本文選題：超聲彈性成像 + 原發(fā)性肝癌�。� 參考：《第二軍醫(yī)大學(xué)》2014年碩士論文

【摘要】：研究背景及目的 原發(fā)性肝癌是最常見的惡性腫瘤之一。在世界范圍內(nèi)，男性原發(fā)性肝癌發(fā)病率居第五，死亡率在腫瘤中居第二；女性發(fā)病率居第七，死亡率在腫瘤中居第六。原發(fā)性肝細(xì)胞癌又是其中的最主要的病理類型，占全球原發(fā)性肝癌的70%-85%。我國是原發(fā)性肝細(xì)胞癌的高發(fā)區(qū)，這些發(fā)病和死亡的病例其中一半來自中國，目前主要依靠早診斷早治療來提高患者生存率。 超聲檢查是診斷肝臟疾病最常用的手段之一，由于其方便、無創(chuàng)、價廉等特點，被廣泛的應(yīng)用在各種肝臟疾病的診斷和鑒別診斷中，包括原發(fā)性肝細(xì)胞癌的診斷和鑒別。超聲彈性成像技術(shù)是近年發(fā)展起來的新技術(shù)，它通過了解所檢測組織的硬度以判別其良惡性，與常規(guī)超聲和超聲造影獲取到的信息完全不同，有其獨特性。實時組織彈性成像作為超聲彈性成像技術(shù)的一種，，采用評分法和SR值法對肝實性占位性病變進(jìn)行檢查，得到病灶的彈性測值，有助于腫瘤的良惡性診斷。但由于肝實性占位性病變的特殊性，除了病灶病理類型的差異外，病灶的硬度可能受某些病理指標(biāo)的影響，如分化程度、有無包膜、有無瘤內(nèi)出血、有無壞死等，這方面目前暫無相關(guān)研究。 本課題以原發(fā)性肝細(xì)胞癌患者為研究對象，進(jìn)行實時組織彈性成像檢查，獲取彈性測值，用病理指標(biāo)分組進(jìn)行對照和相關(guān)分析，初步探討在原發(fā)性肝細(xì)胞肝癌中病理指標(biāo)與實時組織彈性成像測值的相關(guān)性和對與良性局灶性病變鑒別診斷效能的影響。 研究方法 1、病例選擇： 第一部分研究分析了2011年8月～2013年8月在我院經(jīng)手術(shù)病理證實的原發(fā)性肝細(xì)胞癌患者73例，其中男性65例，女性7例。 第二部分研究分析了2011年8月～2013年10月在我院經(jīng)手術(shù)病理證實的原發(fā)性肝細(xì)胞肝癌73例，良性局灶性病變患者39例（肝血管瘤14例、局灶性結(jié)節(jié)性增生9例、肝腺瘤6例、血管平滑肌脂肪瘤7例及孤立性壞死性結(jié)節(jié)、硬化結(jié)節(jié)、脂肪浸潤各1例）。其中男性83例，女性29例。 以上研究均在檢查前告知患者及家屬本研究的方法、目的和可能存在的風(fēng)險，并簽署《知情同意書》。 2、擬行原發(fā)性肝細(xì)胞癌的實時組織彈性成像與病理指標(biāo)相關(guān)性研究： 73例原發(fā)性肝細(xì)胞肝癌患者均行實時組織彈性成像檢查，獲取彈性評分和SR值，將評分和SR值分別在包膜、瘤內(nèi)出血、壞死、微血管癌栓、組織類型和癌旁肝組織分型中作分組比較；將癌旁肝組織類型設(shè)為偏相關(guān)因素，對病理各指標(biāo)與SR比值進(jìn)行Pearson偏相關(guān)分析。 3、擬行實時組織彈性成像中肝硬化對原發(fā)性肝細(xì)胞肝癌與良性局灶性病變鑒別診斷的影響： 運用實時組織彈性成像技術(shù)對上述73例原發(fā)性肝細(xì)胞肝癌患者及39例良性局灶性病變患者分為肝硬化組與非肝硬化組，分別以≥3分、SR≥3.47為惡性腫瘤為診斷標(biāo)準(zhǔn)，將評分法和SR值法的診斷結(jié)果與病理結(jié)果做比較，分析兩組診斷效能的差別。 結(jié)果 1、各項病理指標(biāo)分組比較顯示評分和SR值在不同癌旁組織分型（肝硬化組和非肝硬化組）中有統(tǒng)計學(xué)差異（P0.05）。將癌旁肝組織類型設(shè)為偏相關(guān)因素，對病理各指標(biāo)與SR比值進(jìn)行Pearson偏相關(guān)分析。結(jié)果顯示，消除癌旁肝組織不同類型影響后，SR值與瘤內(nèi)出血呈負(fù)相關(guān)，表明有瘤內(nèi)出血病人其SR值較無出血病人低，其余指標(biāo)與SR值無相關(guān)關(guān)系。 2、結(jié)果顯示評分法和SR值法在總的和肝硬化組的診斷效能均與病理診斷不一致（P0.05），非肝硬化組的診斷效能均與病理診斷一致（Kappa值分別為0.5412和0.5698，P均為0.0000）。非硬化組中評分法和SR值法的一致百分率、靈敏度、特異度、誤診率、漏診率分別為77.27%和78.79%、76.32%和78.95%、78.57%和78.57%、21.43%和21.43%、23.68%和21.05%。評分法和SR值法在非硬化組的診斷效能高于硬化組。 結(jié)論 1、原發(fā)性肝細(xì)胞肝癌硬度測值與癌旁肝組織肝硬化和瘤內(nèi)出血有關(guān)。 2、原發(fā)性肝細(xì)胞肝癌與良性病變的鑒別診斷受病灶旁肝組織肝硬化的影響。
[Abstract]:Background and purpose of research
Primary liver cancer is one of the most common malignant tumors. In the world, the incidence of male primary liver cancer is fifth, the mortality rate is second in the tumor, the incidence of female is seventh, the mortality rate is sixth in the tumor. Primary hepatocellular carcinoma is the most important type of disease, which accounts for the 70%-85%. of the primary liver cancer in the world. It is a high incidence area of primary hepatocellular carcinoma. Half of these cases and deaths are from China. It is mainly based on early diagnosis and early treatment to improve the patient's survival rate.
Ultrasonic examination is one of the most commonly used methods for the diagnosis of liver diseases. Because of its convenience, noninvasive and inexpensive, it is widely used in the diagnosis and differential diagnosis of various liver diseases, including the diagnosis and identification of primary hepatocellular carcinoma. Ultrasound elastography is a new technology developed in recent years. It has been used to understand the detected tissues. It is different from conventional ultrasound and ultrasound contrast and has its uniqueness. As one of the ultrasonic elastic imaging techniques, the real-time tissue elastic imaging is used to examine the liver solid occupying lesions by scoring and SR values, and the elastic measurement of the lesion is helpful to the diagnosis of benign and malignant tumors. However, due to the specificity of the liver solid space occupying lesions, in addition to the pathological types of the lesions, the lesion's hardness may be influenced by some pathological indexes, such as the degree of differentiation, or without capsule, or without tumor, and whether there is necrosis or not, and there is no related Research for the present.
This subject takes the patients of primary hepatocellular carcinoma as the research object, carries on the real-time tissue elastic imaging examination, obtains the elastic measurement, uses the pathological indexes to carry on the contrast and correlation analysis, and preliminarily discusses the correlation between the pathological indexes of the primary hepatocellular carcinoma and the real-time tissue elastography and the identification of the benign focal lesions. The effect of breaking efficiency.
research method
1, case selection:
In the first part, 73 cases of primary hepatocellular carcinoma confirmed by surgery and pathology in our hospital from August 2011 to August 2013 were analyzed, including 65 males and 7 females.
The second part studied 73 cases of primary hepatocellular carcinoma confirmed by operation and pathology in our hospital from August 2011 to October 2013, 39 cases of benign focal lesions (14 cases of hepatic hemangioma, 9 cases of focal nodular hyperplasia, 6 cases of hepatic adenoma, 7 cases of angiomyolipoma and solitary necrotic nodules, sclerotic nodules, and 1 cases of fatty infiltration). Among them, 83 were male and 29 were female.
The above study informed the patients and their families about the method, purpose and possible risks before the examination, and signed the informed consent.
2, to study the correlation between real-time tissue elastography and pathological findings in primary hepatocellular carcinoma.
73 cases of primary hepatocellular carcinoma were examined by real time tissue elastic imaging to obtain elastic score and SR value. The scores and SR values were compared in the capsule, intratumoral hemorrhage, necrosis, microvascular tumor thrombus, tissue type and paracancerous liver tissue classification, and the type of para cancer liver tissue was set as partial correlation factor, and the pathological indexes and SR ratio were compared. Pearson partial correlation analysis was carried out.
3, the effect of cirrhosis in real-time tissue elastography on the differential diagnosis of primary hepatocellular carcinoma and benign focal lesions:
The 73 cases of primary hepatocellular carcinoma and 39 cases of benign focal lesions were divided into cirrhosis group and non cirrhosis group by real time tissue elastic imaging. The diagnostic criteria of malignant tumors were equal to 3 and SR 3.47, respectively. The diagnostic results of the scoring and SR values were compared with the pathological results, and the diagnostic efficiency of the two groups was analyzed. Difference.
Result
1, the pathological indexes showed that scores and SR values were statistically different (P0.05) in different paracancerous tissue types (cirrhosis group and non cirrhosis group). The type of para cancer liver tissue was set as partial correlation factor, and the Pearson partial correlation analysis was carried out on the pathological indexes and the ratio of SR. The results showed that the effects of different types of liver tissue were eliminated. The SR value was negatively correlated with intratumoral hemorrhage, indicating that the SR value of patients with intratumoral hemorrhage was lower than that of patients without bleeding. Other indicators were not related to SR value.
2, the results showed that the diagnostic efficiency of the score method and the SR value method in the total and liver cirrhosis group was not consistent with the pathological diagnosis (P0.05). The diagnostic efficiency of the non cirrhosis group was in accordance with the pathological diagnosis (Kappa value was 0.5412 and 0.5698, and P was 0 respectively). The percentage of the score, sensitivity, specificity, misdiagnosis rate and leakage rate in the non sclerosis group were the same as that in the SR value method. The diagnostic rates were 77.27% and 78.79%, 76.32% and 78.95%, 78.57% and 78.57%, 21.43% and 21.43%, and 23.68% and 21.05%. scores and SR values were higher in the non sclerosis group than in the sclerosis group.
conclusion
1, the hardness of primary hepatocellular carcinoma is related to liver cirrhosis and intratumoral hemorrhage.
2, the differential diagnosis between primary hepatocellular carcinoma and benign lesions is affected by Para hepatic cirrhosis.

【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R735.7;R445.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 杜陽春;廖新紅;楊紅;;實時組織彈性成像評價肝纖維化程度的初步研究[J];廣西醫(yī)科大學(xué)學(xué)報;2012年02期

2 蔣長秀;何云;楊紅;彭濤;李智賢;江健寧;葉新平;李璇;黎玉瓊;;實時組織彈性成像彈性特征量定量與肝纖維化程度的相關(guān)分析[J];廣西醫(yī)學(xué);2011年10期

3 趙娜;申志揚;郭琦;;早期肝纖維化的實時組織彈性成像定量分析[J];鄭州大學(xué)學(xué)報(醫(yī)學(xué)版);2011年06期

4 孟繁坤;鄭穎;徐曉鸞;穆曉潔;丁蕾;;實時組織超聲彈性成像與瞬時彈性成像評價慢性乙肝感染肝纖維化程度的對比研究[J];臨床超聲醫(yī)學(xué)雜志;2011年12期

5 李藝;王燕;曾敏霞;欒艷艷;常婷;胡兵;;實時超聲彈性成像五分法與應(yīng)變率比值法在肝腫瘤定性診斷中的價值[J];臨床超聲醫(yī)學(xué)雜志;2012年12期

6 陳潔鑫;徐曉紅;徐輝雄;周宏蓮;;聲脈沖輻射力彈性成像技術(shù)評價牛肝組織射頻消融的實驗研究[J];臨床超聲醫(yī)學(xué)雜志;2013年03期

7 方玲;何光彬;孟欣;張苗苗;秦海英;王莉;周曉東;;實時組織彈性成像在評價肝臟腫瘤中的初步應(yīng)用[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2010年10期

8 方玲;周曉東;何光彬;張苗苗;孟欣;秦海英;王莉;;超聲彈性成像對肝腫瘤良惡性的鑒別診斷價值[J];現(xiàn)代腫瘤醫(yī)學(xué);2010年11期

9 葉家才;崔書中;巴明臣;;原發(fā)性肝癌的流行病學(xué)特征及其危險因素[J];實用醫(yī)學(xué)雜志;2008年10期

10 管小鳳;羅葆明;;超聲彈性成像在腫瘤良惡性鑒別中的應(yīng)用[J];現(xiàn)代儀器;2012年04期

本文編號：1847921