fMRI纵向评估肾癌患者腹腔镜下肾部分切除术后余肾功能的初步研究

发布时间：2018-03-09 02:00

  本文选题：肾癌　切入点：肾部分切除术　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的动脉自旋标记(ASL)、体素内不相干运动(IVIM)纵向评估肾癌患者腹腔镜下肾部分切除术后余肾功能的初步研究。对象与方法纳入30例拟行腹腔镜肾部分切除术的肾肿瘤患者及30例年龄与之相匹配的健康志愿者,术前采用99mTc-DTPA肾核素扫描评估术前健侧肾的肾小球滤过率(glomerular filtration rate,GFR)。并于核素检查72小时内及术后3个月、6个月、12个月行ASL、IVIM扫描,通过后处理获得皮质的肾血流量(renal blood flow,RBF)值、肾皮髓质的假扩散系数(ADC of pseudodiffusion,ADC_(fast))、灌注分数(perfusion fraction,PF)值。采用SPSS 19.0统计学软件进行统计学分析,计量资料用x±s的形式表示。对各肾脏皮质RBF值及皮髓质的ADC_(fast)、PF值行正态分布检验,经证实数据满足正态分布后,采取组内相关系数(intra-class correlation coefficient,ICC)分析2名医师测量肾脏皮髓质各指标值的一致性,ICC≥0.75认为一致性好,0.40≤ICC0.75认为一致性中等,ICC0.40认为一致性差。采取独立样本t检验比较健康志愿者组双肾皮质间、髓质间及皮髓质间各指标值的差异,并取健康志愿者组左肾的各指标值进行下一步的分析;采取独立样本t检验比较患者术前患侧余肾、健侧肾脏皮髓质ADC_(fast)、PF值差异;采取Pearson相关分析研究患者健侧肾脏术前各指标值与GFR间的相关性,以及健侧肾皮质ADC_(fast)、PF与RBF之间的相关性;采取重复测量方差分析比较各时间点肾脏皮髓质各指标值的差异;采取独立样本t检验比较患者组术后12个月与正常对照组肾脏皮髓质各指标值的差异。p0.05为差异有统计学意义。结果(1)两名医师对肾脏皮髓质IVIM、ASL各指标值测量的一致性均良好,ICC均在0.75以上。(2)健康志愿者双肾皮质间、双肾髓质间RBF、ADC_(fast)、PF差异均无统计学意义(p0.05)。(3)健康志愿者双肾皮质RBF、ADC_(fast)、PF值均明显大于髓质,差异具有统计学意义(p0.05)。(4)患者患侧及健侧肾脏皮髓质间ADC_(fast)、PF值均存在明显差异(p0.05)。(5)健侧肾皮质RBF、ADC_(fast)及PF值与GFR均呈正相关性(R值分别为0.560、0.532、0.678,p0.01)。(6)健侧肾髓质ADC_(fast)及PF值与GFR均呈正相关性(R值分别为0.622、0.601,p0.01)。(7)健侧肾髓质ADC_(fast)及PF值与RBF均呈正相关性(R值分别为0.537、0.598,p0.01)。(8)术后3月患侧残余肾组织皮质RBF、皮髓质ADC_(fast)、PF值较术前升高(p0.05);术后6月较3月患侧残余肾组织各参数值较术前升高(p0.05),12月时较前未见明显变化。(9)术后3月健侧肾组织皮质RBF、皮髓质ADC_(fast)、PF值较术前下降(p0.05),术后6月较3月患侧残余肾组织各参数值较术前下降(p0.05),12月时较前亦未见明显变化。(10)术后12月患者患侧及健侧肾脏皮髓质RBF、ADC_(fast)、PF与健康对照组差异均无统计学意义(p0.05)。结论ASL、IVIM可以用来评价肾功能,且纵向评估腹腔镜下肾癌部分切除术后余肾血流灌注功能具有一定的价值。
[Abstract]:Objective to evaluate the residual renal function in patients with renal cell carcinoma after laparoscopic partial nephrectomy by arterial spin labeling (ASLL) and intra voxel incoherent motility (IVIMI). Participants and methods 30 patients with renal swelling undergoing laparoscopic partial nephrectomy were included in this study. Tumor patients and 30 age-matched healthy volunteers, Preoperative 99mTc-DTPA renin scan was used to evaluate glomerular filtration rateGFR in healthy kidney before operation. ASLI-IVIM was performed within 72 hours of radionuclide examination and 3 months, 6 months and 12 months after radionuclide examination. Renal blood flow rate (RBFs) of renal cortex was obtained by post-processing. The pseudo-diffusivity coefficient of renal medulla is ADC of pseudodiffusion.Perfusion fraction and perfusion fraction are analyzed by SPSS 19.0 statistical software, and the measured data are expressed in the form of x 卤s. The normal distribution of RBF value of each kidney cortex and the value of RBF fast PF of skin medulla are tested. After confirming that the data satisfy the normal distribution, The intra-group correlation coefficient (intra-class correlation cofficient) was used to analyze the consistency of each index value measured by two physicians in renal dermatomedullary. ICC 鈮，

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