本文選題：結(jié)腸腫瘤 + 多層螺旋CT　； 參考：《大連醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：結(jié)腸癌是胃腸道中常見的惡性腫瘤，，如何做到準(zhǔn)確定性診斷和分期是選擇最佳治療方案的基礎(chǔ)。目前，國(guó)內(nèi)結(jié)腸腫瘤檢查和診斷以內(nèi)視鏡、X線造影檢查為主，結(jié)腸鏡因具有影像直觀、可進(jìn)行活檢及有病理結(jié)果等優(yōu)點(diǎn)而應(yīng)用廣泛，X線造影有操作簡(jiǎn)便、影像清晰、費(fèi)用低廉等優(yōu)點(diǎn)成為結(jié)腸腫瘤的篩選手段，而這兩種方法對(duì)于結(jié)腸癌的腸壁增厚程度、腸壁周圍浸潤(rùn)、淋巴結(jié)轉(zhuǎn)移及遠(yuǎn)端臟器轉(zhuǎn)移均有局限性。多層螺旋CT（Multi-slice CT MSCT）掃描具有創(chuàng)傷小，速度快，圖像清晰，可以多方位顯示病變的優(yōu)點(diǎn)，在臨床上的應(yīng)用比較廣泛。MSCT可以結(jié)合軸位及多平面重組圖像，CT仿真內(nèi)視鏡(CT virtual endoscopy)技術(shù)，能有效地顯示腫瘤的大小、形態(tài)和部位，確定腫瘤的侵犯范圍、淋巴結(jié)轉(zhuǎn)移和遠(yuǎn)端臟器轉(zhuǎn)移等。MSCT在結(jié)腸腫瘤的診斷中具有重要的指導(dǎo)作用。本項(xiàng)研究是探討應(yīng)用MSCT在結(jié)腸腫瘤檢查中的診斷價(jià)值。目的：探討MSCT在結(jié)腸腫瘤診斷的應(yīng)用價(jià)值。 方法：本文收集了2009年10月至2011年5月來(lái)大連醫(yī)科大學(xué)附屬二院普外科就診的45例結(jié)腸癌患者進(jìn)行腹部MSCT檢查，檢查前準(zhǔn)備與結(jié)腸鏡檢查前腸道準(zhǔn)備相同，檢查當(dāng)日禁食水，造影劑過(guò)敏試驗(yàn)，檢查前10分鐘肌注低張藥物，掃描前向結(jié)腸內(nèi)注入空氣，常規(guī)行腹腔普通掃描及增強(qiáng)掃描，將得到的圖像由2位主治醫(yī)師以上職稱的影像診斷醫(yī)師共同閱片，對(duì)病灶位置，形態(tài)、大小、腸壁增厚程度、病變周圍浸潤(rùn)，有無(wú)淋巴結(jié)（數(shù)目、大小、位置及強(qiáng)化程度）及有無(wú)遠(yuǎn)處轉(zhuǎn)移等進(jìn)行診斷，做出定性診斷及分期。統(tǒng)計(jì)學(xué)分析：采用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析，病變CT值的變化采用重復(fù)測(cè)量計(jì)數(shù)方差分析，計(jì)數(shù)資料組間比較采用x2檢驗(yàn)（Fisher準(zhǔn)確概率值），計(jì)量資料組間比較采用t檢驗(yàn)（兩獨(dú)立樣本t檢驗(yàn)），檢驗(yàn)水平＜0.05。 結(jié)果：MSCT對(duì)結(jié)腸癌診斷準(zhǔn)確度為100%，對(duì)腫瘤T分期的敏感度為92.86%，準(zhǔn)確度為91.11%，陽(yáng)性預(yù)測(cè)值86.36%，陰性預(yù)測(cè)值88%；對(duì)N分期敏感度達(dá)85.71%，準(zhǔn)確度為80%，陽(yáng)性預(yù)測(cè)值75%，陰性預(yù)測(cè)值85.71%。 結(jié)論： 1、MSCT掃描作為一種新的檢查方法可以有效地顯示結(jié)腸癌的形態(tài)、大小和部位，對(duì)結(jié)腸腫瘤術(shù)前定位和判斷腫瘤外浸潤(rùn)范圍有一定價(jià)值； 2、MSCT掃描可清楚顯示結(jié)腸癌遠(yuǎn)處臟器轉(zhuǎn)移情況，對(duì)周圍臟器侵犯和區(qū)域淋巴結(jié)轉(zhuǎn)移的評(píng)估可為臨床提供較好的參考價(jià)值； 3、MSCT掃描有望成為結(jié)腸癌術(shù)前分期的一個(gè)重要手段。
[Abstract]:Objective: colon cancer is a common malignant tumor in gastrointestinal tract. At present, the examination and diagnosis of colon neoplasms in China are mainly made by endoscopy X-ray radiography. Because of the advantages of direct image, biopsy and pathological results, colonoscopy has the advantages of simple operation and clear image. The advantages of low cost have become the screening methods for colon cancer, but these two methods have limitations on the thickening degree of colon cancer wall, invasion of intestinal wall, lymph node metastasis and distal organ metastasis. Multi-slice spiral CT(Multi-slice CT (MSCT) scan has the advantages of small trauma, fast speed, clear image, and can display lesions in many directions. It can be widely used in clinic. MSCT can be combined with CT virtual endoscopy (CT virtual copy) technology of axial and multiplanar recombination images. MSCT can effectively show the size, shape and location of the tumor, determine the range of tumor invasion, lymph node metastasis and distal organ metastasis, etc. MSCT plays an important role in the diagnosis of colon tumors. This study is to evaluate the diagnostic value of MSCT in colon neoplasms. Objective: to evaluate the value of MSCT in the diagnosis of colon tumors. Methods: from October 2009 to May 2011, 45 patients with colon cancer received abdominal MSCT examination in general surgery of second affiliated Hospital of Dalian Medical University. The preparation before examination was the same as that before colonoscopy. Contrast agent allergy test, 10 minutes before examination, intramuscular injection of hypotonic drugs, injection of air into the colon before scanning, routine abdominal cavity scanning and enhanced scanning. The resulting images were read by two or more imaging diagnostics with the title of attending physician or above. The location, shape, size, thickening degree of intestinal wall, infiltration around the lesion, lymph nodes (number, size, location and enhancement degree) and distant metastasis were diagnosed, and qualitative diagnosis and staging were made. Statistical analysis: SPSS13.0 software was used for statistical analysis, and the CT value of lesion was analyzed by repeated measurement counting variance analysis. X 2 test was used to test Fisher accurate probability value, and t test was used to compare counting data group (two independent samples t test, test level < 0.05). Results the accuracy of the diagnosis of colon cancer was 100, the sensitivity to T staging of tumor was 92.86, the accuracy was 91.1111, the positive predictive value was 86.36, the negative predictive value was 880.The sensitivity of N staging was 85.71l, the accuracy was 80, the positive predictive value was 755,85.71, and the negative predictive value was 85.71. Conclusion: As a new method, MSCT scan can effectively show the shape, size and location of colon cancer. 2MSCT scan can clearly show the distant organ metastasis of colon cancer. The evaluation of peripheral organ invasion and regional lymph node metastasis can provide a good reference value for clinic. MSCT scan is expected to be an important means of preoperative staging of colon cancer.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R730.44;R735.35

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本文編號(hào)：1988720