本文關(guān)鍵詞：膽囊隆起性病變的致病危險因素分析及其影像學診斷　出處：《上海交通大學》2015年博士論文　論文類型：學位論文

  更多相關(guān)文章： 膽囊隆起性病變 危險因素 超聲造影 CT鑒別診斷

【摘要】：目的明確膽囊隆起性病變的致病危險因素并比較超聲造影及增強CT對腫瘤性及非腫瘤性病灶鑒別診斷能力。背景膽囊隆起性病變分為腫瘤性及非腫瘤性兩類,其致病危險因素尚未有明確定論。由于兩者的治療原則不同,故對病灶類型的準確鑒別至關(guān)重要。目前多種影像學手段被應用于病灶性質(zhì)的鑒別,但其鑒別效能尚不明確。方法分析2014年1月至2014年12月至我院體檢中心行健康查體人群的病史資料及檢驗結(jié)果,描述膽囊隆起性病變的一般規(guī)律,并通過Logistic回歸分析疾病相關(guān)危險因素。同時對于2013年10月至2014年12月間至我科就診且病灶最大徑大于10mm的膽囊隆起性病變患者,通過對比超聲造影、增強CT及手術(shù)病理結(jié)果,比較兩種影像學手段對膽囊隆起性病變病理性質(zhì)的鑒別能力。結(jié)果膽囊隆起性病變在此特定人群的患病率為5.22%,其中男性患病率為6.35%,女性患病率為3.61%。年齡(P=0.000),性別(P=0.000),超重(BMI25)(P=0.011),總膽固醇(P=0.003),高密度脂蛋白(P=0.000),低密度脂蛋白(P=0.000),合并脂肪肝(P=0.000)以及合并頸動脈斑塊(P=0.000)等指標在膽囊隆起性病變患病人群及正常人群間存在差異。Logistic回歸分析表明男性、超重、合并脂肪肝及頸動脈斑塊、高總膽固醇及高低密度脂蛋白是疾病致病的危險因素。對比超聲造影、增強CT及手術(shù)病理結(jié)果發(fā)現(xiàn)：對于最大徑超過10mm的病灶而言,超聲造影對腫瘤性病灶的診斷靈敏度為73.3%,特異度為83.3%；而增強CT的診斷靈敏度為93.3%,特異度為75.0%。結(jié)論膽囊隆起性病變在我國東部沿海大城市人口中的發(fā)病率與西方報道基本持平,絕大部分患者病灶最大徑小于10mm。男性,中年(40-60歲),超重(BMI25),合并脂肪肝及動脈粥樣硬化斑塊,血總膽固醇及LDL水平的上升可視為疾病的危險因素。超聲造影及薄層增強CT均對膽囊隆起性病灶腫瘤性及非腫瘤性的術(shù)前鑒別有一定作用,對于最大徑超過10mm的病灶而言,增強CT對病灶性質(zhì)的判斷準確度優(yōu)于超聲造影。
[Abstract]:Objective to identify the risk factors of cholecystic protuberance lesions and to compare the ability of contrast-enhanced CT and contrast-enhanced ultrasonography in the differential diagnosis of neoplastic and non-neoplastic lesions. Background Cholecystic eminence lesions can be divided into two categories: neoplastic and non-neoplastic. There is no clear conclusion on the risk factors of the disease. Because of the different principles of treatment, it is very important for the accurate identification of lesion types. At present, many imaging methods have been used to distinguish the nature of the lesions. Methods from January 2014 to December 2014, the history and results of health examination were analyzed. To describe the general law of gallbladder protuberance lesions. The disease risk factors were analyzed by Logistic regression analysis. At the same time, for the STD with cholecystic eminence larger than 10mm in the period from October 2013 to December 2014, the largest diameter of the lesion was larger than 10mm. Become a patient. Contrast contrast-enhanced contrast-enhanced CT and surgical and pathological results. Results the prevalence rate of cholecystic eminence lesions in this particular population was 5.22 and the prevalence rate of male was 6.35%. The prevalence rate of female was 3.61. Age was 0.000, sex was 0.000, overweight BMI25 / P0. 011, total cholesterol was 0.003). High density lipoprotein (HDLP) and low density lipoprotein (LDL-C) were 0.000 and 0.000 respectively. Combined with fatty liver and carotid plaques (P = 0.000) and carotid plaque (n = 0.000, P = 0.000, P = 0.000, P = 0.000). Logistic regression analysis showed that there was a significant difference between the patients with cholecystic protuberance disease and the normal population. Overweight, fatty liver and carotid plaque, high total cholesterol and high density lipoprotein were risk factors of disease. Contrast-enhanced contrast-enhanced ultrasonography. Contrast-enhanced CT and pathology showed that the sensitivity and specificity of contrast-enhanced contrast-enhanced ultrasonography in the diagnosis of tumor lesions were 73.3 and 83.3 for the lesions with a maximum diameter of more than 10 mm. The diagnostic sensitivity of enhanced CT was 93.3 and the specificity was 75.0. Conclusion the incidence of cholecystic protuberance lesions in the population of large cities along the eastern coast of China is basically the same as that reported in western countries. The largest diameter of lesions in most patients was less than 10mm. male, aged 40-60 years old, was overweight and complicated with fatty liver and atherosclerotic plaques. The elevation of serum total cholesterol and LDL levels can be regarded as the risk factors of the disease. Both contrast-enhanced CT and contrast-enhanced CT can play a certain role in the preoperative differential diagnosis of neoplastic and non-neoplastic lesions of gallbladder eminence. For the lesions with a maximum diameter of more than 10 mm, the accuracy of contrast-enhanced CT in judging the nature of lesions is superior to that of contrast-enhanced ultrasonography.
【學位授予單位】：上海交通大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R575.6;R816.5

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