發(fā)布時(shí)間：2018-02-28 15:45

  本文關(guān)鍵詞： 肺腫瘤 腺癌 體層攝影術(shù) X線(xiàn)計(jì)算機(jī) 病理　出處：《青島大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:按照2015版WHO肺腫瘤組織學(xué)分類(lèi)標(biāo)準(zhǔn),探討浸潤(rùn)性周?chē)头蜗侔┑腗SCT征象與五種主要病理亞型的相關(guān)性,對(duì)臨床治療提供一定的參考。方法:收集青島大學(xué)附屬醫(yī)院2015年10至2016年10月間手術(shù)切除且病理證實(shí)的352例周?chē)徒䴘?rùn)肺腺癌患者的臨床及病理資料。依據(jù)最新的WHO(2015)肺腫瘤組織學(xué)分類(lèi)標(biāo)準(zhǔn),將浸潤(rùn)性肺腺癌病理亞型分為五組:實(shí)性組、微乳頭組、乳頭組、腺泡組、附壁組。按肺腺癌預(yù)后差異,將浸潤(rùn)性肺腺癌主要組織學(xué)亞型進(jìn)行分級(jí),1級(jí)為附壁型,2級(jí)為乳頭和腺泡型,3級(jí)為實(shí)性和微乳頭型。使用秩和檢驗(yàn)和卡方檢驗(yàn)對(duì)微乳頭型,實(shí)性型,乳頭型,腺泡型,附壁型5種病理亞型在年齡、性別、病變位置、病變大小(橫軸位最大徑)、毛刺征、分葉征、空泡征、病變密度、空氣支氣管征、空洞、囊腔樣改變、胸膜凹陷征、血管集束征、病灶強(qiáng)化程度等是否存在差異進(jìn)行統(tǒng)計(jì)分析。部分資料采用Spearman秩相關(guān)法、Kruskal-Wallis檢驗(yàn)、Bonferroni檢驗(yàn)、Fisher確切概率法對(duì)相關(guān)資料進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:352例患者,其中男150例(42.6%),女202例(57.4%),年齡范圍40-81歲,平均年齡60.6±8.7歲。其中附壁型組53例(15%),腺泡型組196例(56%),乳頭型組41例(12%),實(shí)性型30例組(8%),微乳頭型組32例(9%)。病變大小、分葉征和空氣支氣管征在5組周?chē)徒䴘?rùn)性肺腺癌病理亞型中差異可見(jiàn)統(tǒng)計(jì)學(xué)意義(P0.05);附壁型在病變大小方面與其它四型病例亞型存在統(tǒng)計(jì)學(xué)差異(P0.01),附壁型病變較小,病灶大小顯著小于其它四型;分葉征在附壁型與其它四型病理亞型之間可見(jiàn)統(tǒng)計(jì)學(xué)差異(P0.05),附壁型肺腺癌其分葉征出現(xiàn)機(jī)率小于其它四型腺癌;腺泡型與其它四種病理亞型在空氣支氣管征方面可見(jiàn)統(tǒng)計(jì)學(xué)差異(P0.05),腺泡型肺腺癌其空氣支氣管征出現(xiàn)機(jī)率大于其它四型腺癌,其它四型之間在空氣支氣管征方面差異未見(jiàn)顯著統(tǒng)計(jì)學(xué)差異。病灶中的實(shí)性成分比例在浸潤(rùn)性腺癌1級(jí)組,2級(jí)組及3級(jí)組中差異具有統(tǒng)計(jì)學(xué)意義(P0.01);動(dòng)態(tài)增強(qiáng)掃描,浸潤(rùn)性腺癌的1級(jí)組、2級(jí)組及3級(jí)組平掃與增強(qiáng)后CT值比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05);性別、病變部位、毛刺征、空洞、胸膜凹陷征、血管集束征、病變的囊腔樣改變?cè)谖⑷轭^型組、實(shí)性型組、乳頭型組、附壁型組及腺泡型組等5組周?chē)徒䴘?rùn)性肺腺癌病理亞型之間未見(jiàn)顯著統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:周?chē)徒䴘?rùn)性肺腺癌不同病理亞型的MSCT表現(xiàn)有一定差異,附壁型腺癌組的病變大小小于其余四種浸潤(rùn)性肺腺癌病理亞型,MSCT圖像中其分葉征的出現(xiàn)率低于其它病理亞型;腺泡型肺腺癌組的空氣支氣管征出現(xiàn)率高于其余4種浸潤(rùn)性肺腺癌病理亞型;病變中的實(shí)性成分比例越高,浸潤(rùn)性肺腺癌的組織學(xué)級(jí)別越高。
[Abstract]:Objective: to investigate the correlation between the MSCT signs of invasive peripheral lung adenocarcinoma and five major pathological subtypes according to the 2015 WHO criteria for lung tumor histological classification. Methods: to collect the clinical and pathological data of 352 patients with peripheral invasive lung adenocarcinoma surgically resected from 2015 to October 2016 in Qingdao University affiliated Hospital. Lung neoplasms histological classification criteria, The pathological subtypes of invasive lung adenocarcinoma were divided into five groups: solid group, micronipple group, papilla group, acinar group, wall attached group. The main histological subtypes of invasive lung adenocarcinoma were classified as mural type, grade 2, papilla and acinar type, grade 3, solid and micropapillary type. Rank sum test and chi-square test were used to study micropapillary type, solid type, papillary type, acinar type, and acinar type. The age, sex, location, size of lesion (axial maximum diameter, burr sign, lobulation sign, vacuole sign, lesion density, air bronchus sign, cavity, cystic cavity change, pleural depression sign, etc. Statistical analysis was carried out on whether there were differences in vascular cluster sign, enhancement degree of lesion and so on. Some of the data were statistically analyzed by Spearman rank correlation method and Kruskal-Wallis test and Fisher exact probability test. There were 150 males and 202 females with a mean age range of 60.6 鹵8.7 years, ranging from 40 to 81 years old, including 53 cases in the wall-attached type group, 196 cases in the acinar type group, 41 cases in the papillary type group and 82 cases in the solid type group, 32 cases in the micropapillary type group and 32 cases in the micropapillary type group. The difference of lobulation sign and air bronchus sign in the pathological subtypes of peripheral invasive lung adenocarcinoma was statistically significant (P 0.05), and there was a statistical difference between the wall type and the other four types in the size of the lesion (P 0.01), but the lesion of the wall type was small. The lesion size was significantly smaller than that of the other four types, and the lobulation sign was significantly different from the other four types of pathological subtypes (P 0.05), and the incidence of lobulation sign in the parietal lung adenocarcinoma was lower than that in the other four types of adenocarcinoma. There was significant difference in air bronchus sign between acinar type and other four pathological subtypes (P 0.05). The incidence of air bronchi sign in acinar type lung adenocarcinoma was higher than that in other four types of adenocarcinoma. There was no significant difference in air bronchial sign between the other four types. The proportion of solid components in the lesion was significantly different in grade 1, grade 1, grade 2 and grade 3 of invasive adenocarcinomas (grade 1, grade 2 and grade 3, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01). The difference of CT value between grade 1, grade 2 and grade 3 of invasive adenocarcinoma was statistically significant (P 0.05), sex, lesion site, burr sign, cavity, pleural depression sign, vascular cluster sign, and so on. The cystic changes of the lesions were found in the micropapillary, solid, papillary, papillary type groups. There was no significant difference between the pathological subtypes of peripheral invasive lung adenocarcinoma and acinar type. Conclusion: the MSCT findings of different pathological subtypes of peripheral invasive lung adenocarcinoma are different to some extent. The lesion size of the adjoining type adenocarcinoma group was smaller than that of the other four invasive lung adenocarcinoma subtypes (MSCT), and the occurrence rate of lobulation sign was lower than that of other pathological subtypes. The incidence of air bronchus sign in acinar lung adenocarcinoma group was higher than that in the other four invasive lung adenocarcinoma subtypes, and the higher the proportion of solid components in the lesion was, the higher the histological grade of invasive lung adenocarcinoma was.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R734.2;R730.44

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳萬(wàn)青;鄭榮壽;曾紅梅;鄒小農(nóng);張思維;赫捷;;2011年中國(guó)惡性腫瘤發(fā)病和死亡分析[J];中國(guó)腫瘤;2015年01期

2 張麗;吳寧;;基于肺腺癌國(guó)際新分類(lèi)的影像新觀(guān)點(diǎn)與研究進(jìn)展[J];癌癥進(jìn)展;2014年02期

3 賀太平;楊創(chuàng)勃;;囊泡狀肺癌的螺旋CT診斷[J];現(xiàn)代醫(yī)用影像學(xué);2012年05期

4 徐建平;呂莉萍;;109例支氣管活檢肺腺癌的臨床病理分析[J];臨床與實(shí)驗(yàn)病理學(xué)雜志;2012年07期

5 王建衛(wèi);唐威;吳寧;;肺磨玻璃結(jié)節(jié)多層CT自動(dòng)體積和密度測(cè)量的可重復(fù)性研究[J];醫(yī)學(xué)影像學(xué)雜志;2012年04期

6 朱雄增;張杰;;肺腺癌IASLC/ATS/ERS國(guó)際多學(xué)科分類(lèi)解讀[J];臨床與實(shí)驗(yàn)病理學(xué)雜志;2012年03期

7 方霞;易祥華;;肺腺癌國(guó)際多學(xué)科最新分類(lèi)解析[J];中華結(jié)核和呼吸雜志;2012年02期

8 宋敏;胡成平;肖奎;;469例經(jīng)支氣管鏡檢查確診40歲以下肺癌患者的臨床分析[J];中國(guó)肺癌雜志;2008年03期

9 王文獻(xiàn),王亞菲,文利,鄒利光,劉衛(wèi)金,梁開(kāi)運(yùn),廖翠薇,席道友,孫清榮;小肺癌的HRCT特征及其診斷價(jià)值[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2005年07期

10 宋偉,金征宇,嚴(yán)洪珍,王l，

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