本文選題：成人 + 縱隔肺門淋巴結(jié)腫大��； 參考：《廣州醫(yī)科大學》2017年碩士論文

【摘要】：背景成人縱隔肺門淋巴結(jié)腫大可見于淋巴結(jié)結(jié)核、淋巴結(jié)轉(zhuǎn)移癌、淋巴瘤、結(jié)節(jié)病、巨淋巴細胞增生癥及非特異性淋巴結(jié)炎等多種不同性質(zhì)疾病,是以上幾種疾病所伴隨的一種影像學征象。雖然疾病的性質(zhì)不同,但淋巴結(jié)腫大的影像學形態(tài)表達方式大體相同、比較抽象、缺乏特征和特點,臨床上對不同類型縱隔疾病的影像學定性及鑒別診斷較為困難。因此,充分認識成人縱隔肺門淋巴結(jié)核引起的淋巴結(jié)腫大的影像學細節(jié)征象及特點,對疾病的診斷、鑒別診斷及及時治療至關重要。目的通過研究分析成人縱隔肺門淋巴結(jié)結(jié)核的多層螺旋CT(MSCT)細節(jié)征象,同時以淋巴結(jié)轉(zhuǎn)移癌及縱隔淋巴瘤作對照研究分析,提高對成人縱隔肺門淋巴結(jié)結(jié)核的認識及鑒別度,為臨床診斷及治療提供重要幫助。材料與方法收集我院(廣州市胸科醫(yī)院)自2011年1月1日到2016年7月30日確診的成人縱隔肺門淋巴結(jié)結(jié)核患者104例(作為研究組;共544個成人縱隔淋巴結(jié)結(jié)核病灶的MSCT平掃及增強掃描細節(jié)征象)。其中成人縱隔肺門淋巴結(jié)結(jié)核病灶經(jīng)規(guī)則抗結(jié)核治療隨訪大于和或等于1年、以淋巴結(jié)結(jié)核病灶顯著縮小(大于和或等于1/2)或鈣化為最后診斷、經(jīng)取痰組織細胞學培養(yǎng)陽性診斷、經(jīng)頸部或腋下淋巴結(jié)穿刺活檢病理診斷、經(jīng)纖維支氣管鏡取病變組織病理診斷或經(jīng)手術(shù)活組織病理診斷。并與廣州市胸科醫(yī)院同時期確診的52例淋巴結(jié)轉(zhuǎn)移癌患者(作為對照組1;共250個淋巴結(jié)轉(zhuǎn)移癌病灶的MSCT平掃及增強掃描細節(jié)征象)及21例縱隔淋巴瘤(作為對照組2)進行對比研究分析。通過對研究組與對照組患者MSCT平掃及增強薄層掃描細節(jié)特點的對比研究,分析成人縱隔淋巴結(jié)結(jié)核的MSCT細節(jié)征象特征。對成人縱隔肺門淋巴結(jié)結(jié)核病灶(研究組104例共544個)的細節(jié)征象評價因素包括:病灶的大小、發(fā)生的部位、邊緣、形態(tài)、密度變化、融合情況、鈣化灶情況、強化程度與方式、周圍脂肪間隙情況以及病灶與周圍血管、氣管支氣管關系等;將成人縱隔肺門淋巴結(jié)結(jié)核與淋巴結(jié)轉(zhuǎn)移癌、縱隔淋巴瘤各征象進行對比研究分析。因為是兩個獨立樣本,組間比較采用兩個獨立樣本頻率的χ2檢驗、Fisher's確切概率法或χ2檢驗的連續(xù)性校正。對成人縱隔肺門淋巴結(jié)結(jié)核病灶(研究組:104例共544個)與淋巴結(jié)轉(zhuǎn)移癌(對照組1:52例共250個)及21例縱隔淋巴瘤(對照組2)的細節(jié)征象兩兩對比評價因素包括:病灶的大小、發(fā)生部位、邊緣、形態(tài)、密度變化、融合情況、鈣化灶情況、強化程度與方式、周圍脂肪間隙情況以及病灶與周圍血管、氣管支氣管關系等。結(jié)果1、成人縱隔肺門淋巴結(jié)結(jié)核病灶發(fā)生部位主要分布為:排在前五位的分別是,4R區(qū)86例共105個,7區(qū)56例共79個,2R區(qū)66例共78個,10R區(qū)43例共56個,10L區(qū)34例共38個。其中縱隔肺門淋巴結(jié)結(jié)核病灶局限于1個區(qū)域的僅3例,其余均為多個區(qū)域淋巴結(jié)發(fā)生結(jié)核病灶。2、成人縱隔肺門淋巴結(jié)結(jié)核病灶MSCT平掃細節(jié)征象:病灶大小1-4cm共101例521個(95.8%),4cm共5例23個(4.2%),36例107個(31.2%)病灶合并鈣化;79例316個(58.1%)病灶不融合,38例228個(41.9%)病灶融合;32例174個(40.0%)病灶平掃密度均勻,81例370個(60.0%)病灶平掃密度不均勻,與對照組1及對照組2對比,均為P0.05,有統(tǒng)計學意義;其中研究組(縱隔肺門淋巴結(jié)結(jié)核組)高于對照組(淋巴結(jié)轉(zhuǎn)移癌組、淋巴瘤組)的是:1-4cm的病灶,鈣化灶,病灶的不融合和密度的不均勻。3、成人縱隔肺門淋巴結(jié)結(jié)核病灶MSCT增強掃描細節(jié)征象:22例94個(17.2%)病灶明顯均勻強化,與淋巴結(jié)轉(zhuǎn)移癌組對比,χ2=10.380,P0.05,有顯著統(tǒng)計學意義,與淋巴瘤組對比,χ2=0.515,P0.05,無統(tǒng)計學意義;32例101個(18.6%)病灶輕中度強化,與淋巴結(jié)轉(zhuǎn)移癌組對比χ2=1.926,P0.05,無統(tǒng)計學意義,與淋巴瘤組對比χ2=18.462,P0.05,有顯著統(tǒng)計學意義;37例108個(19.8%)病灶邊緣薄壁環(huán)形強化,與淋巴結(jié)轉(zhuǎn)移癌組對比χ2=5.191,P0.05,有顯著統(tǒng)計學意義,與淋巴瘤組對比χ2=6.396,P0.05,有顯著統(tǒng)計學意義;6例20個(3.7%)病灶邊緣厚壁環(huán)形強化,與淋巴結(jié)轉(zhuǎn)移癌組對比χ2=33.591,P0.05,有顯著統(tǒng)計學意義,與淋巴瘤組對比χ2=4.186,P0.05,無統(tǒng)計學意義;29例72個(13.2%)病灶環(huán)形細小分隔樣強化,與淋巴結(jié)轉(zhuǎn)移癌組對比χ2=9.190,P0.05,有顯著統(tǒng)計學意義,與淋巴瘤組對比χ2=7.625,P0.05,有顯著統(tǒng)計學意義;33例94個(17.2%)病灶多環(huán)重疊性強化,與淋巴結(jié)轉(zhuǎn)移癌組對比χ2=6.319,P0.05,有顯著統(tǒng)計學意義,與淋巴瘤組對比χ2=4.274,P0.05,有顯著統(tǒng)計學意義;6例18個(3.3%)病邊緣結(jié)節(jié)樣強化,與淋巴結(jié)轉(zhuǎn)移癌組對比χ2=9.506,P0.05,有顯著統(tǒng)計學意義,與淋巴瘤組對比χ2=0.034,P0.05,無統(tǒng)計學意義;6例22個(4.0%)病灶無明顯強化,與淋巴結(jié)轉(zhuǎn)移癌組對比χ2=3.230,P0.05,無統(tǒng)計學意義;與淋巴瘤組對比χ2=1.273,P0.05,無統(tǒng)計學意義。淋巴結(jié)結(jié)核組高于淋巴結(jié)轉(zhuǎn)移癌組的強化特點是:邊緣薄壁環(huán)形強化、環(huán)形細小分隔樣強化、多環(huán)重疊性強化(PO.05);結(jié)核組高于淋巴瘤組的強化特點是:邊緣薄壁環(huán)形強化,環(huán)形細小分隔樣強化(PO.05)結(jié)論1、成人縱隔肺門淋巴結(jié)結(jié)核有主要的好發(fā)部位,主要以4R區(qū)、2R區(qū)和7區(qū)、10R和10L區(qū)為主;2、在研究組(成人縱隔肺門淋巴結(jié)結(jié)核)與對照組1、2(對照組1:淋巴結(jié)轉(zhuǎn)移癌;對照組2:縱隔淋巴瘤)對比研究中發(fā)現(xiàn):成人縱隔肺門淋巴結(jié)結(jié)核的鈣化灶情況、病灶的不融合及病灶密度的不均勻情況均明顯高于淋巴結(jié)轉(zhuǎn)移癌及縱隔淋巴瘤。3、成人縱隔肺門淋巴結(jié)結(jié)核以多種不同形態(tài)強化為主要特點:可呈不均勻強化、邊緣薄壁環(huán)形強化、環(huán)形細小分隔樣強化、多環(huán)融合性強化邊緣呈微結(jié)節(jié)樣強化并存中心低密度區(qū)、無明顯強化、鄰近血管被包繞;其中研究組(成人縱隔肺門淋巴結(jié)結(jié)核)出現(xiàn)率高于對照組1(淋巴結(jié)轉(zhuǎn)移癌)的強化特點是:病灶不均勻強化、邊緣薄壁環(huán)形強化、環(huán)形細小分隔樣強化和多環(huán)融合性強化(P0.05);研究組(成人縱隔肺門淋巴結(jié)結(jié)核)出現(xiàn)率高于對照組2(縱隔淋巴瘤)的強化特點是:邊緣薄壁環(huán)形強化和環(huán)形細小分隔樣強化(P0.05)。4、成人縱隔肺門淋巴結(jié)結(jié)核具有自限性,病灶短徑一般4cm,區(qū)別于淋巴結(jié)轉(zhuǎn)移癌與淋巴瘤的腫瘤性生長方式,病變短徑多大于4cm。5、MSCT掃描具有較高的形態(tài)及密度分辨率,易于對縱隔肺門淋巴結(jié)結(jié)核的檢出,對各種原因所致縱隔肺門淋巴結(jié)腫大的診斷、鑒別具有重要意義。
[Abstract]:Background the enlargement of the hilar lymph nodes in the mediastinum of the adult can be seen in many different diseases, such as nodule tuberculosis, lymph node metastasis, lymphoma, sarcoidosis, giant lymphocytic hyperplasia and nonspecific lymphadenitis. It is an imaging sign associated with the above diseases. Although the nature of the disease is different, the imaging form of lymph nodes is enlarged. State expression is generally the same, abstract, lack of characteristics and characteristics. It is difficult to identify and differentiate the imaging of different types of mediastinal diseases. Therefore, we fully understand the imaging details and characteristics of the lymphadenopathy caused by the mediastinal pulmonary hilar tuberculosis, and the diagnosis, differential diagnosis and timely treatment of the disease. Objective to study and analyze the details of the multi-slice spiral CT (MSCT) of adult mediastinal pulmonary hilar nodules, and to study and analyze the lymph node metastasis and mediastinal lymphoma, and to improve the recognition and differentiation of the adult mediastinal pulmonary hilar nodule tuberculosis, and provide important help for the diagnosis and treatment of the clinic. 104 cases of adult mediastinal pulmonary hilar nodules confirmed by our hospital (Guangzhou Chest Hospital) from January 1, 2011 to July 30, 2016 (as a study group; a total of 544 adult mediastinal tuberculous lesions of the mediastinal lymph nodes, MSCT scan and enhanced scan details). Among them, adult mediastinal pulmonary hilar lymph nodes were followed up by regular anti tuberculosis treatment. More than and equal to 1 years, the nodule lesion of the lymph nodes was significantly reduced (greater than and or equal to 1/2) or calcification as the final diagnosis. The positive diagnosis of sputum tissue cytology was diagnosed by biopsy of the phlegm tissue. The pathological diagnosis of the cervical or axillary lymph node biopsy, the pathological diagnosis of the pathological tissue by the fiberoptic bronchoscopy, and the pathological diagnosis of the surgical tissue through the operation, and Guangzhou city. 52 cases of lymph node metastases diagnosed at the same time in the thoracic hospital (as control group 1, MSCT plain and enhanced scan details in 250 lymph node metastases) and 21 cases of mediastinal lymphoma (as control group 2) were compared and analyzed. The details of MSCT plain scan and enhanced thin layer scan in the study group and the control group were observed. The characteristics of MSCT details in adult mediastinal lymph node tuberculosis were analyzed. The evaluation factors of the details of the adult mediastinal pulmonary hilar nodule tuberculosis (544 of the 104 cases) included the size, location, edge, morphology, density, fusion, calcification, enhancement and manner, and the surrounding fat. The gap and the relationship between the lesion and the surrounding vessels, tracheobronchial relationship, and so on; compare and analyze the signs of the adult mediastinal lymph node tuberculosis with lymph node metastasis and mediastinal lymphoma. It is two independent samples, and the two independent sample frequencies are compared with the chi 2 test, the exact probability method or the continuity of the chi 2 test. Correction. For adult mediastinal pulmonary hilar nodules (544) and 104 cases of lymph node metastasis (250 in the control group, 250 in the control group) and 21 cases of mediastinal lymphoma (control group 2), the 22 evaluation factors included the size, location, edge, morphology, density, fusion, calcification, calcification, calcification, enhancement, and enhancement. Degree and mode, the surrounding fat space and the relationship between the focus and the surrounding vessels, tracheobronchial and so on. Results 1, the main distribution of tuberculosis foci in the adult mediastinal pulmonary hilar lymph nodes was the first five, 86 cases in 4R area, 79 in 56 cases in 7 areas, 78 in 66 cases in the area of 10R, 43 in region of 2R and 34 in District 10L. The tuberculous foci of the pulmonary portal lymph nodes were limited to 1 regions in only 3 cases, and the rest were.2 in multiple regional lymph nodes, and MSCT scan details in adult mediastinal pulmonary hilar nodules: 101 cases, 521 (95.8%) of the lesion size 1-4cm, 23 (4.2%) in 5 cases of 4cm, 107 (31.2%) with calcification in 107 (31.2%), 79 (58.1%) lesions. No fusion, 228 (41.9%) lesion fusion in 38 cases, 32 cases with 174 (40%) uniform scan density, 81 cases with 370 (60%) unevenly scanning density, compared with the control group 1 and the control group 2, all were P0.05, and the study group (mediastinal pulmonary hilar nodule group) was higher than the control group (lymph node metastasis and Lymphoma Group): 1-4cm lesions, calcification, non fusion and uneven density of.3, and MSCT enhanced scan details of the adult mediastinal pulmonary hilar nodules: 22 cases (17.2%) were obviously enhanced, compared with the lymph node metastasis group, X 2=10.380, P0.05, statistically significant, and compared with the Lymphoma Group, Chi 2=0.515, P0.05, no statistics. Study significance; 32 cases (18.6%) of 101 (18.6%) light and moderate enhancement, compared with lymph node metastatic carcinoma group, X 2=1.926, P0.05, no statistical significance, compared with the Lymphoma Group, X 2=18.462, P0.05, and significant statistical significance; 37 cases 108 (19.8%) edge thin-walled circular enhancement, and lymph node metastatic carcinoma group compared with 2=5.191, P0.05, significant statistical significance. Compared with the Lymphoma Group, the X 2=6.396 and P0.05 were statistically significant. 6 cases (3.7%) had a thick circumferential enhancement on the edge of the lesion, and compared with the lymph node metastasis group, X 2=33.591, P0.05, with significant statistical significance, compared with the Lymphoma Group, 2=4.186, P0.05, and no statistically significant sense; 29 cases were 72 (13.2%) foci of ring-shaped fine separation, and lymph nodes. The metastatic carcinoma group compared with the X 2=9.190, P0.05, significant statistical significance, compared with the Lymphoma Group x 2=7.625, P0.05, there were significant statistical significance; 33 cases 94 (17.2%) polycyclic overlapping enhancement, and lymph node metastatic carcinoma group compared with 2=6.319, P0.05, significant statistical meaning, and lymphoma group compared with 2=4.274, P0.05, significant statistical significance. 6 cases of 18 (3.3%) patients with marginal nodular enhancement, compared with the lymph node metastasis group, X 2=9.506, P0.05, had significant statistical significance, compared with the Lymphoma Group x 2=0.034, P0.05, no statistical significance, 6 cases 22 (4%) no significant enhancement, and lymph node metastatic carcinoma group to X 2=3.230, P0.05, no statistical significance; and lymphoma group compared Chi 2=1.273 P0.05, no statistical significance. The enhancement characteristic of the lymph node tuberculosis group is higher than that of the lymph node metastasis group: marginal thin-walled ring strengthening, circular fine separation enhancement and multi ring overlapping enhancement (PO.05). The enhancement characteristic of the tuberculosis group is higher than the Lymphoma Group: the marginal thin-walled ring strengthening, the circular fine separation enhancement (PO.05) conclusion 1, the adult mediastinum. The main location of tuberculosis of the hilar lymph node was mainly 4R, 2R and 7, 10R and 10L. 2, in the study group (adult mediastinal pulmonary hilar nodule tuberculosis) and the control group 1,2 (control group 1: lymph node metastasis cancer; control group 2: mediastinal lymphoma) contrast study: calcification focus of adult mediastinal pulmonary hilar nodules, focus of focus. Nonuniformity of non fusion and lesion density were significantly higher than that of lymph node metastases and mediastinal lymphoma.3. Adult mediastinal pulmonary hilar nodule tuberculosis was characterized by a variety of different morphologic intensification: inhomogeneous enhancement, marginal thin-walled ring enhancement, annular fine separation enhancement, and polycyclic fortified edges with micro nodular enhancement. In the central low density area, there was no obvious enhancement and adjacent vessels were wrapped around, and the rate of the study group (adult mediastinal pulmonary hilar nodule tuberculosis) was higher than that of the control group of 1 (lymph node metastasis), which was characterized by uneven intensification of the lesions, marginal thin-walled ring enhancement, annular fine separation enhancement and polycyclic fusion (P0.05); the study group (adult longitudinal) The occurrence rate of pulmonary portal lymph node tuberculosis was higher than that of the control group of 2 (mediastinal lymphoma), which was characterized by marginal thin-walled ring strengthening and annular fine separation enhancement (P0.05).4. The adult mediastinal pulmonary hilar lymph node tuberculosis was self limited, the short diameter of the lesion was generally 4cm, and the tumor growth pattern of lymph node metastasis and lymphoma was different from that of lymphomas, and the short diameter of the lesion was different. More than 4cm.5, MSCT scanning has high morphological and density resolution, and it is easy to detect tuberculosis of the mediastinal hilar lymph nodes. It is of great significance for the diagnosis of the mediastinal lymph node enlargement caused by various causes.
【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R52;R816.41

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