【摘要】：目的： 1.探討多層螺旋CT在宮頸癌分期中的價(jià)值。 2.探討多層螺旋CT在判斷宮頸癌淋巴結(jié)轉(zhuǎn)移的價(jià)值。 材料與方法： 1.一般資料：搜集山東省腫瘤醫(yī)院2012年1月至2013年1月臨床確診為并均行手術(shù)治療的宮頸癌160例，術(shù)后均有病理證實(shí)，術(shù)前均行CT檢查。對(duì)搜集到的病例行CT分期，記錄其FIGO分期和手術(shù)病理分期，并記錄其淋巴結(jié)轉(zhuǎn)移結(jié)果。年齡24~76歲，平均年齡45.9歲，大多數(shù)有相同的癥狀，表現(xiàn)為接觸性出血、陰道分泌物增多或絕經(jīng)后陰道流血。 2.方法：CT掃描采用PHILIPS128排CT進(jìn)行平掃+增強(qiáng)掃描。掃描條件120KV，200mAs，層厚5mm，對(duì)所獲得的數(shù)據(jù)按0.625mm，層距0.312mm，采用標(biāo)準(zhǔn)算法進(jìn)行拆薄，然后把重建圖像傳輸?shù)焦ぷ髡�，并用雙窗寬、窗位（40,220；40,400）進(jìn)行MPR重建，重建平面包括矢狀位，冠狀位。增強(qiáng)掃描造影劑選用優(yōu)維顯，劑量1.5ml／kg，注射速度2.5ml／s，經(jīng)肘靜脈高壓注射。掃描前4h囑患者禁食，并作摒氣訓(xùn)練，掃描范圍從第三腰椎開始到恥骨聯(lián)合，先做平掃，再做增強(qiáng)。 對(duì)160例宮頸癌患者的CT分期、FIGO分期與手術(shù)分期做比較分析。 對(duì)搜集的宮頸癌患者的淋巴結(jié)轉(zhuǎn)移情況進(jìn)行評(píng)價(jià)。 結(jié)果： CT對(duì)宮頸癌分期的總準(zhǔn)確度為80.00%（128/160），過低判斷6.25%（10/160）,過高判斷13.75%（22/160）。FIGO分期的總準(zhǔn)確率為61.25%（98/160），過低判斷22.50%（36/160），過高判斷16.25%（26/160）。 160例患者經(jīng)手術(shù)病理證實(shí)有淋巴結(jié)轉(zhuǎn)移者23.75%（38/160），52個(gè)區(qū)域出現(xiàn)淋巴結(jié)轉(zhuǎn)移，經(jīng)CT判斷轉(zhuǎn)移25.00%(40/160)，54個(gè)區(qū)域出現(xiàn)淋巴結(jié)轉(zhuǎn)移，靈敏度Se=71.05%，特異度Sp=89.34%，約登指數(shù)YI=0.60，漏診率β=28.95%，誤診率α=11.66%，陽性預(yù)測值+PV=67.50%，陰性預(yù)測值-PV=90.83%。手術(shù)病理證實(shí)的淋巴結(jié)轉(zhuǎn)移閉孔區(qū)轉(zhuǎn)移最高，，達(dá)44.74%，髂外和髂內(nèi)組其次，分別為31.58%、26.32%，髂總組為13.16%，腹主動(dòng)脈最低，為2.63%，宮旁組18.42%。 結(jié)論： 1.CT分期準(zhǔn)確性顯著高于FIGO分期，治療前CT檢查已經(jīng)作為宮頸癌的常規(guī)檢查方法之一，在一定程度上可以彌補(bǔ)FIGO分期的不足。 2.多層螺旋CT對(duì)宮頸癌淋巴結(jié)轉(zhuǎn)移的診斷有較高的準(zhǔn)確率。綜合分析淋巴結(jié)大小，數(shù)目及密度等因素，可為臨床治療方案的選擇提供依據(jù)。宮頸癌淋巴結(jié)轉(zhuǎn)移有一定的規(guī)律性，以宮旁和閉孔區(qū)淋巴結(jié)轉(zhuǎn)移率最高，尤其需注意宮旁淋巴結(jié)，容易漏診。
[Abstract]:Objective: 1. To investigate the value of multilayer spiral CT in cervical cancer staging. 2. To evaluate the value of multilayer spiral CT in the diagnosis of lymph node metastasis of cervical cancer. Materials and methods: 1. General data: from January 2012 to January 2013, 160 cases of cervical cancer diagnosed clinically and treated surgically in Shandong Cancer Hospital were collected. All cases were proved by pathology after operation, and all patients were examined by CT before operation. CT staging, FIGO staging, surgical and pathological staging, and lymph node metastasis were recorded. The average age was 45.9 years. Most of them had the same symptoms, such as contact bleeding, increased vaginal discharge or postmenopausal vaginal bleeding. 2. Methods: CT scan was performed with PHILIPS128 row CT. The scanning condition is 120kV / 200mAs5mm, the data is 0.625mm and the interval is 0.312mm, then the reconstructed image is transferred to the workstation with the standard algorithm and the window width is 40220mm; 40400) MPR reconstruction, reconstruction plane including sagittal and coronal. Contrast-enhanced contrast agents were injected with proveratropium at a dose of 1.5 ml / kg, injection rate of 2.5 ml / s, and cubital venous hypertension. Four hours before the scan, the patient was told to fast, and trained to hold the breath. The scanning range was from the third lumbar vertebra to the pubic symphysis. CT staging, FIGO staging and surgical staging were compared among 160 patients with cervical cancer. The lymph node metastasis of cervical cancer patients was evaluated. Results: the total accuracy of CT in staging cervical cancer was 80.00% (128 / 160), low by 6.25% (10 / 160) and high by 13.75% (22 / 160). FIGO), and the total accuracy of CT was 61.25% (98 / 160). Too low to judge 22.50% (36 / 160), too high to judge 16.25% (26 / 160). Lymph node metastasis was found in 23.75% (38 / 160) of 160 patients confirmed by operation and pathology, lymph node metastasis occurred in 52 regions, 25.00% (40 / 160) by CT, 54 regions with lymph node metastasis and sensitivity of Se=71.05%,. The misdiagnosis rate 偽 = 11.66, the positive predictive value PV=67.50%, negative predictive value-PV=90.83%., the misdiagnosis rate 偽 = 11.66, the YI=0.60, missed diagnosis rate 尾 = 28.95, the positive predictive value PV=67.50%, negative predictive value, the positive predictive value PV=67.50%, negative predictive value-PV=90.83%.. The metastases in the obturator region of lymph node confirmed by operation and pathology were the highest (44.74), the external iliac and internal iliac groups were 31.58 and 26.32 respectively, the total iliac group was 13.1616, and the abdominal aorta was the lowest (2.63). Para-uterine group 18.42. Conclusion: the accuracy of 1.CT staging is significantly higher than that of FIGO staging. Before treatment, CT examination has been regarded as one of the routine examination methods for cervical cancer, which can make up for the deficiency of FIGO staging to some extent. 2. Multilayer spiral CT has a high accuracy in the diagnosis of cervical cancer lymph node metastasis. Comprehensive analysis of the size, number and density of lymph nodes can provide evidence for clinical treatment. Lymph node metastasis of cervical cancer has certain regularity, especially para-uterine lymph node and obturator region lymph node metastasis rate is the highest, especially should pay attention to the para-uterine lymph node, easy to miss diagnosis.
【學(xué)位授予單位】：濟(jì)南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R737.33;R730.44

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