肾细胞癌的CT影像学表现与病理学类型的相关性研究

发布时间：2018-05-01 20:49

本文选题：肾癌 + 病理分型　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的:回顾分析四种不同病理组织类型的肾癌的术前CT影像学资料,总结四种肾细胞癌亚型的CT影像学表现,旨在术前对不同病例分型的肾细胞癌有较为准确的初步诊断,进而对临床治疗方案等起到一定的指导作用。方法:收集从2011年7月到2016年7月,经宁夏医科大学总医院泌尿外科行手术治疗,且术后病理明确诊断为肾癌的病例,选取其中透明细胞癌50例;乳头状癌15例;嫌色细胞癌10例;多房囊性肾癌6例。对每种肾癌亚型发病年龄、临床特征及性别差异进行统计;并对四种肾癌亚型CT图像进行不同分期的CT值、强化幅度以及强化形式的统计分析;观察不同病理类型肿瘤内部的变化,包括钙化、坏死囊变等,明确有无统计学差异。结果:1、所收集到的四种肾癌在临床表现方面,典型的“肾癌三联征”比例都较少,且差异在四种肾癌间无明显统计学意义(P0.05)。在有临床症状的患者中,以血尿、腰痛、腹部包块中一种或两种主诉就诊的患者的比例较典型三联征患者高,部分患者表现为副瘤综合征;而临床无症状患者的比例较高,通常为体检发现,或是因其它疾病就诊过程中发现肾脏占位性病变。2、四种肾癌在性别比较中差异无统计学意义(P0.05)。3、在CT平扫中,四种肾癌均为低密度影,其中乳头状癌及嫌色细胞癌密度较透明细胞癌高,经统计分析后有统计学意义(P0.05)。4、进行增强扫描后,透明细胞癌表现出典型的“快进快出”特征,在动脉期其强化最快,强化幅度最高,与其它三种肾癌具有统计学意义(P0.05);实质期,透明细胞癌强化较前下降,但仍高于其他三类肾癌,差异具有统计学意义(P0.05)。在排泄期,四种肾癌亚型的CT值较前均呈下降趋势,但透明细胞癌仍最高,差异有统计学意义(P0.05)。5、在强化形式上,透明细胞癌主要以不均匀强化为主,而乳头状癌及嫌色细胞癌均匀强化占优势,多房囊性肾癌囊壁及囊内分隔强化明显。进行统计分析后差异有统计学意义。透明细胞癌较乳头状癌及嫌色细胞癌更容易出现囊变坏死,而多房囊性肾癌本身以囊变为特征。结论:1、不同肾癌亚型因病理组织学基础不同,在CT影像学方面具有可观察并具有统计学意义的的差异。2、透明细胞癌在动脉期的明显强化仍然是此类肾癌的特征性改变。3、CT因高分辨率、对不同组织有较准确成像以及操作方便,目前仍是诊断肾癌的首选检查手段。
[Abstract]:Objective: To review and analyze the preoperative CT imaging data of four different pathological types of renal cell carcinoma and to sum up the CT imaging findings of the four subtypes of renal cell carcinoma. The purpose of this study was to make a more accurate preliminary diagnosis of renal cell carcinoma in different cases and to guide the clinical treatment. Methods: collect from 7 in 2011. From month to July 2016, 50 cases of transparent cell carcinoma, 15 cases of papillary carcinoma, 10 cases of chromophobe cell carcinoma and 6 cases of multilocular cystic renal carcinoma were selected by surgical treatment in the Department of Urology, General Hospital of Ningxia Medical University, and the postoperative pathology was clearly diagnosed as renal carcinoma. Four types of renal carcinoma subtype CT images were analyzed by statistical analysis of CT values, intensification amplitude and intensification forms in different stages. The changes of internal changes in different pathological types, including calcification and necrotic cystic change, were clearly observed. Results: 1, the clinical manifestations of four types of renal carcinoma collected, the typical "renal carcinoma triple syndrome" ratio There was less significant difference between the four types of renal carcinoma (P0.05). Among the patients with clinical symptoms, the proportion of one or two cases in the patients with hematuria, lumbago, and abdominal mass was higher than that of the typical triad, and some of the patients showed paraneoplastic syndrome; and the proportion of the patients with clinical symptoms was higher, usually a physical examination. The renal space occupying lesion.2 was found in the process of other diseases, and there was no significant difference (P0.05).3 in the sex comparison between the four types of renal carcinoma. In the CT plain scan, the four kinds of renal carcinoma were low density shadow, and the papillary and chromophobe cell carcinoma density was higher than that of the transparent cell carcinoma, and the statistical significance (P0.05).4 was statistically significant after the statistical analysis. After strong scan, the clear cell carcinoma showed a typical "fast forward and fast out" feature. In the arterial phase, the enhancement was the fastest and the most enhanced, with the other three types of renal cancer (P0.05). In the substance phase, the enhancement of the clear cell carcinoma was lower than that of the other three types of renal cancer, but the difference was statistically significant (P0.05). In the excretory period, four kinds of cancer were found. The CT value of the subtype of renal carcinoma is declining, but the clear cell carcinoma is still the highest, and the difference is statistically significant (P0.05).5. In the intensification form, the main type of clear cell carcinoma is uneven enhancement, while the papillary carcinoma and the chromophobe cell carcinoma are predominant, and the cystic wall and the intraductal septum of the multilocular cystic renal cell carcinoma are obviously strengthened. There is a statistically significant difference in the post difference between the papillary and chromophobe cell carcinoma, and the multiple cystic renal cell carcinoma itself is characterized by cystic degeneration. Conclusion: 1, the different subtypes of renal carcinoma are different from the histopathology based on the CT imaging and have a statistically significant difference in.2, transparent cell carcinoma. The obvious enhancement in the arterial phase is still the characteristic change of.3 in this kind of renal carcinoma. CT is the first choice for diagnosis of renal cancer because of its high resolution, accurate imaging of different tissues and convenient operation.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.11;R730.44

【参考文献】