本文選題：不同部位　切入點(diǎn)：色素痣　出處：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:對(duì)納入研究標(biāo)準(zhǔn)的1316例色素痣樣皮損病例進(jìn)行回顧性分析,探討不同部位的色素痣的組織病理分型,總結(jié)發(fā)病規(guī)律,以提高皮膚科醫(yī)師對(duì)皮膚淺表色素痣的認(rèn)識(shí)程度以及早期診治水平。方法:收集2015年至2016年兩年間大連醫(yī)科大學(xué)附屬第二醫(yī)院皮膚科門診就診初步診斷為色素痣并行手術(shù)切除和組織病理活檢的患者及初步診斷為非色素痣并行組織病理活檢結(jié)果為色素痣的患者共1316例。術(shù)前與患者溝通,交代手術(shù)流程及注意事項(xiàng),記錄患者信息及臨床表現(xiàn),將色素樣皮損在光亮處拍攝照片,術(shù)畢將手術(shù)切除的皮損組織行組織病理檢查。統(tǒng)計(jì)所有患者年齡、性別;統(tǒng)計(jì)所有患者色素痣樣皮損分布部位,將其分為面頸部、軀干部、四肢部、手足部四組(其中軀干組不包括外陰部,手足組不包括甲部);將所有入選病例根據(jù)病理診斷結(jié)果分為交界痣、皮內(nèi)痣、混合痣。統(tǒng)計(jì)面頸部、軀干部、四肢部、手足部每組患者不同組織病理分型。統(tǒng)計(jì)所有病理診斷與臨床診斷不相符的病例,分析漏診及誤診情況。該研究所收集的病例均為我科專業(yè)醫(yī)師接診做出臨床診斷并行手術(shù)切除,組織病理標(biāo)本由我科專業(yè)技師制片,病理組織片由我科專業(yè)病理教授鏡檢診斷,排除患者資料記錄不完全的病例。對(duì)臨床資料和病理資料分類統(tǒng)計(jì)后,采用SPSS 20.0軟件錄入數(shù)據(jù)分析,計(jì)量資料采用均數(shù)±方差表示,采用t檢驗(yàn),計(jì)數(shù)資料用百分率表示,采用χ2檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:Ⅰ.在1316例色素痣樣皮損中,通過(guò)病理結(jié)果,確定診斷為色素痣1092例(83.0%),脂溢性角化病136例(10.3%),藍(lán)痣15例(1.2%),皮膚纖維瘤14例(1.1%),皮脂腺增生7例(0.5%),基底細(xì)胞癌6例(0.5%),疣5例(0.4%),其他如皮脂腺囊腫、血管瘤、日光性角化等共41例(3.1%)。Ⅱ.患者年齡分布2~87歲,平均年齡為34.5±14.0歲,最多分布在20~39歲年齡段。色素痣患者的年齡,主要分布在20~39歲年齡段,年齡偏輕;確脂溢性角化病的患者年齡,主要分布在40~79歲年齡段,年齡偏大;藍(lán)痣的患者年齡主要分布在20~59歲年齡段;皮膚纖維瘤的患者年齡主要分布在20~59歲年齡段;基底細(xì)胞癌的患者年齡主要分布在40~79歲年齡段。疣的患者年齡上分布較平均。Ⅲ.男性402例,女性914例,男女比1:2.27。Ⅳ.確診色素痣病例1092例,面頸部676例(61.9%),軀干部228例(20.9%),四肢部64例(5.9%),手足部124例(11.3%)。其中面頸部色素痣病理分型中交界痣30例(4.5%),皮內(nèi)痣587例(86.8%),混合痣59例(8.7%);軀干部色素痣病理分型中交界痣25例(11.0%),皮內(nèi)痣186例(81.6%),混合痣17例(7.4%);四肢部色素痣病理分型中交界痣19例(29.7%),皮內(nèi)痣35例(54.7%),混合痣10例(15.6%);手足部色素痣病理分型中交界痣102例(82.3%),皮內(nèi)痣16例(12.9%),混合痣6例(4.8%)。Ⅴ.病理診斷結(jié)果與臨床診斷結(jié)果相符合的病例為1045例,不相符的病例為271例,總符合率為79.4%;其中臨床診斷誤診為色素痣的其他疾病病例224例,誤診率為17.7%;臨床診斷誤診為其他疾病的色素痣病例47例,誤診率為4.3%。結(jié)論:Ⅰ.色素痣的臨床診斷中最易誤診的疾病為脂溢性角化病、藍(lán)痣及皮膚纖維瘤。Ⅱ.色素痣誤診的原因主要是肉眼識(shí)別皮損的顏色及形態(tài)存在誤差及個(gè)別皮損臨床表現(xiàn)的差異性。Ⅲ.面頸部色素痣的數(shù)量較其他部位色素痣的數(shù)量多,手足部色素痣惡變的可能性較其他部位大。Ⅳ.色素樣皮損診斷中,與惡性病變的鑒別尤為重要。Ⅴ.病理診斷為色素痣診斷的金標(biāo)準(zhǔn),臨床診斷需與病理診斷相結(jié)合。
[Abstract]:Objective: 1316 cases of skin pigmented nevus samples were included in the study criteria were retrospectively analyzed. The histopathological study of pigmented nevus in different parts of the classification, summarize the pathogenesis regularity, in order to improve the level of awareness of dermatologists superficial skin nevus and early diagnosis and treatment. Methods: collected from 2015 to 2016, two years in the second hospital of Dalian Medical University the Department of dermatology clinic initial diagnosis of pigmented nevus parallel surgical excision and biopsy of the patients and the initial diagnosis of non pigmented nevus parallel biopsy results for nevus patients were 1316 cases. Preoperative communication with patients, account operation processes and precautions, record the patient information and clinical manifestations, the pigment lesions in the light photographs, postoperative surgery lesions histopathology examination. All patients age gender statistics, statistics of all patients with color; Nevus like lesions distribution, which can be divided into the face and neck, trunk, limbs, hand and foot in four groups (the trunk group does not include the vulva, foot group does not include a); all cases according to the pathological diagnosis were divided into junctional nevus, compound nevus. Pine, statistics of face and neck, trunk cadres, limbs, hand and foot, pathological tissues of patients in each group. Statistical classification of all pathological diagnosis and clinical diagnosis was not consistent with the case analysis of misdiagnosis and missed diagnosis. The cases were collected in our department physician admissions to make clinical diagnosis of parallel resection, pathological specimen by my professional technicians the pathological slices, by my professional associate professor of pathology examination diagnosis, patient data records are not completely excluded cases. The clinical data and pathological data classification statistics, analysis using SPSS 20 software for data entry, data measured by the mean square 宸〃紺，

本文編號(hào)：1658552