本文選題：膀胱腫瘤 + 乳頭狀瘤�。� 參考：《南昌大學》2017年碩士論文

【摘要】：目的:1.探討常規(guī)超聲聯合超聲造影(contrast-enhanced ultrasound,CEUS)鑒別膀胱內翻性乳頭狀瘤(inverted papilloma of bladder,IPB)與膀胱尿路上皮癌(papillary urothelial carcinoma,PUC)的應用價值。2.探討低級別膀胱尿路上皮癌(low grade papillary urothelial carcinoma,LGPUC)和高級別膀胱尿路上皮癌(high grade papillary urothelial carcinoma,HGPUC)CEUS時間-強度曲線(time intensity curve,TIC)定量參數與微血管密度(microvessel density,MVD)的相關性。方法:1.回顧性分析自2014年9月至2016年11月南昌大學第一附屬醫(yī)院經病理診斷為IPB患者32例和PUC患者57例的常規(guī)超聲和CEUS表現。采用QLAB分析軟件獲得IPB和PUC的TIC參數,包括上升時間(rise time,RT)、平均渡越時間(mean transit time,MTT)、峰值強度(peak intensiy,PI)、半洗漱時間(time from peak to one half,TPH)、達峰時間(time to peak,TP)、上升斜率(wash in slope,WIS)、半降支斜率(semi-descending slope,DS)絕對值,并進行統計學分析得到IPB和PUC的CEUS特征表現。2.回顧性分析自2013年2月至2016年11月南昌大學第一附屬醫(yī)院術前行CEUS檢查且經手術或膀胱鏡活檢病理診斷為LGPUC患者55例和HGPUC患者50例,術前均行CEUS檢查并利用QLAB分析軟件獲得TIC定量參數,對手術標本進行抗CD34因子免疫組化染色測量MVD,分析兩組CEUS TIC定量參數與MVD的相關性。結果:1.在常規(guī)超聲方面,IPB及PUC兩組腫塊的位置、形態(tài)、長徑/基底寬(Longitudinal/Transverse diame-terratio,L/T)及其內血流情況差異均有統計學意義(P0.05);在CEUS定量參數中,峰值強度(PI)、半降支斜率(DS)、峰值強度減半時間(TPH)、達峰時間(TP)比較,差異均有統計學意義(P0.05),上升時間(RT)、平均渡越時間(MTT)、上升斜率(WIS)比較差異無統計學意義(P0.05)。2.在手術后病理證實55例LGPUC和50例HGPUC的MVD中,HGPUC組的MVD(51.03±20.16)明顯高于LGPUC組(41.39±16.65)(P0.05);LGPUC和HGPUC的TPH與MVD呈正相關(r=0.86,P0.05),DS與MVD呈負相關(r=-0.76,P0.05)。結論:1.CEUS定量分析可較好地反映IPB和PUC的血流灌注情況,常規(guī)超聲及CEUS在IPB和PUC的鑒別診斷中具有較高的臨床價值。2.CEUS在鑒別LGPUC和HGPUC中具有一定的臨床價值。PUC中CEUS定量參數與MVD有一定的相關性,提示CEUS在一定程度上能較好的反映PUC的MVD。CEUS將可作為一項在活體上可重復、相對無創(chuàng)、快捷地評估腫瘤血管生成的新型技術,可為PUC的臨床診斷、個性化治療及預后判斷提供更多的信息。
[Abstract]:Purpose 1. To evaluate the value of conventional contrast-enhanced ultrasound (CEUSS) in differentiating inverted papilloma of bladderma from papillary urothelial carcinoma of bladder. To investigate the correlation between the quantitative parameters of low grade papillary urothelial carcinoma of urinary tract (LGPUC) and high grade papillary urothelial carcinoma of urinary tract (HGPU CCEUS) and microvessel density (MVD). Method 1: 1. From September 2014 to November 2016, 32 patients with IPB and 57 patients with PUC diagnosed by pathology in the first affiliated Hospital of Nanchang University were analyzed retrospectively. The TIC parameters of IPB and PUC were obtained by using QLAB analysis software, including rising time, mean transit time and MTT, peak intensity and peak intensity, half washing time and half from peak to one, peak time to peak-QLAB, rising slope wash in slopewise, semi-descending slope, absolute value of semi-descending slope. The CEUS characteristics of IPB and PUC were obtained by statistical analysis. 2. 2. From February 2013 to November 2016, 55 patients with LGPUC and 50 patients with HGPUC were examined by CEUS and diagnosed by operation or cystoscopic biopsy in the first affiliated Hospital of Nanchang University from February 2013 to November 2016. The quantitative parameters of TIC were obtained by QLAB software before operation, and the correlation between CEUS TIC quantitative parameters and MVD was analyzed by immunohistochemical staining of anti-CD34 factor. The result is 1: 1. There were significant differences in the location, shape, long diameter / basal width of long diameter / basal width Transverse diamterratiol / T) and internal blood flow between the two groups in conventional ultrasound, and in the quantitative parameters of CEUS, there was no significant difference between the two groups (P < 0.05). There were significant differences in peak intensity (Pi), semi-descending slope (DSN), peak intensity half time (TPH) and peak time (TP). There was no significant difference between peak intensity and peak intensity (P 0.05), average transit time (MTT), and rise slope (wise) were not significantly different (P 0.05 路2). In the MVD of 55 cases of LGPUC and 50 cases of HGPUC, the MVD(51.03 鹵20.16 in HGPUC group was significantly higher than that in LGPUC group (41.39 鹵16.65) and TPH in HGPUC was positively correlated with MVD in 55 cases of LGPUC and 50 cases of HGPUC. Conclusion: 1. The quantitative analysis of CEUs can better reflect the blood flow perfusion of IPB and PUC. Conventional ultrasound and CEUS have high clinical value in differential diagnosis of IPB and PUC. 2.CEUS has certain clinical value in differentiating LGPUC and HGPUC. The quantitative parameters of CEUS in LGPUC and HGPUC have certain correlation with MVD. The results suggest that MVD.CEUS, which can reflect PUC to a certain extent, can be used as a new technique to evaluate tumor angiogenesis in vivo, which can be repeated in vivo, relatively noninvasive, and can be used as a clinical diagnosis of PUC. Personalized treatment and prognostic judgment provide more information.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R737.14

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