肝囊性包蟲病的CT影像與臨床病理學的相關性分析
發(fā)布時間：2018-12-27 07:21
【摘要】：目的：探討肝囊性包蟲病的CT特征性影像與臨床病理改變的相關性，并通過該病的影像學依據(jù)了解其自然病程。 方法：對CT診斷并經手術病理證實的558例共691個肝包囊的CT表現(xiàn)及術中所見進行回顧性分析。 結果：1各分型母囊CT值差異有統(tǒng)計學意義（P0.001）。隨著包蟲從CL型向CE5型演變，肝包囊母囊內CT值逐漸增大。母囊與子囊的CT值差異有統(tǒng)計學意義（P0.001）。 2四組反映不同囊內容物性狀（液性，膠胨樣，干酪樣，鈣化）CT值差異有統(tǒng)計學意義（P0.001）。 3術中證實294例中330個囊腫發(fā)生膽瘺。各型包蟲膽瘺發(fā)生率差異有統(tǒng)計學意義（P0.001）。其中CL型和CE1型，CE3型和CE4型，CE4型和CE5型三組包蟲膽瘺發(fā)生率差異無統(tǒng)計學意義（P0.05）。隨著包蟲分型演變，膽瘺的發(fā)生率逐漸增高。 4膽瘺的病例中，肝內膽管擴張36例，發(fā)生率12.24%；外囊“月牙樣”突起67例，發(fā)生率為20.30%；囊內結石25例，發(fā)生率為7.58%；“同心圓征”29例，發(fā)生率為8.79%；氣─液平面24例，，發(fā)生率為7.27%；子囊偏心性排列42例，發(fā)生率12.72%。 5肝內破裂：158囊，發(fā)生率22.9%，CT示病灶形似“葫蘆”，囊壁薄厚不均，突出部分較��；肝外破裂：92囊，發(fā)生率13.3%，CT示包囊突出肝外生長，突出部分形狀不規(guī)則、囊壁較厚、內可見條索狀高密度分割影。 6454個突出肝外或鄰近肝緣生長的肝包囊中267個出現(xiàn)“肝包膜環(huán)形凹陷”的CT表現(xiàn)，發(fā)生率58.81%。各型包蟲肝包膜環(huán)形凹陷發(fā)生率差異有統(tǒng)計學意義（P0.001）。其中CL型和CE1型，CE1型和CE2型，CE4型和CE5型三組包蟲肝包膜環(huán)形凹陷發(fā)生率多重比較差異均無統(tǒng)計學意義（P0.003125）隨著包蟲分型演變，突出肝外或鄰近肝緣生長的包囊中肝包膜環(huán)形凹陷的發(fā)生率逐漸增高。 7單囊囊腫組合子囊囊腫組中各型包蟲肝包囊平均直徑分別比較差異有統(tǒng)計學意義（P0.001）。隨著包蟲分型演變，肝包囊逐漸變小，且單囊囊腫縮小的趨勢要大于多囊囊腫。 8273個囊腫發(fā)生不同程度的鈣化，鈣化率38.4%。單囊囊腫組與多囊囊腫組僅囊壁鈣化或僅囊內鈣化的發(fā)生率分別比較差異有統(tǒng)計學意義(P0.001)；同時鈣化的發(fā)生率差異無統(tǒng)計學意義(P0.05)。單囊囊腫組囊內發(fā)生鈣化與多囊囊腫組囊壁發(fā)生鈣化分別所對應分型鈣化程度差異有統(tǒng)計學意義（P0.001）。 9根據(jù)肝包囊退行性變的程度和變化趨勢分為退行性變前期、囊液濃縮期、實體包塊期和鈣化期四個時期。 結論: CT影像在反映肝囊性包蟲病自然病程中不同時期囊內容性狀、包蟲活性、體積縮小與鈣化趨勢等臨床病理改變，以及判斷肝包囊是否發(fā)生膽瘺、破裂，預測包蟲的生長狀態(tài)等方面有著重要價值；為認識其自然病程，選擇干預措施提供影像學依據(jù)。
[Abstract]:Objective: to investigate the correlation between CT characteristic imaging and clinicopathological changes of hepatic cystic hydatid disease and to understand its natural course. Methods: the CT findings and intraoperative findings of 691 hepatic cysts diagnosed by CT and confirmed by operation and pathology were retrospectively analyzed. Results: 1 there was significant difference in CT value of each type of maternal sac (P0. 001). With the evolution of hydatid from CL type to CE5 type, the CT value increased gradually. There was significant difference in CT between mother and daughter (P0. 001). (2) there were significant differences in CT values among the four groups (liquid, peptone, cheese and calcification). 3Bile fistula was found in 330 cysts of 294 cases. The incidence of hydatid fistula was significantly different among different types of hydatid fistula (P 0.001). There was no significant difference in the incidence of hydatid fistula between CL type and CE1 type, CE3 type and CE4 type, CE4 type and CE5 type (P0.05). With the development of hydatid type, the incidence of biliary fistula increased gradually. (4) in the cases of biliary fistula, there were 36 cases of intrahepatic bile duct dilatation (12.2445%), 67 cases of crescent-like protuberance (20.30%), 25 cases of intracystic stones (7.58%) and 7.58 cases of intrahepatic cholangiectasis. There were 29 cases of concentric circle sign with an incidence rate of 8.79, 24 cases of gas-liquid plane with an incidence rate of 7.27, and 42 cases of eccentricity of oocysts with an incidence rate of 12.72%. 5Intrahepatic rupture: 158 bursa, the incidence of 22. 9% CT showed that the lesion was similar to "gourd", the wall of cyst was uneven and the projecting part was thin; Extrahepatic rupture: 92 bursa, the incidence of 13. 3% CT showed that the cyst protruded extrahepatic growth, prominent part of irregular shape, thicker cystic wall, can be seen in the high density segmenting stripe. Of the 6454 hepatic cysts with extrahepatic herniation or adjacent hepatic marginal growth, 267 had "hepatic capsule annular indentation", the incidence of which was 58.81. There were significant differences in the incidence of hepatic capsule ring depression among different types of hydatid (P 0.001). There was no significant difference in the incidence of hepatic capsule ring depression between CL type and CE1 type, CE1 type and CE2 type, CE4 type and CE5 type (P0.003125). The incidence of annular indentation of the hepatic capsule in extrahepatic or adjacent hepatic bursa increased gradually. 7 there were significant differences in the mean diameters of hepatic hydatid cysts in the group of single cyst combined with oocyst cyst (P0.001). With the development of hydatid type, the hepatic cyst becomes smaller and the single cyst shrinks more than polycystic cyst. 8273 cysts had different degrees of calcification, and the calcification rate was 38.4%. There was significant difference between single cyst group and polycystic cyst group in the incidence of calcification of the cyst wall or only in the cyst (P0.001), while there was no significant difference in the incidence of calcification between the single cyst group and the polycystic cyst group (P0.05). The degree of calcification in single cyst group was significantly different from that in polycystic cyst group (P0.001). 9 according to the degree and change trend of hepatic cyst degeneration, there are four stages: predegenerative phase, cystic fluid concentration stage, solid mass stage and calcification stage. Conclusion: CT images can reflect the changes of cystic contents, hydatid activity, volume reduction and calcification in different stages of the natural course of hepatic cystic hydatid disease, as well as determine whether the hepatic cyst has biliary fistula or rupture. It is of great value to predict the growth state of hydatid. In order to understand the natural course of disease, choose the intervention measures to provide imaging basis.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R532.32;R816.5
本文編號：2392702
[Abstract]:Objective: to investigate the correlation between CT characteristic imaging and clinicopathological changes of hepatic cystic hydatid disease and to understand its natural course. Methods: the CT findings and intraoperative findings of 691 hepatic cysts diagnosed by CT and confirmed by operation and pathology were retrospectively analyzed. Results: 1 there was significant difference in CT value of each type of maternal sac (P0. 001). With the evolution of hydatid from CL type to CE5 type, the CT value increased gradually. There was significant difference in CT between mother and daughter (P0. 001). (2) there were significant differences in CT values among the four groups (liquid, peptone, cheese and calcification). 3Bile fistula was found in 330 cysts of 294 cases. The incidence of hydatid fistula was significantly different among different types of hydatid fistula (P 0.001). There was no significant difference in the incidence of hydatid fistula between CL type and CE1 type, CE3 type and CE4 type, CE4 type and CE5 type (P0.05). With the development of hydatid type, the incidence of biliary fistula increased gradually. (4) in the cases of biliary fistula, there were 36 cases of intrahepatic bile duct dilatation (12.2445%), 67 cases of crescent-like protuberance (20.30%), 25 cases of intracystic stones (7.58%) and 7.58 cases of intrahepatic cholangiectasis. There were 29 cases of concentric circle sign with an incidence rate of 8.79, 24 cases of gas-liquid plane with an incidence rate of 7.27, and 42 cases of eccentricity of oocysts with an incidence rate of 12.72%. 5Intrahepatic rupture: 158 bursa, the incidence of 22. 9% CT showed that the lesion was similar to "gourd", the wall of cyst was uneven and the projecting part was thin; Extrahepatic rupture: 92 bursa, the incidence of 13. 3% CT showed that the cyst protruded extrahepatic growth, prominent part of irregular shape, thicker cystic wall, can be seen in the high density segmenting stripe. Of the 6454 hepatic cysts with extrahepatic herniation or adjacent hepatic marginal growth, 267 had "hepatic capsule annular indentation", the incidence of which was 58.81. There were significant differences in the incidence of hepatic capsule ring depression among different types of hydatid (P 0.001). There was no significant difference in the incidence of hepatic capsule ring depression between CL type and CE1 type, CE1 type and CE2 type, CE4 type and CE5 type (P0.003125). The incidence of annular indentation of the hepatic capsule in extrahepatic or adjacent hepatic bursa increased gradually. 7 there were significant differences in the mean diameters of hepatic hydatid cysts in the group of single cyst combined with oocyst cyst (P0.001). With the development of hydatid type, the hepatic cyst becomes smaller and the single cyst shrinks more than polycystic cyst. 8273 cysts had different degrees of calcification, and the calcification rate was 38.4%. There was significant difference between single cyst group and polycystic cyst group in the incidence of calcification of the cyst wall or only in the cyst (P0.001), while there was no significant difference in the incidence of calcification between the single cyst group and the polycystic cyst group (P0.05). The degree of calcification in single cyst group was significantly different from that in polycystic cyst group (P0.001). 9 according to the degree and change trend of hepatic cyst degeneration, there are four stages: predegenerative phase, cystic fluid concentration stage, solid mass stage and calcification stage. Conclusion: CT images can reflect the changes of cystic contents, hydatid activity, volume reduction and calcification in different stages of the natural course of hepatic cystic hydatid disease, as well as determine whether the hepatic cyst has biliary fistula or rupture. It is of great value to predict the growth state of hydatid. In order to understand the natural course of disease, choose the intervention measures to provide imaging basis.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R532.32;R816.5
【參考文獻】
相關期刊論文 前10條
1 亞力坤·依明;古蘭拜爾·玉蘇甫;;MSCT對肝泡狀棘球蚴病的診斷價值[J];放射學實踐;2011年01期
2 傅曉文;;肝包蟲性囊腫術后復發(fā)再手術24例臨床分析[J];甘肅醫(yī)藥;2011年08期
3 五四;鄭云慧;陳煥新;才讓卓瑪;;超聲引導下經皮肝穿抽吸硬化介入治療肝包蟲囊腫[J];中國介入影像與治療學;2010年02期
4 趙玉元;;肝包蟲囊腫鈣化并多發(fā)結石4例[J];蘭州大學學報(醫(yī)學版);2006年01期
5 周東海;何寧;趙志文;李炳翠;黃進;周俊林;;34例肝包蟲CT診斷與分析[J];蘭州大學學報(醫(yī)學版);2007年03期
6 桂東川;趙峰;謝百超;唐敬;;肝包蟲囊腫破入膽道系統(tǒng)20例CT診斷[J];農墾醫(yī)學;2007年01期
7 桑樹果,張立亭;介入CT肝包蟲抽吸硬化治療14例[J];內蒙古民族大學學報(自然科學版);2005年01期
8 鮑俊杰;滕國春;白志勇;;囊型肝包蟲的CT診斷[J];內蒙古醫(yī)學雜志;2007年11期
9 匡楚龍,蘭征科;CT導引下經皮穿刺硬化治療肝包蟲囊腫[J];介入放射學雜志;2005年04期
10 楊宏強;彭心宇;張示杰;牛建華;宋發(fā)亮;李勇;王成偉;孫紅;;肝內管道CT三維重建在囊性肝包蟲病中的應用研究及意義[J];實用放射學雜志;2006年05期
本文編號：2392702
本文鏈接：http://www.sikaile.net/yixuelunwen/yundongyixue/2392702.html
最近更新
教材專著
