本文選題：胃腸道　切入點：神經(jīng)內(nèi)分泌腫瘤　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分胃腸道神經(jīng)內(nèi)分泌腫瘤CT表現(xiàn)與病理分級對照分析目的:探討胃腸道神經(jīng)內(nèi)分泌腫瘤CT表現(xiàn)與病理學(xué)分級的相關(guān)性。方法:選取我院收治的27例胃腸道神經(jīng)內(nèi)分泌腫瘤患者為研究資料,所有患者術(shù)前均行CT平掃及增強檢查,并經(jīng)手術(shù)病理學(xué)證實。對所有患者的一般資料、影像學(xué)特征及其與病理學(xué)分級的對照關(guān)系進行回顧性分析。參照2010年WHO對神經(jīng)內(nèi)分泌腫瘤分類標(biāo)準(zhǔn),分為神經(jīng)內(nèi)分泌瘤(Neuroendocrine tumor,NET)G1、G2和神經(jīng)內(nèi)分泌癌(Neuroendocrine carcinoma,NEC)G3兩組。結(jié)果:由于本研究收集病例數(shù)較少,故分為兩組神經(jīng)內(nèi)分泌腫瘤(NET)和神經(jīng)內(nèi)分泌癌(NEC)進行研究。27例胃腸道神經(jīng)內(nèi)分泌腫瘤患者中,NET(G1+G2)患者16例,男11例,患者的平均年齡為(54.62±2.66)歲;NEC(G3)患者共11例,男7例,患者的平均年齡為(54.24±2.33)歲。不同級別胃腸道內(nèi)分泌腫瘤在性別、年齡、腫瘤大小、邊界、生長方式、壞死囊變、網(wǎng)膜種植轉(zhuǎn)移方面,差異無統(tǒng)計學(xué)意義(P0.05)。NEC組生長方式主要為透壁性,壞死囊變多見,大部分病變伴有鄰近組織的侵犯,常有淋巴結(jié)及遠處轉(zhuǎn)移;兩組病變在透壁性生長、淋巴轉(zhuǎn)移、鄰近組織侵犯及遠處轉(zhuǎn)移方面,差異有統(tǒng)計學(xué)意義(P0.05)。增強后,NEC組腫瘤多為明顯不均勻強化,然而不同級別內(nèi)分泌腫瘤的強化程度及方式差異均無統(tǒng)計學(xué)意義(P0.05),但經(jīng)計算分析各期掃描病灶的絕對強化程度以及病灶與肝臟靜脈期CT值差的差異有統(tǒng)計學(xué)差異(P0.05)。結(jié)論:CT在胃腸道神經(jīng)內(nèi)分泌腫瘤病理分級方面有較大價值,通過對透壁性生長、遠處淋巴結(jié)轉(zhuǎn)移、鄰近器官侵犯、遠處轉(zhuǎn)移等CT征象進行觀察,以及強化程度的定量指標(biāo)的測量存在統(tǒng)計學(xué)意義,并且A及△A敏感度及特異性更高,具有更好的檢驗效能。CT檢查有助于對胃腸道神經(jīng)內(nèi)分泌腫瘤分化程度進行評估,以指導(dǎo)臨床手術(shù)方案的制定。第二部分胰腺神經(jīng)內(nèi)分泌腫瘤CT表現(xiàn)與病理分級對照分析目的:探討胰腺神經(jīng)內(nèi)分泌腫瘤CT表現(xiàn)與病理學(xué)分級的相關(guān)性。方法:選取我院收治的41例胰腺神經(jīng)內(nèi)分泌腫瘤患者為研究資料,所有患者術(shù)前均行CT平掃、增強檢查,并經(jīng)手術(shù)病理學(xué)證實。對所有患者的一般資料、影像學(xué)特征及其與病理學(xué)分級的對照關(guān)系進行回顧性分析。參照2010年WHO病理組織學(xué)關(guān)于胰腺神經(jīng)內(nèi)分泌腫瘤分類系統(tǒng),根據(jù)Ki-67和核分裂數(shù),把胰腺神經(jīng)內(nèi)分泌腫瘤分為三個等級:G1、G2和G3。結(jié)果:41例胰腺神經(jīng)內(nèi)分泌腫瘤患者中,G1、G2、G3組患者分別為17例、13例、11例,其中男性25例,平均年齡為(45.78±3.55)歲;不同級別腫瘤性別、年齡、腫瘤位置、大小、生長方式、形態(tài)和有無鈣化、囊變壞死、內(nèi)分泌功能無統(tǒng)計學(xué)差異(P0.05);壞死囊變由于腫瘤體積較大,缺血所致;鈣化主要是因為營養(yǎng)不良,這兩種征象均與腫瘤大小及血供有關(guān),并不能準(zhǔn)確發(fā)映出腫瘤的病理類型。CT增強后,不同級別腫瘤在各期掃描中的絕對強化程度、病灶與肝臟靜脈期CT值差有統(tǒng)計學(xué)差異(P0.05);雖然AP、VP、BP的計算在理論上消除了對比劑注射速度及CT掃描時間的影響,但經(jīng)數(shù)據(jù)分析三者并無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:不同級別胰腺神經(jīng)內(nèi)分泌腫瘤在臨床特征及CT征象無統(tǒng)計學(xué)差異。不同級別腫瘤增強掃描動脈期及平衡期的絕對強化程度以及其與肝臟靜脈期CT差值有統(tǒng)計學(xué)差異,并且A及△A敏感度及特異性更高,具有更好的檢驗效能。所以,CT檢查對胰腺神經(jīng)內(nèi)分泌腫瘤的診斷有較高價值,有助于評估胰腺神經(jīng)內(nèi)分泌腫瘤的病理分級。
[Abstract]:The first part of gastrointestinal neuroendocrine tumor expression of CT and pathological grading control analysis objective: To investigate the correlation between pathological classification of gastrointestinal neuroendocrine tumors CT and pathology. Methods: 27 cases of gastrointestinal neuroendocrine tumor patients in our hospital as the research data, all patients underwent preoperative CT scan and enhanced scan. By surgery and pathology. The general data of all patients were retrospectively analyzed, comparison between the imaging features and pathological classification. According to the standard of WHO in 2010 to neuroendocrine tumor classification, divided into tumor secrete nerve (Neuroendocrine tumor, NET) in G1, G2 and neuroendocrine carcinoma (Neuroendocrine carcinoma, NEC G3) two groups. Results: the study collected a small number of cases, it is divided into two groups of neuroendocrine tumors (NET) and neuroendocrine carcinoma (NEC) of.27 patients with gastrointestinal neuroendocrine In cancer patients, NET (G1+G2) 16 cases, 11 cases were male, the average age of the patients was (54.62 + 2.66); NEC (G3) in patients with a total of 11 cases, 7 cases were male, the average age of the patients was (54.24 + 2.33) years old. Gastrointestinal endocrine tumors at different levels of gender, age, tumor size, boundary, growth pattern, cystic and necrotic omental metastasis, there was no statistically significant difference (P0.05) growth of.NEC group was mainly transmural necrosis, cystic, invaded most of lesions with adjacent tissue, often with lymph node and distant metastasis; two lesions in transmural group growth, lymph node metastasis, adjacent tissue invasion and distant metastasis, the difference was statistically significant (P0.05). After enhancement, the tumor of NEC group were obviously heterogeneous enhancement, but the differences were not statistically significant enhancement degree and different levels of endocrine tumors (P0.05), but the calculation analysis of the absolute phase scan lesions The degree of enhancement and disease and hepatic venous phase CT value difference was statistically difference (P0.05). Conclusion: CT has great value in gastrointestinal neuroendocrine tumor pathological grade, through the growth of transmural, distant lymph node metastasis, distant metastasis and invasion of neighboring organs, CT signs were observed, and strengthen the quantitative measurement the degree has statistical significance, and the A and A sensitivity and higher specificity and effectiveness of.CT examination has better contribute to gastrointestinal neuroendocrine tumor differentiation was assessed in order to develop guiding clinical surgery scheme. The second part of pancreatic neuroendocrine tumors CT appearance and pathological grade were analyzed objective: To investigate the correlation between pathological classification of pancreatic neuroendocrine tumors CT and pathology. Methods: 41 cases of pancreatic neuroendocrine tumor patients in our hospital as the research data, the The patient underwent preoperative CT scan, enhanced scan, and confirmed by surgery and pathology. The general data of all patients were retrospectively analyzed, comparison between the imaging features and pathological grading. In reference to the 2010 WHO on histopathology of pancreatic neuroendocrine tumor classification system based on Ki-67 and mitotic count, the pancreas neuroendocrine tumors are divided into three levels: G1, G2 and G3. results: 41 cases of patients with pancreatic neuroendocrine tumors, G1, G2, G3 groups were 17 cases, 13 cases, 11 cases, including 25 cases of male, mean age (45.78 + 3.55) years; different levels of tumor sex, age tumor location, size, growth, morphology and calcification, cystic necrosis, no significant difference in endocrine function (P0.05); cystic necrosis due to the tumor volume is larger, mainly because of calcification caused by ischemia; malnutrition, these two features are correlated with tumor size and blood For, and can not accurately reflect the pathological type of.CT tumor after enhancement, different levels of tumor in different stages of scanning in the absolute degree of enhancement, the lesions and hepatic venous phase CT value difference was statistically different (P0.05); while AP, VP, BP calculation to eliminate the effect of contrast agent injection speed and CT scanning time in theory, but through the data analysis of three was not statistically significant (P0.05). Conclusion: there was no significant difference in different levels of pancreatic neuroendocrine tumors in clinical characteristics and CT features of different levels. The absolute strong degree of tumor enhancement on arterial phase scanning and equilibrium phase as well as the hepatic venous phase difference had statistical difference between CT and A. A and the sensitivity and specificity of higher testing efficiency is better. Therefore, a higher value of CT examination in the diagnosis of pancreatic neuroendocrine tumors, pathological classification is helpful to evaluate pancreatic neuroendocrine tumors.

【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735;R730.44

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