本文選題：超聲檢查 + 卵巢腫瘤　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的(1)本研究第一個(gè)目的是以超聲醫(yī)師的主觀診斷結(jié)果為對(duì)照,以病理結(jié)果為金標(biāo)準(zhǔn),探討簡單規(guī)則鑒別附件區(qū)良惡性包塊的臨床價(jià)值。(2)探討簡單規(guī)則結(jié)合低年資醫(yī)師的診斷效能。方法(1)收集從2012年2月至2014年6月經(jīng)病理證實(shí)的200例患者200個(gè)附件區(qū)包塊的超聲檢查圖像。(2)分別由2位不同年資超聲醫(yī)師回顧性分析其聲像圖特征,根據(jù)經(jīng)驗(yàn)得出主觀診斷,測(cè)試者根據(jù)簡單規(guī)則得出診斷結(jié)論,構(gòu)建受試者工作特征性曲線(ROC)。(3)利用SPSS軟件比較不同年資超聲醫(yī)師、簡單規(guī)則對(duì)附件區(qū)包塊的ROC曲線下面積。(4)利用SPSS軟件比較不同年資超聲醫(yī)師、簡單規(guī)則對(duì)附件區(qū)包塊的敏感度、特異度。(5)分析良性患者、惡性患者年齡以及良惡性包塊大小有無統(tǒng)計(jì)學(xué)差異。(6)分析不同年資醫(yī)師結(jié)合簡單規(guī)則的診斷效能。結(jié)果1.根據(jù)簡單規(guī)則診斷的ROC曲線下面積(AUC)為0.887,高年資醫(yī)師診斷的AUC為0.920,低年資醫(yī)師診斷的AUC為0.828。2.簡單規(guī)則診斷敏感度為83.3%,特異度為84.3%,高年資醫(yī)師診斷敏感度為94.4%,特異度為81.1%,兩者有統(tǒng)計(jì)學(xué)意義(Z≈2.3,P=0.0230.05);低年資醫(yī)師敏感度為76.4%,特異度為72.7%,與簡單規(guī)則有差異有統(tǒng)計(jì)學(xué)差異(Z≈1.98,P=0.0480.05)。3.患者年齡17~89歲,平均(45.1±13.7)歲,良性組病人年齡為(37.2±12.9)歲,明顯小于惡性組(53.3±13.5)歲,統(tǒng)計(jì)有差異(t=-7.56,P≈0.000.005)。最大徑1.0~20.0cm,平均(7.7±4.2)cm,良性組為(6.8±3.4)cm,惡性組為(9.3±4.9)cm,兩組比較差異有統(tǒng)計(jì)學(xué)意義(t=-7.56,P≈0.000.05)。4.高年資醫(yī)師在參考簡單規(guī)則前后其診斷效能并未有明顯的改觀(Az,0.96vs0.92,P=0.2055),而低年資醫(yī)師參考簡單規(guī)則后其診斷效能有明顯的提高(Az,0.828to0.89,P=0.012),但是仍然低于高年醫(yī)師的診斷效能(Az,0.89vs0.92,P=0.0241)。結(jié)論1.簡單規(guī)則能夠簡單快速的診斷附件區(qū)腫塊塊,具有較好的臨床應(yīng)用前景,幫助超聲醫(yī)師提高對(duì)附件區(qū)腫塊的鑒別診斷效能,尤其是對(duì)低年資醫(yī)師。2.但簡單規(guī)則的使用需要醫(yī)生對(duì)其深刻的理解和靈活的運(yùn)用,也要在運(yùn)用過程中不斷積累經(jīng)驗(yàn),總結(jié)規(guī)律;IOTA對(duì)于卵巢腫瘤超聲詞匯、定義都需要進(jìn)一步的遵循和推廣。3.對(duì)于簡單規(guī)則不能診斷的疾病,需要高級(jí)醫(yī)師進(jìn)行主觀評(píng)價(jià)或者臨床醫(yī)師或病理醫(yī)師共同會(huì)診,一起得到針對(duì)超聲聲像圖變化的合理的解釋。
[Abstract]:Objective 1) the first objective of this study is to compare the subjective diagnostic results of ultrasound physicians with the results of pathology as the gold standard. To explore the clinical value of simple rule in differentiating benign and malignant masses in adnexal region. Methods from February 2012 to June 2014, 200 patients with 200 patients with adnexal mass confirmed by pathology were collected. The ultrasonographic features of 200 patients with adnexal mass were analyzed retrospectively by two ultrasound physicians with different years of service, and subjective diagnosis was obtained according to experience. According to the simple rule, the tester drew the diagnosis conclusion, and constructed the operating characteristic curve of the subjects, using SPSS software to compare the ultrasonic doctors of different years. Simple rules for the area under the ROC curve of the adnexal mass.) the SPSS software was used to compare the ultrasound doctors of different years. The sensitivity, specificity and specificity of the simple rule to the adnexal mass were analyzed. The age of malignant patients and the size of benign and malignant mass were statistically different. Result 1. The area under the ROC curve diagnosed by simple rules was 0.887, the AUC diagnosed by the senior physician was 0.920, and the AUC diagnosed by the junior physician was 0.828.2. The diagnostic sensitivity of simple rule was 83.3, the specificity was 84.3, the sensitivity of senior physician was 94.4 and the specificity was 81.1, the sensitivity of the two was 76.4 and the specificity was 72.7, and the sensitivity of junior physician was 76.4and the specificity was 72.7, which was significantly different from that of simple rule. The age of the patients was 17 ~ 89 years (mean 45.1 鹵13.7) years, and that of benign patients was 37.2 鹵12.9 years, which was significantly lower than that of malignant patients (53.3 鹵13.5) years old. The difference was statistically significant (P < 0.05). The maximum diameter was 1.0 ~ 20.0 cm (mean 7.7 鹵4.2 cm), 6.8 鹵3.4 cm in benign group and 9.3 鹵4.9 cm in malignant group. The difference between the two groups was statistically significant. The diagnostic efficacy of senior doctors before and after reference to simple rules was not significantly improved. However, the diagnostic efficacy of young doctors with reference to simple rules was significantly improved, but it was still lower than that of older physicians. Conclusion 1. Simple rules can be used to diagnose adnexal mass easily and quickly. It has a good prospect of clinical application and helps ultrasound doctors to improve the differential diagnosis of adnexal mass, especially for junior physician. 2. However, the use of simple rules requires doctors to understand and apply them flexibly, and to accumulate experience in the process of application. The definition of IOTA for ovarian neoplasms need to be further followed and popularized. For diseases that can not be diagnosed by simple rules, it is necessary for senior doctors to make subjective evaluation or clinicians or pathologists to consult together to get a reasonable explanation for the changes of ultrasound images.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R737.3

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