本文選題：膀胱癌　切入點：彩超　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討膀胱腫瘤抗原(BTA)、泌尿系彩超、尿脫落細(xì)胞學(xué)聯(lián)合檢查在膀胱癌診斷中的價值。方法:前瞻性研究了自2016年3月起就診于吉林大學(xué)白求恩第三醫(yī)院的50例膀胱癌疑似患者,這些患者均有不同程度的間歇性無痛肉眼血尿伴或不伴尿頻尿急尿痛等與膀胱癌相關(guān)的癥狀,并依據(jù)排除標(biāo)準(zhǔn)排除了不合規(guī)患者。對這些患者均給予尿常規(guī)、尿細(xì)胞學(xué)、尿BTA、經(jīng)腹泌尿系彩超、膀胱鏡等相關(guān)檢查,觀察各檢查項目的靈敏度、特異度及診斷符合率,并通過之間的相互聯(lián)合檢驗,比較聯(lián)合后靈敏度的變化。結(jié)果:50例膀胱癌疑似患者中最終經(jīng)膀胱鏡病理確診為膀胱移行細(xì)胞癌34例(低級別12例、高級別22例)。泌尿系統(tǒng)良性疾病16例(分別可見乳頭狀瘤、腺性膀胱炎、膀胱炎肉芽腫)。本組研究中可見彩超靈敏度為70.58%,特異度93.75%,存在1例假陽性病例;尿脫落細(xì)胞靈敏度為29.41%,特異度93.75%,也存在1例假陽性,且該例患者尿BTA stat也為陽性,需密切隨訪;BTA stat靈敏度達(dá)為76.47%,特異度為81.25%。三者聯(lián)合檢查診斷出膀胱腫瘤32例,聯(lián)合診斷的靈敏度為94.12%,與各單項檢查比較,均有統(tǒng)計學(xué)差異(P0.05),說明三者聯(lián)合后靈敏度提高,更利于膀胱癌的檢出。三者聯(lián)合后與膀胱鏡比較,差異無顯著性意義(P0.05),說明三者聯(lián)合后的靈敏度與膀胱鏡相似,認(rèn)為三者聯(lián)合檢查是便利、有效、無創(chuàng)的臨床檢查方法,對于有膀胱鏡禁忌或者強烈排斥膀胱鏡檢的患者可考慮通過給予三項檢查聯(lián)合的方式暫緩或減少膀胱鏡檢查次數(shù),如聯(lián)合檢查結(jié)果陽性,需再行膀胱鏡病理活檢確診。其中傳統(tǒng)的彩超與尿細(xì)胞學(xué)聯(lián)合后的靈敏度為76.47%,與膀胱鏡檢查比較存在顯著統(tǒng)計學(xué)差異(P=0.0080.01),再聯(lián)合尿BTA后才可達(dá)到膀胱鏡檢的水平,說明對于疑似膀胱癌患者在給予彩超和尿細(xì)胞學(xué)檢查基礎(chǔ)上有必要加行BTA檢查,BTA在臨床引用中存在實用價值,值得推廣。BTA stat在膀胱癌分級中的靈敏度比較存在統(tǒng)計學(xué)差異(Fisher精確概率法,P=0.0130.05),認(rèn)為BTA stat在高級別腫瘤表現(xiàn)出更高的靈敏度;而BTA stat在不同分期的腫瘤中,靈敏度差異無統(tǒng)計學(xué)意義(Fisher精確概率法,P0.05),認(rèn)為診斷不同分期腫瘤的靈敏度相似。結(jié)論:BTA stat作為一種新的、敏感度高、特異性中等的無創(chuàng)性尿膀胱腫瘤標(biāo)志物,通過與彩超、尿細(xì)胞學(xué)聯(lián)合可提高膀胱癌檢出率,并能起到部分替代膀胱鏡檢查的效果,具有廣闊的應(yīng)用前景。
[Abstract]:Objective: to study the bladder tumor antigen (BTAA), urinary system color Doppler ultrasound (CDFI). The value of combined urine exfoliative cytology in the diagnosis of bladder cancer methods: a prospective study was conducted on 50 suspected bladder cancer patients who had been admitted to Bai Qiuen third Hospital Jilin University since March 2016. These patients all had intermittent painless hematuria with or without frequent urinal pain and other symptoms related to bladder cancer, and excluded irregular patients according to the exclusion criteria. These patients were given routine urine routine, urine cytology, urine cytology, etc. The sensitivity, specificity and diagnostic coincidence rate of each examination item were observed by transabdominal urography, cystoscopy and so on. Results 34 cases of bladder transitional cell carcinoma (12 cases of low grade, 22 cases of high grade) and 16 cases of benign diseases of urinary system (papilloma) were diagnosed by cystoscopy. In this study, the sensitivity of color Doppler ultrasound was 70.58, the specificity was 93.75, there was a false positive case, the sensitivity of exfoliated cells in urine was 29.41, the specificity was 93.75 and there was a false positive in one case, and the urine BTA stat was also positive in this case. The sensitivity of BTA stat was 76.47 and the specificity was 81.25. 32 cases of bladder neoplasms were diagnosed by the three methods, and the sensitivity of combined diagnosis was 94.12. Compared with each single examination, there was statistical difference (P0.05), which indicated that the sensitivity of the three methods was improved after the combination of the three methods. Compared with cystoscopy, there was no significant difference among the three groups, indicating that the sensitivity of the three combined methods was similar to that of cystoscopy, and that the combined examination was a convenient, effective and non-invasive clinical examination method. Patients with cystoscopy taboo or strongly rejected cystoscopy may consider suspending or reducing the number of cystoscopy tests by giving them a combination of three tests, such as positive results. The sensitivity of traditional color ultrasound combined with urocytology was 76.47, and there was a significant difference between cystoscopy and cystoscopy. The level of cystoscopy could be reached only after combined with urinary BTA. It is necessary to add BTA to suspected bladder cancer patients on the basis of color ultrasound and urine cytology. It is worth popularizing the sensitivity of .BTA stat in bladder cancer grade. There is a statistical difference in the sensitivity of .BTA stat in bladder cancer grade. It is concluded that BTA stat has higher sensitivity in high grade tumors, while BTA stat is more sensitive in different stages of bladder cancer. The sensitivity difference was not statistically significant. It was suggested that the sensitivity of stat in the diagnosis of different stages of tumors was similar. Conclusion: BTA stat is a new, highly sensitive, and moderate specific noninvasive marker of urinary bladder tumor. The combination of urinary cytology and cystoscopy can improve the detection rate of bladder cancer and partly replace cystoscopy.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.14

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