本文選題：甲狀腺 + 甲狀腺腫瘤��； 參考：《福建醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的探討灰階超聲、多普勒血流成像及彈性成像鑒別甲狀腺良惡性結(jié)節(jié)的價(jià)值，并嘗試用一種簡(jiǎn)便易行的分類方法制定甲狀腺結(jié)節(jié)惡性危險(xiǎn)度分類報(bào)告方案，并驗(yàn)證其臨床應(yīng)用價(jià)值。 方法第一部分:縱/橫比回顧性分析785例甲狀腺手術(shù)患者的1012個(gè)甲狀腺結(jié)節(jié)的聲像圖，用t檢驗(yàn)比較良、惡性結(jié)節(jié)的最大徑，用卡方檢驗(yàn)或Fisher精確概率法比較結(jié)節(jié)數(shù)目、、邊緣、邊界、暈環(huán)、結(jié)構(gòu)成份、回聲水平、鈣化類型、血流模式、彈性評(píng)分、結(jié)節(jié)與被膜關(guān)系及周圍淋巴結(jié)轉(zhuǎn)移情況等。用Logistic回歸(逐步法)獲得惡性相關(guān)征象的OR值，據(jù)此賦予有鑒別價(jià)值的征象不同的分值。統(tǒng)計(jì)各分值結(jié)節(jié)的惡性比例及由回歸方程計(jì)算的預(yù)測(cè)概率。 第二部分:根據(jù)預(yù)測(cè)概率及惡性比例對(duì)不同分值的結(jié)節(jié)進(jìn)行初步分類。并結(jié)合文獻(xiàn)報(bào)道及單因素分析結(jié)果對(duì)初步分類方法進(jìn)行調(diào)整，建立一個(gè)分良惡性兩種模式的甲狀腺結(jié)節(jié)分類診斷方案：Ⅰ類“良性結(jié)節(jié)”、Ⅱ類“可能良性”、ⅢA“低度可疑惡性”、ⅢB“中度可疑惡性”、ⅢC“高度可疑惡性”、Ⅳ類“較確定惡性”。應(yīng)用該方案對(duì)術(shù)前患者的甲狀腺結(jié)節(jié)進(jìn)行前瞻性分類評(píng)估，并以手術(shù)病理診斷為金標(biāo)準(zhǔn)分析此方案的應(yīng)用價(jià)值。 結(jié)果第一部分:單純膠質(zhì)囊腫及海綿樣結(jié)節(jié)為良性結(jié)節(jié)的特異性表現(xiàn)；結(jié)節(jié)內(nèi)“暴風(fēng)雪”樣簇狀微鈣化、結(jié)節(jié)突破腺體被膜、甲狀腺周圍淋巴結(jié)轉(zhuǎn)移征象為惡性結(jié)節(jié)的特異征象；中央型血流、低回聲、邊緣不光滑、縱/橫比大于1、厚薄不均暈環(huán)、散在微鈣化及極低回聲這7個(gè)聲像特征與惡性有不同程度的相關(guān)性，其OR值分別為2、7、8、11、16、58、72。 第二部分:回顧性資料中Ⅰ類結(jié)節(jié)均為良性，其余類別的惡性比例隨著分類級(jí)別的提高而增高，該分類方案預(yù)測(cè)惡性的ROC曲線下面積為0.964。前瞻性資料中，術(shù)前分類為Ⅰ類的結(jié)節(jié)均為良性，Ⅱ類、ⅢA、ⅢB、ⅢC、Ⅳ類結(jié)節(jié)的惡性比例同樣隨著級(jí)別的提高而增高，并且各類結(jié)節(jié)惡性比例與回顧性資料相比，差異均無統(tǒng)計(jì)學(xué)意義，，其預(yù)測(cè)惡性的ROC曲線下面積為0.970。 結(jié)論本研究對(duì)甲狀腺結(jié)節(jié)超聲評(píng)估指標(biāo)進(jìn)行分類并評(píng)分，分良惡性兩種模式對(duì)結(jié)節(jié)進(jìn)行TI-RADS (Thyroid Imaging Reporting and Data System,甲狀腺影像報(bào)告與數(shù)據(jù)系統(tǒng))分類，有助于預(yù)測(cè)結(jié)節(jié)的惡性危險(xiǎn)度。
[Abstract]:Objective to study the value of gray scale ultrasound, Doppler flow imaging and elastic imaging in differentiating benign and malignant thyroid nodules, and to make a classification and report scheme of thyroid nodule malignant risk by a simple and convenient classification method. Its clinical application value was verified. Methods the first part: the longitudinal / transverse ratio of 1012 thyroid nodules in 785 patients undergoing thyroid surgery was analyzed retrospectively. The maximum diameter of benign and malignant nodules was compared by t test, and the number and edge of nodules were compared by chi-square test or Fisher accurate probability method. Boundary, halo ring, structural composition, echo level, calcification type, blood flow pattern, elastic score, the relationship between nodule and capsule and lymph node metastasis. The OR value of malignant correlation signs was obtained by Logistic regression (stepwise method). The malignancy ratio of nodule and the prediction probability calculated by regression equation were calculated. Part two: according to the probability of prediction and the proportion of malignancy, the nodules with different scores are preliminarily classified. According to the results of literature report and univariate analysis, the preliminary classification method was adjusted to establish a classification and diagnosis scheme of thyroid nodule classified into benign and malignant models: type 鈪

本文編號(hào)：1977084