本文選題：超聲成像 + 超聲解剖　； 參考：《廣西醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：通過尸體標(biāo)本的斷層切面與正常人喉部的超聲聲像對比,建立喉部的超聲解剖及聲像圖的對應(yīng)關(guān)系,在此基礎(chǔ)上進(jìn)行喉癌的超聲診斷,并初步探討喉癌侵犯聲門旁間隙及甲狀軟骨的超聲聲像表現(xiàn)及其臨床應(yīng)用價值。 方法：將4具尸體標(biāo)本根據(jù)喉部解剖標(biāo)志做不同層厚的斷層,典型部位從另外尸體再做補充斷面,以完成正常喉部不同解剖標(biāo)志的斷面。40例正常對照者取仰臥位,頭略向后仰,頸下加枕,使頸部充分伸直。采用經(jīng)體表途徑,在舌骨水平上緣開始至環(huán)狀軟骨下緣區(qū)域掃查。按超聲掃查常規(guī),掃查分橫、縱、斜切面三種,識別喉部主要解剖組織結(jié)構(gòu)：舌骨、會厭軟骨、甲狀軟骨、環(huán)狀軟骨、室?guī)А⒙晭�、喉室等�?對87例到耳鼻咽喉-頭頸外科就診的臨床懷疑為喉癌的患者,于術(shù)前進(jìn)行喉部超聲檢查和CT檢查。超聲檢查和CT檢查結(jié)果與喉鏡活檢病理診斷或(和)術(shù)后病理診斷進(jìn)行對照分析,獲得喉癌的聲像圖表現(xiàn)。探討超聲檢查和CT檢查診斷喉癌侵犯聲門旁間隙及甲狀軟骨的敏感性、特異性,并進(jìn)行有關(guān)的統(tǒng)計分析。 結(jié)果：4具尸體標(biāo)本按喉部解剖標(biāo)志共計做斷而36份,基本上展示了喉部的重要解剖結(jié)構(gòu)；對40例正常成年人喉部進(jìn)行超聲成像的結(jié)果表明,超聲成像可清晰顯示喉部的正常解剖結(jié)構(gòu)。在87例喉癌可疑病人中,病理證實喉癌74人,其中T1 29、T2 14、T3 15、T4 16例,余原位癌2例,不典型增生5例,炎癥6例。74例喉癌患者中,大部分T：,和所有T,患者均行喉全切除術(shù)(1例出現(xiàn)遠(yuǎn)處轉(zhuǎn)移而放棄治療)。超聲判斷喉癌侵犯聲門旁間隙15例,CT判斷喉癌侵犯聲門旁間隙14例；超聲檢查和CT檢查對喉癌侵犯聲門旁間隙的檢出率比較P0.01,表明兩種檢查在判斷喉癌侵犯聲門旁間隙的檢出率有差異。超聲判斷喉癌侵犯甲狀軟骨的符合率為93.3%(14/15),CT超聲判斷喉癌侵犯甲狀軟骨的符合率為80%(12/15)；超聲檢查和CT檢查對喉癌侵犯甲狀軟骨的檢出率比較P0.05,表明兩種檢查在判斷喉癌侵犯甲狀軟骨的檢出率有差異,超聲檢查要優(yōu)于CT檢查。 結(jié)論：超聲成像可比較良好地顯示喉部的解剖結(jié)構(gòu)。超聲成像可以初步診斷喉癌,顯示腫物的部位、大小、形態(tài)、數(shù)目、內(nèi)部回聲和血供狀況等信息。超聲成像可作出判斷喉癌侵犯聲門旁間隙及甲狀軟骨與否,與CT有一定的差異。超聲成像在喉癌分期中具有重要的價值,可為臨床制定治療方案提供重要的依據(jù)。
[Abstract]:Objective: to establish the relationship between ultrasonic anatomy and sonogram of larynx by comparing the sectional section of cadaveric specimen with that of normal human larynx, and to diagnose laryngeal carcinoma by ultrasound. The ultrasonographic features and clinical value of laryngeal carcinoma invading the paraventral space and thyroid cartilage were discussed. Methods: four cadavers were divided into four sections with different thickness according to the laryngeal anatomical markers, and the typical parts were used as supplementary sections from other cadavers to complete the supine position of 40 normal subjects with different anatomical markers of normal larynx. Add a pillow under the neck to fully straighten the neck. The hyoid bone was scanned from the upper edge of the hyoid bone to the lower edge of the annular cartilage by the method of body surface. The main anatomical structures of larynx, hyoid bone, epiglottic cartilage, thyroid cartilage, annular cartilage, ventricular band, vocal cord, laryngeal ventricle, etc. Eighty-seven patients with suspected laryngeal carcinoma were examined by ultrasonography and CT before operation. The results of ultrasonography and CT were compared with pathological diagnosis of laryngoscopic biopsy or / and postoperative pathological diagnosis, and the sonographic manifestations of laryngeal carcinoma were obtained. To investigate the sensitivity and specificity of ultrasonography and CT in the diagnosis of laryngeal carcinoma invading the paraventral space and thyroid cartilage. Results A total of 36 specimens of 4 cadavers were amputated according to the anatomic marks of the larynx, which basically showed the important anatomical structure of the larynx, and the ultrasonic imaging of the larynx of 40 normal adults showed that, The normal anatomical structure of the larynx can be clearly demonstrated by ultrasound imaging. Of the 87 suspected laryngeal cancer patients, 74 were confirmed by pathology, including 16 cases of T29 T 214 T 3 15 T 4, 2 cases of residual carcinoma in situ, 5 cases of atypical hyperplasia, 6 cases of inflammation and 74 cases of laryngeal cancer. All patients underwent total laryngectomy (1 patient with distant metastasis and abandoned treatment). 14 cases of laryngeal carcinoma involving paraventral space were evaluated by CT scan. The detection rate of invasive paraventral space of laryngeal carcinoma was compared with that of CT examination (P0.01), which indicated that the detection rate of the two kinds of examination was different in judging the invasive paraventral space of laryngeal carcinoma. The coincidence rate of thyroid cartilage invasion by ultrasound was 93.3% (14 / 15) and the coincidence rate of CT was 80% (12 / 15). The detection rate of laryngeal carcinoma invading thyroid cartilage was compared with that of CT examination (P0.05), which indicated that there was a difference between the two kinds of examination in the diagnosis of laryngeal carcinoma invading thyroid cartilage, and ultrasonic examination was superior to CT examination. Conclusion: ultrasonic imaging can show the anatomic structure of larynx well. Ultrasound imaging can be used to diagnose laryngeal carcinoma, showing the location, size, shape, number, internal echo and blood supply of the tumor. Ultrasonic imaging can be used to judge the invasion of paraventral space and thyroid cartilage in laryngeal carcinoma, which is different from CT. Ultrasound imaging plays an important role in the staging of laryngeal carcinoma and can provide important basis for clinical treatment.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R739.65

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本文編號：2066405