本文選題：MSCT　切入點(diǎn)：回盲部　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過(guò)對(duì)臨床病理證實(shí)了的回盲部良性及惡性病變CT征象的分析,總結(jié)出有助于對(duì)回盲部病變進(jìn)行良、惡性鑒別的有意義CT表現(xiàn),加深對(duì)回盲部病變影像特征的理解,進(jìn)而提高該部位病變影像診斷的準(zhǔn)確率。方法:選取2016年1月-2017年1月期間于山西醫(yī)科大學(xué)第一醫(yī)院醫(yī)學(xué)影像科行全腹部CT掃描的75例回盲部病變患者的CT圖象進(jìn)行分析,再進(jìn)行病例隨訪獲得其手術(shù)病理或腸鏡活組織檢查等臨床資料證實(shí)病變的性質(zhì)。其中男性患者41例,女性患者34例,年齡分布19-86歲,中位年齡56歲。使用我院GE 64排Light VCT螺旋CT機(jī)掃描,掃描范圍從膈下到盆腔水平。掃描結(jié)束后圖像信息傳輸至AW4.6工作站,運(yùn)用MPR進(jìn)行圖像后處理,并由2名高年資醫(yī)師參與盲法閱片,意見(jiàn)不統(tǒng)一時(shí)經(jīng)討論達(dá)到一致。根據(jù)病理結(jié)果將所有病例分為:良性病例組,惡性病例組,觀測(cè)指標(biāo)包括:1.病變腸管長(zhǎng)度;2.病變腸管壁厚度;3.病變腸管與正常管壁的分界情況;4.病變腸管壁的分層情況;5.末段回腸是否受累;6.腸周渾濁程度。將收集到的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,總結(jié)并歸納出相關(guān)的CT診斷結(jié)論。結(jié)果:共收集到75例符合條件的病例,所有病例均經(jīng)過(guò)手術(shù)病理或者腸鏡活組織檢查得出最后診斷,結(jié)果顯示良性病例40例,惡性病例35例。所觀測(cè)的6組觀測(cè)指標(biāo)中,病變腸管長(zhǎng)度良性組為97.50±68.75mm,惡性組為75.00±34.00mm,結(jié)果顯示差異無(wú)統(tǒng)計(jì)學(xué)意義;病變腸管壁厚度良性組為10.55±5.73mm,惡性組22.00±20.30mm,結(jié)果顯示差異有統(tǒng)計(jì)學(xué)意義;病變腸管與正常腸管分界的比較中,結(jié)果顯示差異有統(tǒng)計(jì)學(xué)意義,即惡性病變組較良性病變組,病變腸管與正常腸管分界明顯;管壁“分層樣”改變,在兩組病例中的檢出率差異存在統(tǒng)計(jì)學(xué)意義,說(shuō)明良性病變更易出現(xiàn)管壁分層樣改變;末段回腸受累情況在兩組病變中的檢出率差異存在統(tǒng)計(jì)學(xué)意義,即良性病變更易侵犯末段回腸;腸周“渾濁征”在兩組病變中的檢出率差異存在統(tǒng)計(jì)學(xué)意義,即良性病變腸周渾濁較惡性病變嚴(yán)重。結(jié)論:1.病變腸管壁厚度、病變腸管與正常腸管分界、病變腸管壁分層及末段回腸是否受累、腸周“渾濁征”的差異等征象對(duì)回盲部良惡性病變的鑒別有重要意義。2.病變腸管壁長(zhǎng)度的差異對(duì)回盲部良惡性鑒別有一定意義,但由于闌尾病變對(duì)周圍結(jié)構(gòu)的影響,其參考價(jià)值在本研究中并不可靠。3.對(duì)于回盲部病變良惡性鑒別診斷須結(jié)合多個(gè)征象進(jìn)行綜合分析評(píng)價(jià)。
[Abstract]:Objective: to analyze the CT features of benign and malignant ileocecal lesions confirmed by clinical pathology, and to summarize the significant CT findings which are helpful in differentiating benign and malignant ileocecal lesions, and to deepen the understanding of the imaging features of ileocecal lesions. Methods: from January 2016 to January 2017, 75 patients with ileocecal lesions underwent total abdominal CT scanning in the Department of Medical Imaging of the first Hospital of Shanxi Medical University. The patients were followed up to obtain clinical data, such as surgical pathology or biopsy, to confirm the nature of the lesions, including 41 male patients and 34 female patients, aged 19-86 years. The median age was 56 years old. GE 64 Light VCT spiral CT scan was used in our hospital. The scanning range was from subphrenic to pelvic level. After scanning, the image information was transmitted to AW4.6 workstation, and the image was processed by MPR. According to the pathological results, all cases were divided into benign case group and malignant case group. The observed indexes include: 1. The length of the diseased intestine 2. The thickness of the diseased intestinal wall 3. The boundary between the diseased intestinal wall and the normal wall 4. The stratification of the diseased intestinal wall 5. Whether the ileum in the last segment is involved or not 6. The degree of periintestinal turbidity. The number of cases to be collected. According to statistical analysis, Results: a total of 75 eligible cases were collected. All the cases were finally diagnosed by pathology or biopsy. The results showed that 40 cases were benign. 35 cases of malignant cases were observed. In the 6 groups, the length of the lesion intestine was 97.50 鹵68.75 mm in benign group and 75.00 鹵34.00 mm in malignant group, the difference was not statistically significant, the thickness of intestinal wall was 10.55 鹵5.73 mm in benign group and 22.00 鹵20.30 mm in malignant group. In the comparison of the boundary between the diseased and normal intestinal duct, the difference was statistically significant, that is, the boundary between the diseased intestinal duct and the normal intestinal canal was obvious in the malignant lesion group than in the benign lesion group, and the "stratification" of the wall of the lesion was observed. The difference of detection rate between the two groups was statistically significant, which indicated that the benign lesions were more prone to the stratification of the tube wall, and the incidence of ileal involvement at the end of the two groups was significantly different between the two groups. That is, benign lesions are more likely to invade the terminal ileum, and there is a significant difference in the detection rate of periintestinal turbid sign between the two groups, that is, benign lesions are more serious than malignant ones. Conclusion 1. The boundary between the diseased intestine and the normal intestine, the stratification of the diseased intestinal wall and the involvement of the ileum at the end of the lesion, The difference of periintestinal "turbidity" signs is of great significance for the differential diagnosis of benign and malignant ileocecal lesions. 2. The differences in the length of intestinal wall of ileocecal lesions have a certain significance for differentiating benign and malignant ileocecal lesions, but due to the influence of appendicitis on the surrounding structures, Its reference value is not reliable in this study. The differential diagnosis of benign and malignant ileocecal lesions should be combined with multiple signs for comprehensive analysis and evaluation.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.3;R730.44

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