本文選題：腎癌　切入點(diǎn)：腎部分切除術(shù)　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的動脈自旋標(biāo)記(ASL)、體素內(nèi)不相干運(yùn)動(IVIM)縱向評估腎癌患者腹腔鏡下腎部分切除術(shù)后余腎功能的初步研究。對象與方法納入30例擬行腹腔鏡腎部分切除術(shù)的腎腫瘤患者及30例年齡與之相匹配的健康志愿者,術(shù)前采用99mTc-DTPA腎核素掃描評估術(shù)前健側(cè)腎的腎小球?yàn)V過率(glomerular filtration rate,GFR)。并于核素檢查72小時內(nèi)及術(shù)后3個月、6個月、12個月行ASL、IVIM掃描,通過后處理獲得皮質(zhì)的腎血流量(renal blood flow,RBF)值、腎皮髓質(zhì)的假擴(kuò)散系數(shù)(ADC of pseudodiffusion,ADC_(fast))、灌注分?jǐn)?shù)(perfusion fraction,PF)值。采用SPSS 19.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)量資料用x±s的形式表示。對各腎臟皮質(zhì)RBF值及皮髓質(zhì)的ADC_(fast)、PF值行正態(tài)分布檢驗(yàn),經(jīng)證實(shí)數(shù)據(jù)滿足正態(tài)分布后,采取組內(nèi)相關(guān)系數(shù)(intra-class correlation coefficient,ICC)分析2名醫(yī)師測量腎臟皮髓質(zhì)各指標(biāo)值的一致性,ICC≥0.75認(rèn)為一致性好,0.40≤ICC0.75認(rèn)為一致性中等,ICC0.40認(rèn)為一致性差。采取獨(dú)立樣本t檢驗(yàn)比較健康志愿者組雙腎皮質(zhì)間、髓質(zhì)間及皮髓質(zhì)間各指標(biāo)值的差異,并取健康志愿者組左腎的各指標(biāo)值進(jìn)行下一步的分析;采取獨(dú)立樣本t檢驗(yàn)比較患者術(shù)前患側(cè)余腎、健側(cè)腎臟皮髓質(zhì)ADC_(fast)、PF值差異;采取Pearson相關(guān)分析研究患者健側(cè)腎臟術(shù)前各指標(biāo)值與GFR間的相關(guān)性,以及健側(cè)腎皮質(zhì)ADC_(fast)、PF與RBF之間的相關(guān)性;采取重復(fù)測量方差分析比較各時間點(diǎn)腎臟皮髓質(zhì)各指標(biāo)值的差異;采取獨(dú)立樣本t檢驗(yàn)比較患者組術(shù)后12個月與正常對照組腎臟皮髓質(zhì)各指標(biāo)值的差異。p0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果(1)兩名醫(yī)師對腎臟皮髓質(zhì)IVIM、ASL各指標(biāo)值測量的一致性均良好,ICC均在0.75以上。(2)健康志愿者雙腎皮質(zhì)間、雙腎髓質(zhì)間RBF、ADC_(fast)、PF差異均無統(tǒng)計(jì)學(xué)意義(p0.05)。(3)健康志愿者雙腎皮質(zhì)RBF、ADC_(fast)、PF值均明顯大于髓質(zhì),差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。(4)患者患側(cè)及健側(cè)腎臟皮髓質(zhì)間ADC_(fast)、PF值均存在明顯差異(p0.05)。(5)健側(cè)腎皮質(zhì)RBF、ADC_(fast)及PF值與GFR均呈正相關(guān)性(R值分別為0.560、0.532、0.678,p0.01)。(6)健側(cè)腎髓質(zhì)ADC_(fast)及PF值與GFR均呈正相關(guān)性(R值分別為0.622、0.601,p0.01)。(7)健側(cè)腎髓質(zhì)ADC_(fast)及PF值與RBF均呈正相關(guān)性(R值分別為0.537、0.598,p0.01)。(8)術(shù)后3月患側(cè)殘余腎組織皮質(zhì)RBF、皮髓質(zhì)ADC_(fast)、PF值較術(shù)前升高(p0.05);術(shù)后6月較3月患側(cè)殘余腎組織各參數(shù)值較術(shù)前升高(p0.05),12月時較前未見明顯變化。(9)術(shù)后3月健側(cè)腎組織皮質(zhì)RBF、皮髓質(zhì)ADC_(fast)、PF值較術(shù)前下降(p0.05),術(shù)后6月較3月患側(cè)殘余腎組織各參數(shù)值較術(shù)前下降(p0.05),12月時較前亦未見明顯變化。(10)術(shù)后12月患者患側(cè)及健側(cè)腎臟皮髓質(zhì)RBF、ADC_(fast)、PF與健康對照組差異均無統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論ASL、IVIM可以用來評價腎功能,且縱向評估腹腔鏡下腎癌部分切除術(shù)后余腎血流灌注功能具有一定的價值。
[Abstract]:Objective to evaluate the residual renal function in patients with renal cell carcinoma after laparoscopic partial nephrectomy by arterial spin labeling (ASLL) and intra voxel incoherent motility (IVIMI). Participants and methods 30 patients with renal swelling undergoing laparoscopic partial nephrectomy were included in this study. Tumor patients and 30 age-matched healthy volunteers, Preoperative 99mTc-DTPA renin scan was used to evaluate glomerular filtration rateGFR in healthy kidney before operation. ASLI-IVIM was performed within 72 hours of radionuclide examination and 3 months, 6 months and 12 months after radionuclide examination. Renal blood flow rate (RBFs) of renal cortex was obtained by post-processing. The pseudo-diffusivity coefficient of renal medulla is ADC of pseudodiffusion.Perfusion fraction and perfusion fraction are analyzed by SPSS 19.0 statistical software, and the measured data are expressed in the form of x 鹵s. The normal distribution of RBF value of each kidney cortex and the value of RBF fast PF of skin medulla are tested. After confirming that the data satisfy the normal distribution, The intra-group correlation coefficient (intra-class correlation cofficient) was used to analyze the consistency of each index value measured by two physicians in renal dermatomedullary. ICC 鈮，

本文編號：1586480