本文選題：脊柱腫瘤 + 栓塞��； 參考：《第二軍醫(yī)大學》2014年碩士論文

【摘要】：研究背景：選擇性動脈栓塞是脊柱腫瘤外科術前常常采用的一項安全有效的輔助治療方法。有研究認為，只有富血供的腫瘤進行術前栓塞才有意義，對乏血供腫瘤行術前栓塞可能是沒有必要的。因此，術前評價脊柱腫瘤血供狀態(tài)對指導臨床治療非常重要。MR動態(tài)增強可以發(fā)現腫瘤血流動力學的異常，區(qū)分富血供及乏血供腫瘤，術前提供有價值的信息。但目前對脊柱腫瘤，缺少MRI動態(tài)增強與DSA血管造影的對照研究，術前是否可用MRI動態(tài)增強評價腫瘤血供尚不明確。本課題對擬行外科切除術的脊柱腫瘤病人，術前采用MR動態(tài)增強與DSA血管造影對照，研究其評價脊柱腫瘤血供狀態(tài)的價值，探討術前栓塞對脊柱腫瘤外科治療的臨床意義。 第一部分MR動態(tài)增強與DSA對照對脊柱腫瘤血供狀態(tài)的評價 研究目的:通過與DSA血管造影對比，探討MR動態(tài)增強評價脊柱腫瘤血供狀態(tài)的價值。 材料與方法:2012年7月至2014年1月行脊柱腫瘤術前栓塞的患者，共40例，其中男23例，女17例，平均年齡47歲（16-74歲），入院后均行MR動態(tài)增強掃描，之后于術前完成DSA引導下選擇性動脈栓塞，外科切除后取得病理。研究脊柱腫瘤的動態(tài)增強曲線參數及DSA染色表現,探討其相關性,以DSA染色為金標準繪制ROC曲線，得出曲線下面積AUC ROC。 結果：腫瘤動態(tài)增強曲線的最大斜率Slopemax、腫瘤與正常椎體最大斜率比值S1/S0與DSA染色的相關性分別為0.847、0.899（均P0.01）。S1/S0、Slopemax判斷脊柱腫瘤乏血供的ROC曲線下面積分別為0.971、0.930（P0.01），此時S1/S0的cut-off值為1.325（敏感性87.5%，特異性100%）。S1/S0、Slopemax判斷脊柱腫瘤富血供的ROC曲線下面積分別為0.988、0.979（P0.01），此時S1/S0的cut-off值為1.870（敏感性100%，特異性96.4%）。MR強化程度判斷脊柱腫瘤乏血供與富血供的ROC曲線下面積分別為0.547、0.697，均P0.05。 結論：MR動態(tài)增強可以更為精確地判斷脊柱腫瘤病變的血供程度，與DSA血管造影有很好的一致性，是一個術前評價血供的良好指標，有很大的臨床應用價值。 第二部分: MR動態(tài)增強鑒別脊柱良惡性腫瘤的價值 研究目的:探討MR動態(tài)增強鑒別脊柱良惡性腫瘤的價值。 材料與方法:2012年7月至2014年1月行脊柱腫瘤外科切除的患者，共40例，男23例，女17例，平均年齡47歲（16-74歲），入院后均行MR動態(tài)增強掃描，行外科手術切除并取得術后病理。研究動態(tài)增強曲線參數、MR強化程度等在脊柱良、惡性腫瘤鑒別中的意義。 結果：脊柱良、惡性腫瘤的MR強化程度有統(tǒng)計學差異，，Z=-4.019，P0.01；良、惡性腫瘤的動態(tài)增強曲線類型無明顯統(tǒng)計學差異，Z=-0.556，P=0.578。腫瘤與正常椎體最大斜率比S1/S0、腫瘤最大斜率Slopemax、最大強化值Emax、最大強化比ERmax、達峰時間TTP等指標在良、惡性腫瘤分組中的表現無統(tǒng)計學差異，均P0.05。 結論：MR動態(tài)增強曲線在脊柱良、惡性腫瘤中的表現無明顯統(tǒng)計學差異，不能單獨用作判斷，學結合其他形態(tài)學改變。 第三部分:脊柱腫瘤外科術前血管栓塞的臨床意義 研究目的:對比脊柱腫瘤術前栓塞后行外科切除術中出血、圍手術期輸血量及并發(fā)癥的差異，評價術前栓塞的臨床應用價值。材料與方法:2012年07月至2014年01月擬行脊柱腫瘤外科切除術的患者，共80例，術前栓塞組40例，平均年齡47.0±15.9歲，其中男性24例，女性16例，胸椎病變18例，腰椎病變9例，骶椎病變13例。對照組（未栓塞）40例，平均年齡46.1±17.9歲，其中男性25例，女性15例，胸椎病變17例，腰椎病變13例，骶椎病變9例。對比2組病例術中出血量、圍手術期輸血量及并發(fā)癥差異。 結果：栓塞組40例患者共對188支腫瘤供血血管進行了造影，對其中的167支供血血管進行了栓塞。栓塞組術中出血量1740±746ml,對照組術中出血量2516±1374ml，兩者之間有明顯統(tǒng)計學差異（P0.01）。栓塞組圍手術期輸血量1425±1348ml，對照組1845±1348ml，兩組之間無明顯統(tǒng)計學差異（P0.05）。栓塞組無一例栓塞并發(fā)癥及手術并發(fā)癥，對照組2例手術并發(fā)癥。 結論：脊柱腫瘤術前栓塞是一項安全有效的措施，可以顯著降低術中出血量，減少術中并發(fā)癥。
[Abstract]:Background: selective arterial embolization is a safe and effective adjuvant therapy that is often used before spinal tumor surgery. Clinical therapy is very important for.MR dynamic enhancement, which can detect abnormal hemodynamics of tumor, distinguish rich blood supply and lack of blood supply, and provide valuable information before operation. However, it is not clear that MRI dynamic enhancement can be used to evaluate the blood supply by dynamic enhancement of MRI before operation. The value of MR dynamic enhancement and DSA angiography was used to evaluate the value of the evaluation of the state of blood supply of spinal tumors and the clinical significance of preoperative embolization on the surgical treatment of spinal tumors.
Part MR dynamic contrast-enhanced DSA evaluation of blood supply status of spinal tumors
Objective: To evaluate the value of MR dynamic enhancement in evaluating the blood supply state of spinal tumors by comparing with DSA angiography.
Materials and methods: from July 2012 to January 2014, 40 cases of spinal tumor preoperative embolization were performed, including 23 males and 17 females, with an average age of 47 years (16-74 years old). MR dynamic enhanced scan was performed after admission. Then, selective arterial embolization was performed under DSA guidance before operation, and pathology was obtained after external excision. The dynamic enhancement curve of spinal tumor was studied. Parameters and DSA staining were performed to explore the correlation. DSA curve was used as the gold standard to draw ROC curve, and the area under the curve AUC ROC. was obtained.
Results: the maximum slope Slopemax of the tumor dynamic enhancement curve, the correlation of the ratio of S1/S0 to the maximum slope of the tumor and the normal vertebral body was 0.847,0.899 (P0.01).S1/S0 respectively. The ROC curve under the ROC curve of the spinal tumor for the spinal tumor was 0.971,0.930 (P0.01), respectively, and the S1/S0 cut-off value was 1.325 (sensitivity 87.5%, respectively). Heterosexual 100%).S1/S0, Slopemax determined that the area under the ROC curve for the blood supply of spinal tumors was 0.988,0.979 (P0.01), and the cut-off value of S1/S0 was 1.870 (sensitivity 100%, specificity 96.4%).MR strengthening degree to determine the area under ROC curve under the ROC curve of spinal tumor and rich blood supply respectively 0.547,0.697, P0.05.
Conclusion: the dynamic enhancement of MR can be more accurate in judging the blood supply of the spinal tumor, and it is in good agreement with the DSA angiography. It is a good index to evaluate the blood supply before operation, and has great clinical value.
The second part: the value of dynamic enhanced MR in differentiating benign and malignant tumors of the spine.
Objective: To investigate the value of dynamic contrast-enhanced MR in differential diagnosis of benign and malignant spinal tumors.
Materials and methods: from July 2012 to January 2014, 40 cases of surgical resection of spinal tumors were performed in 40 cases, 23 males and 17 females, with an average age of 47 years (16-74 years old). After admission, the dynamic enhanced scan was performed with surgical excision and postoperative pathology. The parameters of dynamic enhancement curve and the degree of MR enhancement were used in the identification of benign and malignant tumors of the spine. Significance.
Results: there was a statistical difference in the degree of MR enhancement of benign and malignant tumors of the spine. There was no significant difference in the dynamic enhancement curve of Z=-4.019, P0.01, benign and malignant tumor. The maximum slope of Z=-0.556, P=0.578. tumor and normal vertebral body was S1/S0, the maximum slope Slopemax, the maximum strengthening value Emax, the maximum enhancement ratio ERmax, and the peak time TTP and so on. There was no significant difference in the scores of benign and malignant tumors, P0.05.
Conclusion: there is no significant difference in MR dynamic enhancement curve in benign and malignant tumors of spine.
The third part: the clinical significance of preoperative embolization for spinal tumors.
Objective: To compare the difference of blood transfusion, perioperative blood transfusion and complications after preoperative embolization of spinal tumor, evaluate the clinical value of preoperative embolization. Materials and methods: 80 cases, 40 cases of preoperative embolization group from 07 months to 01 months of 2012 and 40 cases of preoperative embolization group, mean age 47 + 15.9 years old, Among them, there were 24 males, 16 females, 18 thoracic vertebrae, 9 cases of lumbar vertebrae, 13 cases of sacral lesions and 40 cases of the control group (not embolism), the average age was 46.1 + 17.9 years old, including 25 males, 15 cases, 17 cases of thoracic vertebrae, 13 cases of lumbar vertebrae and 9 cases of sacral lesions.
Results: 40 patients in the embolization group underwent a total of 188 blood supply vessels of the tumor, and 167 of them were embolized. The amount of bleeding in the embolization group was 1740 + 746ml, and the amount of bleeding in the control group was 2516 + 1374ml. There were significant differences between the two groups (P0.01). The blood transfusion volume in the perioperative period of the embolization group was 1425 + 1348ml, and the control group was 1845 + 134. 8ml, there was no significant difference between the two groups (P0.05). There was no embolism complication and operative complication in the embolization group, but 2 cases in the control group.
Conclusion: preoperative embolization for spinal tumors is a safe and effective measure, which can significantly reduce intraoperative blood loss and reduce intraoperative complications.
【學位授予單位】：第二軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R738.1;R445.2

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