本文選題：超聲造影　切入點(diǎn)：強(qiáng)化CT　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探索超聲造影聯(lián)合強(qiáng)化CT在腎臟腫瘤診斷中的臨床應(yīng)用價(jià)值。方法:收集2015年3月至2017年1月份于河北醫(yī)科大學(xué)第二醫(yī)院泌尿外科住院并手術(shù)治療患者101例。患者術(shù)前均完善超聲造影以及強(qiáng)化CT檢查。行超聲造影檢查的病人依據(jù)其病灶的強(qiáng)化及消退方式以及是否存在環(huán)狀強(qiáng)化即“假包膜”等征象判斷其良惡性。行強(qiáng)化CT檢查的病人依據(jù)其是否存在“快進(jìn)快出”等征象判斷其良惡性。與患者術(shù)后病理結(jié)果相比較。結(jié)果:術(shù)后病理回報(bào)為惡性的73例病人中,超聲造影考慮為惡性的為68例,CT考慮為惡性的為66例。術(shù)后病理回報(bào)為良性的28例病人中,超聲造影診斷出約20例,強(qiáng)化CT診斷出為23例。超聲造影診斷的敏感性、特異性、準(zhǔn)確性分別為93.2%(68/73),71.4%(20/28),87.%(88/101);強(qiáng)化CT的敏感性、特異性和準(zhǔn)確性分別為90.4%(66/73)、82.1%(23/28)和88.1%(89/101),而超聲造影聯(lián)合強(qiáng)化CT診斷腎臟腫瘤的敏感性、特異性和準(zhǔn)確性分別為100%(73/73)、96.4%(27/28)和99.0%(100/101)。以術(shù)后病理為金標(biāo)準(zhǔn),分別算出超聲造影、強(qiáng)化CT及兩種檢查方法聯(lián)合診斷腎臟腫瘤的準(zhǔn)確率。三者之間,超聲造影與強(qiáng)化CT相比在腎臟腫瘤病變的診斷能力方面無差異性(P0.05),而兩者聯(lián)合起來診斷腎臟腫瘤的能力高于其中任何一種方法單獨(dú)診斷腎臟腫瘤的能力。結(jié)論:1超聲造影在檢查敏感性方面高于強(qiáng)化CT。2超聲造影在檢查的特異性和準(zhǔn)確性上低于強(qiáng)化CT。3超聲造影、強(qiáng)化CT兩者結(jié)合可以提高腎臟腫瘤診斷的準(zhǔn)確性。4對(duì)于患有腎腫瘤的病人術(shù)前均應(yīng)常規(guī)行超聲造影+強(qiáng)化CT檢查,從而進(jìn)一步提高腎腫瘤術(shù)前診斷的準(zhǔn)確率,減少不必要的手術(shù)治療,進(jìn)而減少患者痛苦,減輕患者負(fù)擔(dān),節(jié)約醫(yī)療成本,避免過度醫(yī)療。
[Abstract]:Objective: to explore the clinical value of contrast-enhanced CT in the diagnosis of renal neoplasms. Methods: from March 2015 to January 2017, we collected 101 patients who were hospitalized and operated in the Department of Urology, the second Hospital of Hebei Medical University from March 2015 to January 2017. Cases: all the patients had perfect contrast echocardiography and enhanced CT before operation. The benign and malignant lesions were judged according to the enhancement and regression mode of the lesions and the existence of ring enhancement, that is, "false capsule". The patients undergoing enhanced CT scan were judged to be benign and malignant according to whether there were signs of "fast in and out". Results: among 73 patients whose pathological returns were malignant after operation, the pathological results were compared with those of the patients. Among the 28 cases with benign pathological return after operation, 20 cases were diagnosed by contrast-enhanced CT and 23 cases were diagnosed by enhanced CT. The accuracy was 93.2t / 71.4 / 71.4 / 87.75 / 88 / 101; the sensitivity, specificity and accuracy of the enhanced CT were 90.466 / 73 / 73 and 82.11 / 28, respectively; and the sensitivity, specificity and accuracy of contrast-enhanced CT in the diagnosis of renal tumors were 100 ~ 7373 / 96.27 / 28 and 99.070 / 100 / 101, respectively. The golden standard was post-operative pathology, and the sensitivity, specificity and accuracy of enhanced CT in the diagnosis of renal tumors were 100% 73 / 73% (96. 427 / 28) and 99. 0% / 100% 101% respectively, and the sensitivity, specificity and accuracy of enhanced CT in the diagnosis of renal tumors were 100% 10 1% and 99 0% / 100% 10 1%, respectively. The accuracy rates of contrast-enhanced CT and two methods of combined diagnosis of renal tumors were calculated respectively. There is no difference in the diagnostic ability of contrast-enhanced CT and contrast-enhanced CT in the diagnosis of renal neoplasms (P 0.05), but the ability to diagnose renal tumors in combination is higher than that of any of them alone. Conclusion: 1. The sensitivity of contrast-enhanced contrast-enhanced CT.2 was higher than that of enhanced CT.3 in specificity and accuracy. The combination of enhanced CT and enhanced CT can improve the accuracy of diagnosis of renal neoplasms. 4. In order to improve the accuracy of preoperative diagnosis of renal tumors, contrast-enhanced CT should be performed on all patients with renal tumors before operation. Reduce unnecessary surgical treatment, and then reduce the suffering of patients, reduce the burden of patients, save medical costs, avoid overtreatment.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R737.11;R730.44

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