)模式的影響。材料和方法回顧性分析了2005年1月到2015年12月在第三軍醫(yī)大學(xué)西南醫(yī)院行超聲檢查最大徑5cm的單發(fā)病灶并經(jīng)手術(shù)切除或穿刺活檢病理證實(shí)為HCC的患者,所有病人術(shù)前1月內(nèi)行超聲造影檢查。肉眼觀察病灶超聲造影的動態(tài)增強(qiáng)過程,記錄病灶動脈相增強(qiáng)模式、廓清模式、開始增強(qiáng)時間、達(dá)峰時間及開始廓清時間。計(jì)量資料的組間比較用單因素方差分析或t檢驗(yàn),計(jì)數(shù)資料的組間比較用卡方檢驗(yàn)或確切概率法,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1、共納入276例HCC患者,平均年齡51.1±11.4歲(范圍:23-84歲),其中男性患者240例(86.9%)。230(83.3%)例患者經(jīng)病理和/或?qū)嶒?yàn)室檢查證實(shí)有肝硬化和/或慢性乙型肝炎。所有病灶的平均直徑為3.2±1.0cm(范圍:1.0-4.9cm)。2、270個(97.8%)HCC病灶動脈相為高增強(qiáng),其中203個(75.2%)為整體高增強(qiáng)及67個(24.8%)個為不均勻高增強(qiáng)。高分化HCC(84.4%)及中分化HCC(77.0%)動脈相為整體高增強(qiáng)的比例高于低分化HCC(56.3%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。直徑3cm的HCC病灶動脈相為不均勻高增強(qiáng)(35.2%)的比例高于直徑≤3cm的HCC病灶(10.0%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。肝臟背景不影響HCC動脈相的增強(qiáng)模式。3、270個動脈相高增強(qiáng)的病灶納入廓清模式的研究。高分化HCC延遲相廓清及不廓清的比例分別為41.9%及21.5%,明顯高于中分化HCC(27.6%;10.2%)或低分化HCC(20.3%;3.8%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。中分化HCC與低分化HCC廓清模式的比例差異無統(tǒng)計(jì)學(xué)意義(P0.05)。不同病灶大小及肝臟背景的HCC間各廓清模式的比例差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4、不同分化程度、病灶大小、肝臟背景的HCC間開始增強(qiáng)時間及達(dá)峰時間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。低分化HCC廓清最快(83.0±39.8s),中分化HCC其次(100.4±52.1s),高分化HCC廓清最慢(132.3±54.2s),兩兩比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。直徑3cm的HCC病灶(97.2±51.3s)較直徑≤3cm HCC病灶(113.9±53.5s)廓清更快,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。肝硬化背景HCC(106.5±52.2s)和非肝硬化背景HCC(101.6±54.0s)間開始廓清時間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1、分化程度對HCC超聲造影動態(tài)增強(qiáng)特征有影響,高分化HCC動脈相多為整體增強(qiáng),且大部分病灶為延遲相廓清或不廓清。中分化HCC與低分化HCC間各廓清模式的比例無明顯差別,但低分化HCC開始廓清時間較中分化HCC更早。2、病灶大小影響HCC超聲造影動態(tài)增強(qiáng)特征,直徑3cm HCC病灶動脈相多為不均勻高增強(qiáng),且廓清更快。3、肝臟背景不影響HCC超聲造影動態(tài)增強(qiáng)特征。
[Abstract]:Background Hepatocellular carcinoma (HCC) is a malignant tumor originating from hepatocytes. The incidence of 80%-90%. in primary liver malignancies is in the world. The incidence of HCC is the fifth in male and ninth in women. The mortality rate is second, and the female is sixth. Contrast (Contrast-enhanced ultrasound, CEUS). It is widely used in the diagnosis of liver lesions. The sensitivity and specificity of the diagnosis of HCC are equivalent to enhanced CT (Computed Tomography, computed tomography) and enhanced MRI (Magnetic Resonance Imaging, magnetic resonance imaging). There are differences between the enhanced modes of contrast enhanced ultrasound contrast in different patients, but the factors affecting the enhanced mode are not yet clear. It is reported that there is a difference between high differentiated HCC and medium to low differentiated HCC contrast enhancement mode, but it is not clear whether the difference between HCC and low differentiated HCC is not clear. In addition, it is not clear whether the size of the lesion and the liver background will affect the contrast enhancement mode of HCC. Objective (1) further analysis of the degree of cell differentiation to HCC contrast enhancement The influence of strong pattern, especially the difference between medium differentiated HCC and low differentiated HCC; (2) analysis of the effect of lesion size on enhanced pattern of HCC ultrasound contrast; (3) analysis of the effect of liver background on the enhancement pattern of HCC ultrasound contrast. The materials and methods reviewed the ultrasound examination in Southwest Hospital of Third Military Medical University from January 2005 to December 2015. The single lesion of the maximum diameter 5cm was confirmed by surgical resection or biopsy. All patients were examined by contrast ultrasound before operation in January. The dynamic enhancement process of ultrasound contrast was observed by the naked eye. The enhancement pattern of the artery phase, the clearance mode, the time of enhancement, the time of peak time and the time of clearance were recorded. A single factor ANOVA or t test was used to compare the group comparison with the chi square test or the exact probability method. The difference was statistically significant with P0.05. Results 1, 276 cases of HCC were included, the average age was 51.1 + 11.4 years (range: 23-84 years), of which 240 (86.9%).230 (83.3%) patients were in the pathology and / or laboratory. Liver cirrhosis and / or chronic hepatitis B were confirmed. The average diameter of all lesions was 3.2 + 1.0cm (range: 1.0-4.9cm).2270 (97.8%) HCC focus artery phase was high, of which 203 (75.2%) were high overall and 67 (24.8%) were inhomogeneous high enhancement. High differentiation HCC (84.4%) and middle differentiation HCC (77%) arterial phase increased as a whole The strong ratio was higher than that of low differentiated HCC (56.3%). The difference was statistically significant (P0.05). The proportion of arterial phase in HCC lesion in diameter 3cm was higher than that of HCC lesion with diameter less than 3cm (10%). The difference was statistically significant (P0.05). The liver background did not affect the enhancement pattern of the arterial phase of HCC. The clearance and dissection of the highly differentiated HCC delayed phase were 41.9% and 21.5%, respectively, which were significantly higher than that of middle differentiated HCC (27.6%; 10.2%) or low differentiated HCC (20.3%; 3.8%). The difference was statistically significant (P0.05). There was no significant difference (P0.05) between the differentiated HCC and the low differentiated HCC clearance model (P0.05). There was no statistical significance (P0.05).4, the difference degree of differentiation, the degree of differentiation, the size of the lesion, the beginning of the enhancement time and the peak time difference between the HCC of the liver background were not statistically significant (P0.05). The low differentiated HCC clearance was the fastest (83 + 39.8s), the intermediate HCC was next (100.4 + 52.1s), and the high differentiated HCC clearance was the slowest (132.3 + 54.2s) (132.3 + 54.2s) The difference was statistically significant (P0.05). The HCC lesion in diameter 3cm (97.2 + 51.3s) was faster than the diameter less than 3cm HCC lesion (113.9 + 53.5s), and the difference was statistically significant (P0.05). There was no significant difference in the time difference between the liver cirrhosis background HCC (106.5 + 52.2s) and the non cirrhosis background HCC (101.6 + 54.0s). Conclusion 1 The degree of transformation was influenced by the dynamic enhanced features of HCC ultrasound contrast. Most of the highly differentiated HCC arterial phase was enhanced, and most of the lesions were delayed or dissection. The proportion of the differentiated HCC and the low differentiated HCC was not significantly different, but the low differentiated HCC began to clear up the.2 earlier than the medium HCC, and the size of the lesion affected HCC ultrasound. The dynamic contrast enhancement features of 3cm HCC in diameter are mostly uneven and high enhancement, and the clearance of.3 is faster. The liver background does not affect the dynamic enhancement characteristics of HCC ultrasound contrast.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7;R445.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 朱長富;楊光;王聰;;超聲造影對原發(fā)性肝細(xì)胞癌的診斷及與病理分化程度的關(guān)系[J];大連醫(yī)科大學(xué)學(xué)報;2015年04期

2 蔣奕;劉文亞;趙艷萍;潘存雪;齊玲俊;;MRI與MSCT對肝炎肝硬化背景下小肝癌診斷效能的比較[J];實(shí)用放射學(xué)雜志;2012年05期

3 丁可;劉滿榮;楊新官;邱維加;李運(yùn)千;;螺旋CT多期增強(qiáng)掃描對平掃為等密度的肝細(xì)胞癌的診斷[J];實(shí)用放射學(xué)雜志;2011年11期

4 徐金鋒;劉慧玉;羅慧;魏章洪;吳瑛;;超聲造影對肝細(xì)胞肝癌病理分級的研究[J];中國超聲醫(yī)學(xué)雜志;2011年09期

5 郭明江;陳龍華;金吳東;;PET-CT和MRI與螺旋CT對原發(fā)性肝癌病灶檢出的對比觀察[J];中華腫瘤防治雜志;2008年11期

，

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