原发性肝癌的肺部转移CT研究

发布时间：2018-02-02 23:10

本文关键词： 原发性肝癌肺转移体层摄影术　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:回顾性分析总结原发性肝癌肺部转移发生率及其的CT表现特点,为临床诊断提供可靠依据。材料方法:收集本院2013年1月至2014年12月期间经手术病理证实或临床确诊为肝癌的病例4268例,其中初次发现肺部转移共计344例,经过影像随访证实为肺转移瘤的病例共计97例,发生率约8.06%,包括男85例,女12例,年龄21~76岁,平均48.5岁。以常规肺窗及纵隔窗观察转移瘤病灶的数目与分布,评价病灶的边缘、形态及内部结构、密度、强化方式等。分析比较不同肝癌类型肺转移瘤的CT影像学特点及随访变化。结果:(1)原发肿瘤:本组97例原发肝癌大小在1cm-23cm,其中以巨块型肝癌最多见(59例,达60.82%),其次是混合型肝癌(18例,达18.56%)、弥漫型肝癌(6例,6.85%)、结节型肝癌(14例,14.43%)。其中有16例合并门脉癌栓(16.49%,最多)、其余合并癌栓的?部位依次为下腔静脉6例、肝静脉4例、肠系膜上静脉2例;原发性肝癌肺部转移的发生率约8.06%(344/4268)。(2)肺转移瘤的分布:瘤灶以多发转移最多见(53例,54.64%),其次是弥漫转移型(27例,27.83%),单发结节转移(17例,17.52%);转移瘤多位于两肺下叶,靠近肺野外带。(3)肺转移瘤的大小、形态及边缘:本组肺转移瘤大小范围在0.1~3cm,形状以结节状最多见(86例,88.66%)、其次为圆形(40例,41.24%)、软组织肿块形(9例,9.27%);转移灶边缘多光整(93例,95.88%),少数表现为边缘模糊(4例,4.12%)。(4)肺转移瘤的密度和强化方式:本组病例CT平扫密度多表现为均匀(92例,94.85%),少数表现为不均匀(5例,5.15%);转移灶内出现者空洞1例(1%);共计65例行增强扫描,其中轻度强化最多见(26例,40%),其次为明显强化(26例,40%)、中度强化(4例,6.15%)、9例未见强化。(5)随诊情况:肝癌首诊合并肺转移患者23例,另74例患者是在随访复查过程中出现肺转移瘤,动态随访次数为1-3次、时间1-24个月。大部分肺转移灶表现为增多增大,少数不变或缩小、减少。(6)肝癌合并癌栓患者的肺部转移瘤特点:合并门脉癌栓及其他癌栓的肺转移瘤以多发转移常见,单发及弥漫转移较少见。(7)肺内伴随征象及肺外转移情况:肺内伴发征象包括胸腔积液(30例,30.93%)、气胸(2例,2.06%)、胸膜结节(4例,4.12%)、肺门淋巴结增大(6例,6.18%)及纵膈淋巴结增大(7例,7.23%);肺外以淋巴结转移最常见(18例,18.56%),其次发生部位有肾上腺(3例)、脾脏(1例)。结论:(1)发生肺部转移的原发性肝癌中,以巨块型肝癌最多见,且多数合并门静脉癌栓;(2)肝癌肺转移瘤特点表现为两肺多发结节灶病灶,大小不一,边缘多清楚,密度较均匀,增强轻度和明显强化,以两肺下叶多见、靠近肺野外带;(3)大多数转移瘤随访数目增多、形态增大,且伴随肺部其他征象及肺外转移的出现。
[Abstract]:Objective: to retrospectively analyze the incidence of pulmonary metastasis of primary liver cancer and its CT features. Materials: from January 2013 to December 2014, 4268 cases of liver cancer confirmed by surgery and pathology were collected. A total of 344 cases of pulmonary metastasis were found for the first time, 97 cases were confirmed as pulmonary metastases by imaging follow-up, the incidence was about 8.06%, including 85 cases of males and 12 cases of females, aged 21 76 years. The average age was 48.5 years. The number and distribution of metastatic lesions were observed by conventional pulmonary window and mediastinal window, and the edge, shape, internal structure and density of the lesions were evaluated. The CT imaging features and follow-up changes of lung metastases of different types of liver cancer were analyzed and compared. Results the primary tumors were: the size of primary liver cancer was 1cm-23cm in this group. Among them, 59 cases (60.82%) were found in giant liver cancer, 18 cases (18.56) in mixed type, 6 cases (6.85%) in diffuse type of liver cancer. Among them, 16 cases were complicated with portal vein tumor thrombus 16.49%, most of which were complicated with tumor thrombus. 6 cases were inferior vena cava, 4 cases were hepatic vein and 2 cases were superior mesenteric vein. The incidence of pulmonary metastasis of primary liver cancer was about 8.06 / 42680.2The distribution of pulmonary metastases: 53 cases with multiple metastases were most frequently seen in multiple metastases (54.64%). The second was diffuse metastasis in 27 cases (27.83%) and single nodular metastasis in 17 cases (17.52%). Most of the metastatic tumors were located in the lower lobes of the two lungs and near the field zone of the lung. The size, shape and edge of the metastatic tumors were 0.1 ~ 3 cm, and 86 cases were nodule in shape. 88.66%, followed by 40 cases of circular gyrus, 41.24%, and 9 cases of soft tissue mass, 9.27%. There were 93 cases with multiple light correction at the margin of metastatic foci, and 4 cases with blurry margin. 4.12 the density and enhancement mode of pulmonary metastases: in this group, CT plain scan showed homogeneous CT density in 92 cases (94. 85%), and in a few cases, it was uneven in 5 cases (P < 0 05). 5.15; The cavity in the metastatic focus was found in 1 case. A total of 65 cases were examined with enhanced scan, of which 26 cases with mild enhancement and 40 cases with moderate enhancement were found, followed by 26 cases with obvious enhancement and 40 cases with moderate enhancement, and 4 cases with moderate enhancement (6. 15%). There were 23 cases of HCC with lung metastasis and 74 cases with pulmonary metastasis during follow-up. The frequency of dynamic follow-up was 1-3 times. Most pulmonary metastases showed increased or enlarged, while a few remained unchanged or decreased. The characteristics of pulmonary metastases in patients with hepatocellular carcinoma complicated with tumor thrombus: multiple metastasis is common in patients with portal vein tumor thrombus and other tumor thrombus. Intrapulmonary and extrapulmonary metastasis: 30 cases with pleural effusion and 30.93 cases with pneumothorax, 2 cases with pneumothorax and 2 cases with pneumothorax. There were 4 cases of pleural nodule, 6 cases of hilar lymph node enlargement (6.18%) and 7 cases of mediastinal lymph node enlargement (7.23%). Lymph node metastasis was most common in 18 patients with extrapulmonary metastasis, followed by adrenal gland metastasis in 3 cases and splenic metastasis in 1 case. Conclusion 1) Primary liver cancer with lung metastasis is found. Giant liver cancer was the most common type, and most of them were complicated with portal vein tumor thrombus. (2) the features of lung metastases of liver cancer were multiple nodules in both lungs with different size, clear margin, uniform density, slight enhancement and obvious enhancement, most of which were located in the lower lobes of the two lungs, which were close to the field zone of the lungs. 3) the number and morphology of most metastatic tumors were increased and accompanied by other signs of lung and extrapulmonary metastasis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R730.44

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