發(fā)布時(shí)間：2018-03-18 10:22

  本文選題：皮膚鏡　切入點(diǎn)：脂溢性角化病　出處：《復(fù)旦大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景：皮膚鏡除了可以探測色素結(jié)構(gòu),也可用于識別血管結(jié)構(gòu)和其他精細(xì)的皮膚結(jié)構(gòu)特征。近年來,皮膚鏡技術(shù)越來越多的在一些非色素性皮膚病中有應(yīng)用,如非黑色素性腫瘤,炎癥性及感染性疾病,甚至用于隨訪非色素性疾病的治療效果。脂溢性角化病、基底細(xì)胞癌、日光性角化病、鮑溫病是臨床上常見的四種非黑素性皮膚腫瘤。這四種疾病在臨床上有時(shí)候僅依據(jù)臨床表現(xiàn)往往較難鑒別,且這四種疾病的危害性與處理方法各不相同。目的：總結(jié)臨床和病理確診的脂溢性角化病、基底細(xì)胞癌、日光性角化病、鮑溫病的皮膚鏡特征,為皮膚鏡鑒別色素性皮損提供依據(jù)。方法：皮膚鏡Heine Delta 20用于觀察病理確診的70例脂溢性角化病,71例基底細(xì)胞癌,51例日光性角化病,14例鮑溫病患者的皮損,放大倍數(shù)一般為10倍,皮膚鏡連接于單反相機(jī)(Nikon D70,日本尼康公司)上以獲取皮膚鏡照片。結(jié)果：本項(xiàng)研究70例脂溢性角化病患者中皮膚鏡下主要表現(xiàn)為粉刺樣開口和粟粒樣囊腫分別為78.6%和65.7%；此外包括腦回狀結(jié)構(gòu)(44.2%),鱗屑(77.1%),發(fā)夾狀血管結(jié)構(gòu)(25.7%)等。71例基底細(xì)胞癌患者中大的藍(lán)灰色卵圓形細(xì)胞巢56例(78.9%),多發(fā)的藍(lán)灰色小球43例(60.7%),潰瘍41例(57.7%),血管模式53例(74.6%)中樹枝狀血管37例(52.1%),毛細(xì)血管擴(kuò)張37例(52.1%)。在表現(xiàn)有非色素性皮損的17例日光性角化病患者中17例(100%)表現(xiàn)為“草莓表面樣”模式,即紅斑背景下的假網(wǎng)格狀結(jié)構(gòu)(74.5%),繞以白色暈圈的凸出的毛囊開口(43.1%),伴以白色至黃色角質(zhì)栓(64.7%)的“靶形”樣毛囊開口,類似草莓的表面；紅斑在非色素性皮損中亦較常見82.4%)。在表現(xiàn)有色素性皮損的19例日光性角化病患者中,表現(xiàn)為毛囊口周圍點(diǎn)狀或球狀結(jié)構(gòu)有10例,“環(huán)形顆粒狀”結(jié)構(gòu)有6例,表現(xiàn)有褐色或黑色假網(wǎng)格結(jié)構(gòu)7例。14例鮑溫病患者中大部分表現(xiàn)有特異性的鱗屑(78.60%)和球狀血管(57.1%),白色無結(jié)構(gòu)區(qū)域(35.5%),棕褐色點(diǎn)狀結(jié)構(gòu)呈簇狀分布(50%)。結(jié)論：皮膚鏡將有助于提高脂溢性角化病、基底細(xì)胞癌、日光性角化病、鮑溫病的診斷率,為臨床上非黑素性腫瘤的鑒別診斷提供有力的幫助。本次研究的不足之處是未展開對診斷標(biāo)準(zhǔn)的診斷敏感性和特異性的評價(jià),有待于進(jìn)一步的后續(xù)研究。而且在應(yīng)用皮膚鏡時(shí),不能脫離病人的臨床特點(diǎn)、實(shí)驗(yàn)室檢查、影像學(xué)表現(xiàn)等,亦不能取代病理活檢。
[Abstract]:Background: in addition to detecting pigmented structures, dermoscopes can also be used to identify vascular and other fine skin structural features. In recent years, dermatoscopy has been increasingly used in some non-pigmented skin diseases. For example, non-melanoma, inflammatory and infectious diseases, and even for follow-up treatment of non-pigmented diseases. Seborrheic keratosis, basal cell carcinoma, sunlight keratosis, Bowen's disease is a common clinical non-melanoma of the skin. These four diseases are sometimes difficult to distinguish according to their clinical manifestations. Objective: to summarize the clinical and pathological features of seborrheic keratosis, basal cell carcinoma, solar keratosis and Bowen's disease. Methods: the dermatoscope Heine Delta 20 was used to observe the skin lesions of 71 cases of basal cell carcinoma and 51 cases of solar keratosis in 70 cases of seborrheic keratosis diagnosed pathologically, and 14 cases of Bowen's disease. The magnification is usually 10 times, Dermoscopy was attached to Nikon D70 (Nikon D70, Japan) to obtain dermoscopy. Results: in this study, 70 patients with seborrheic keratosis presented mainly with pimple-like openings and miliary cysts, respectively. 78.6% and 65.7; in addition, there were 44.2 gyrus, 77.1 scales and 25.775% of basal cell carcinoma. Among the 71 patients with basal cell carcinoma, 56 cases had large blue-gray oval cell nests, 43 cases had multiple blue-gray pellets, 41 cases had ulcers 57.77.7m, and 53 had vascular pattern. There were 37 cases with dendritic vessels and 37 cases with capillary dilatation. Among the 17 cases with nonpigmented keratosis, 17 cases showed "strawberry surface like" pattern. That is, the pseudo-reticular structure in the background of erythema (74.5a) is similar to the surface of strawberry, with a "target-shaped" hair-follicle opening with a white to yellow keratinocyte (64.7a) around the bulging hair follicle opening with a white halo circle. Erythema was also more common in non-pigmented lesions than in non-pigmented lesions. In 19 cases of solar keratosis with pigmented lesions, there were 10 cases with punctate or spherical structures around the hair follicle orifice, and 6 cases with "ring granular" structure. There were 7 cases of brown or black pseudo-grid structure. 14 cases of Bowen's disease. Most of them showed specific scales 78.60) and spherical vessels 57.1%. The white unstructured area was 35. 5% and the brown spot structure was distributed in cluster shape. Conclusion: the dermatoscope will. Help to improve seborrheic keratosis, The diagnostic rate of basal cell carcinoma, solar keratosis and Bowen's disease provides powerful help for the differential diagnosis of non-melanoma in clinic. The deficiency of this study is that the diagnostic sensitivity and specificity of the diagnostic criteria have not been evaluated. Further research is needed. And the application of dermatoscope cannot be separated from the clinical features, laboratory examination, imaging findings, etc., nor can it replace pathological biopsy.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.5

【共引文獻(xiàn)】

相關(guān)期刊論文 前1條

1 趙敏;張倩;;160例脂溢性角化病的臨床與病理分析[J];山西醫(yī)科大學(xué)學(xué)報(bào);2006年08期

相關(guān)碩士學(xué)位論文 前2條

1 孫兆偉;共聚焦激光掃描顯微鏡在表皮增生性疾病診斷和評估治療療效的應(yīng)用[D];天津醫(yī)科大學(xué);2010年

2 李琨;皮膚鏡診斷脂溢性角化病、日光性角化病、基底細(xì)胞癌的臨床研究[D];濟(jì)南大學(xué);2014年

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本文編號：1629180