本文選題：繼發(fā)性甲狀旁腺功能亢進(jìn)癥　切入點(diǎn)：影像學(xué)檢查　出處：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:探討超聲、CT、MIBI三種影像學(xué)檢查方法在繼發(fā)性甲狀旁腺功能亢進(jìn)癥術(shù)前定位診斷中的價(jià)值,以及繼發(fā)性甲狀旁腺功能亢進(jìn)癥的手術(shù)治療意義。方法:回顧性分析我院2012年1月-2016年12月期間在甲乳外科住院的繼發(fā)性甲狀旁腺功能亢進(jìn)癥患者的影像學(xué)檢查資料,結(jié)合手術(shù)后的病理,分別計(jì)算三種影像學(xué)檢查及任意兩種檢查方法聯(lián)合后的靈敏度和特異度。分析三種檢查方法在術(shù)前定位診斷中的價(jià)值。結(jié)果:本組研究共48例患者接受了高頻超聲檢查,檢測出138枚增大腺體,經(jīng)術(shù)中病理檢查證實(shí)其中3枚增生腺體為假陽性,為2枚腫大淋巴結(jié)和1枚甲狀腺結(jié)節(jié);2例未檢出腺體患者經(jīng)病理證實(shí)有7枚增生甲狀旁腺,即漏診7枚;經(jīng)統(tǒng)計(jì)學(xué)計(jì)算,高頻超聲的敏感度為77.97%,特異度為97.82%。49例患者接受了CT平掃+增強(qiáng)的檢查,共檢測出121枚增大腺體,經(jīng)術(shù)中病理檢查證實(shí)其中2枚增生腺體為假陽性,為1枚腫大淋巴結(jié)和1枚甲狀腺結(jié)節(jié);1例未檢出腺體患者經(jīng)病理證實(shí)有4枚增生甲狀旁腺,即漏診4枚;經(jīng)統(tǒng)計(jì)學(xué)計(jì)算,CT檢查的敏感度為66.85%,特異度為98.35%。36例患者接受了99mTc-MIBI檢查,共檢測出72枚增大腺體,經(jīng)術(shù)中病理檢查證實(shí)所有檢出腺體均為甲狀旁腺增生組織,無假陽性。1例未檢出腺體患者經(jīng)病理證實(shí)有4枚增生甲狀旁腺,即漏診4枚;經(jīng)統(tǒng)計(jì)學(xué)計(jì)算,99mTc-MIBI檢查的敏感度為52.56%,特異度為100%。經(jīng)統(tǒng)計(jì)學(xué)分析,高頻超聲敏感度優(yōu)于CT(χ2=5.526,P=0.019)和99mTc-MIBI(χ2=6.172,P=0.013);CT敏感度高于99mTc-MIBI(χ2=4.889,P=0.027);各種聯(lián)合檢查的敏感度均高于單獨(dú)檢查,差異有統(tǒng)計(jì)學(xué)意義,特異度無統(tǒng)計(jì)學(xué)差異;兩兩聯(lián)合檢查中,高頻超聲+CT的敏感度優(yōu)于高頻超聲+99mTc-MIBI(χ2=4.601,P=0.032)和高頻超聲(χ2=18.524,P0.001),有統(tǒng)計(jì)學(xué)差異,三種聯(lián)合檢查方法的特異度無差異。36例患者同時(shí)接受三種檢查方法,共檢出130枚增生腺體,敏感度為94.89%,特異度為100%;其敏感度和特異度與高頻超聲+CT檢查比較,均無統(tǒng)計(jì)學(xué)差異。結(jié)論:1.推薦高頻超聲+CT檢查作為SHPT患者術(shù)前定位診斷的首選檢查方案;2.單獨(dú)采用三種檢查方法時(shí),超聲檢查的敏感性最高,99mTc-MIBI檢查的特異度最高;
[Abstract]:Objective: to investigate the value of three imaging methods of CT and MIBI in the diagnosis of secondary hyperparathyroidism before operation. The significance of surgical treatment of secondary hyperparathyroidism methods: the imaging data of secondary hyperparathyroidism hospitalized in our hospital from January 2012 to December 2016 were analyzed retrospectively. Combined with post-operative pathology, The sensitivity and specificity of the three imaging examinations and any two examination methods were calculated respectively. The value of the three methods in preoperative localization diagnosis was analyzed. Results: 48 patients in this study received high frequency ultrasound examination. 138 enlarged glands were detected, 3 of which were proved to be false positive by intraoperative pathological examination, 2 enlarged lymph nodes and 1 thyroid nodule were found in 2 patients with undetectable glands, 7 hyperplastic parathyroid glands were confirmed by pathology. The sensitivity of high frequency ultrasound was 77.97, the specificity was 97.82%. 49 patients underwent plain CT enhanced CT examination, 121 enlarged glands were detected, and 2 of them were confirmed to be false positive by intraoperative pathological examination. Four hyperplastic parathyroid glands were confirmed by pathology in one enlarged lymph node and one thyroid nodule. The sensitivity of CT examination was 66.85 and the specificity was 98.35.36 patients underwent 99mTc-MIBI examination. A total of 72 enlarged glands were detected, all of which were confirmed to be parathyroid hyperplasia by intraoperative pathological examination. There were 4 hyperplastic parathyroid glands (4 hyperplastic parathyroid glands, 4 missed diagnosis) in no false positive cases. The sensitivity of 99mTc-MIBI was 52.56 and the specificity was 100. By statistical analysis, the sensitivity of high-frequency ultrasound was superior to that of CT( 蠂 ~ 2 ~ 2 ~ (5.526) P ~ (0.019)) and ~ ~ (99m) Tc-MIBI (蠂 ~ (2) ~ (2) ~ (6.172U)) ~ (0.013) ~ (1) (蠂 ~ (2)) Tc-MIBI (蠂 ~ (2) 2.889) (蠂 ~ (2)), and the sensitivity of all kinds of combined examination was higher than that of single examination, the difference was statistically significant. The sensitivity of high-frequency ultrasound CT was better than that of high-frequency ultrasound 99mTc-MIBI (蠂 ~ 2 + 4.601) and high-frequency ultrasound (蠂 ~ 2 ~ 2 ~ (18.524) P _ (0.001) P _ (0.001)), the sensitivity of high-frequency ultrasound CT was better than that of high-frequency ultrasound 99mTc-MIBI (蠂 ~ 2 ~ 2 ~ 2 ~ (4.601)). There was no difference in the specificity of the three combined examination methods. 36 patients were examined by three methods at the same time, 130 hyperplasia glands were detected, the sensitivity was 94.89 and the specificity was 100. The sensitivity and specificity of the three methods were compared with that of high-frequency ultrasound CT. Conclusion 1. High frequency ultrasound CT examination is recommended as the first choice for preoperative localization diagnosis in SHPT patients. The sensitivity of ultrasound examination is the highest when using the three methods alone, and the specificity of 99mTc-MIBI examination is the highest.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R653;R692.5

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