1316例不同部位色素痣样皮损的临床与病理分析
发布时间：2018-03-24 13:42
本文选题：不同部位 切入点：色素痣 出处：《大连医科大学》2017年硕士论文
【摘要】：目的:对纳入研究标准的1316例色素痣样皮损病例进行回顾性分析,探讨不同部位的色素痣的组织病理分型,总结发病规律,以提高皮肤科医师对皮肤浅表色素痣的认识程度以及早期诊治水平。方法:收集2015年至2016年两年间大连医科大学附属第二医院皮肤科门诊就诊初步诊断为色素痣并行手术切除和组织病理活检的患者及初步诊断为非色素痣并行组织病理活检结果为色素痣的患者共1316例。术前与患者沟通,交代手术流程及注意事项,记录患者信息及临床表现,将色素样皮损在光亮处拍摄照片,术毕将手术切除的皮损组织行组织病理检查。统计所有患者年龄、性别;统计所有患者色素痣样皮损分布部位,将其分为面颈部、躯干部、四肢部、手足部四组(其中躯干组不包括外阴部,手足组不包括甲部);将所有入选病例根据病理诊断结果分为交界痣、皮内痣、混合痣。统计面颈部、躯干部、四肢部、手足部每组患者不同组织病理分型。统计所有病理诊断与临床诊断不相符的病例,分析漏诊及误诊情况。该研究所收集的病例均为我科专业医师接诊做出临床诊断并行手术切除,组织病理标本由我科专业技师制片,病理组织片由我科专业病理教授镜检诊断,排除患者资料记录不完全的病例。对临床资料和病理资料分类统计后,采用SPSS 20.0软件录入数据分析,计量资料采用均数±方差表示,采用t检验,计数资料用百分率表示,采用χ2检验,P0.05为差异有统计学意义。结果:Ⅰ.在1316例色素痣样皮损中,通过病理结果,确定诊断为色素痣1092例(83.0%),脂溢性角化病136例(10.3%),蓝痣15例(1.2%),皮肤纤维瘤14例(1.1%),皮脂腺增生7例(0.5%),基底细胞癌6例(0.5%),疣5例(0.4%),其他如皮脂腺囊肿、血管瘤、日光性角化等共41例(3.1%)。Ⅱ.患者年龄分布2~87岁,平均年龄为34.5±14.0岁,最多分布在20~39岁年龄段。色素痣患者的年龄,主要分布在20~39岁年龄段,年龄偏轻;确脂溢性角化病的患者年龄,主要分布在40~79岁年龄段,年龄偏大;蓝痣的患者年龄主要分布在20~59岁年龄段;皮肤纤维瘤的患者年龄主要分布在20~59岁年龄段;基底细胞癌的患者年龄主要分布在40~79岁年龄段。疣的患者年龄上分布较平均。Ⅲ.男性402例,女性914例,男女比1:2.27。Ⅳ.确诊色素痣病例1092例,面颈部676例(61.9%),躯干部228例(20.9%),四肢部64例(5.9%),手足部124例(11.3%)。其中面颈部色素痣病理分型中交界痣30例(4.5%),皮内痣587例(86.8%),混合痣59例(8.7%);躯干部色素痣病理分型中交界痣25例(11.0%),皮内痣186例(81.6%),混合痣17例(7.4%);四肢部色素痣病理分型中交界痣19例(29.7%),皮内痣35例(54.7%),混合痣10例(15.6%);手足部色素痣病理分型中交界痣102例(82.3%),皮内痣16例(12.9%),混合痣6例(4.8%)。Ⅴ.病理诊断结果与临床诊断结果相符合的病例为1045例,不相符的病例为271例,总符合率为79.4%;其中临床诊断误诊为色素痣的其他疾病病例224例,误诊率为17.7%;临床诊断误诊为其他疾病的色素痣病例47例,误诊率为4.3%。结论:Ⅰ.色素痣的临床诊断中最易误诊的疾病为脂溢性角化病、蓝痣及皮肤纤维瘤。Ⅱ.色素痣误诊的原因主要是肉眼识别皮损的颜色及形态存在误差及个别皮损临床表现的差异性。Ⅲ.面颈部色素痣的数量较其他部位色素痣的数量多,手足部色素痣恶变的可能性较其他部位大。Ⅳ.色素样皮损诊断中,与恶性病变的鉴别尤为重要。Ⅴ.病理诊断为色素痣诊断的金标准,临床诊断需与病理诊断相结合。
[Abstract]:Objective: 1316 cases of skin pigmented nevus samples were included in the study criteria were retrospectively analyzed. The histopathological study of pigmented nevus in different parts of the classification, summarize the pathogenesis regularity, in order to improve the level of awareness of dermatologists superficial skin nevus and early diagnosis and treatment. Methods: collected from 2015 to 2016, two years in the second hospital of Dalian Medical University the Department of dermatology clinic initial diagnosis of pigmented nevus parallel surgical excision and biopsy of the patients and the initial diagnosis of non pigmented nevus parallel biopsy results for nevus patients were 1316 cases. Preoperative communication with patients, account operation processes and precautions, record the patient information and clinical manifestations, the pigment lesions in the light photographs, postoperative surgery lesions histopathology examination. All patients age gender statistics, statistics of all patients with color; Nevus like lesions distribution, which can be divided into the face and neck, trunk, limbs, hand and foot in four groups (the trunk group does not include the vulva, foot group does not include a); all cases according to the pathological diagnosis were divided into junctional nevus, compound nevus. Pine, statistics of face and neck, trunk cadres, limbs, hand and foot, pathological tissues of patients in each group. Statistical classification of all pathological diagnosis and clinical diagnosis was not consistent with the case analysis of misdiagnosis and missed diagnosis. The cases were collected in our department physician admissions to make clinical diagnosis of parallel resection, pathological specimen by my professional technicians the pathological slices, by my professional associate professor of pathology examination diagnosis, patient data records are not completely excluded cases. The clinical data and pathological data classification statistics, analysis using SPSS 20 software for data entry, data measured by the mean square 宸〃绀，
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