鼻咽部侧位相DR摄片在儿童腺样体肥大诊断中的价值

发布时间：2018-04-01 00:38

本文选题：腺样体肥大　切入点：鼻咽部　出处：《大连医科大学》2011年硕士论文

【摘要】：背景与目的:腺样体是位于鼻咽腔顶壁、蝶骨体底和枕骨斜坡颅外面的一团淋巴组织,其内有各种不同发育时期的淋巴细胞,并有约1/3左右淋巴细胞为T细胞,这些细胞对特异抗原、病毒、细菌具有免疫调节作用,是人体重要的防御免疫器官,但当长期反复遭受炎性刺激时,则可导致腺样体肥大,而腺样体肥大又是阻塞性睡眠呼吸暂停低通气综合征、慢性鼻窦炎、分泌性中耳炎、下呼吸道感染及肺心病等的病因及重要相关因素,长期鼻塞或张口呼吸,可出现“腺样体面容”,严重时可导致肺源性心脏病,因此早期准确地诊断腺样体肥大并给予及时正确的临床治疗以防止或减少并发症的产生具有重要的临床意义。在日常的影像诊断工作中,经常遇到因鼻塞、流涕及睡眠时打鼾、憋气、张口呼吸甚至夜间憋醒来就诊检查的儿童,在拍摄完鼻咽部侧位片后如何准确诊断腺样体肥大需要一个明确的诊断标准,另外没有临床症状的正常儿童是否也存在腺样体肥大,腺样体肥大程度与临床症状严重程度是否有相关性,以往虽然有这方面的研究文献,但是对腺样体肥大与临床症状关系阐述不明确。本研究旨在探讨鼻咽部侧位相直接数字化摄片对腺样体肥大的诊断价值。方法:选择35例能配合影像检查的正常儿童(称为对照组)和50例临床诊断为腺样体肥大的患儿(称为研究组),并全部使用DR进行鼻咽部标准侧位相摄影检查,观察分析对照组和研究组腺样体的形态特征,并在西门子计算机工作站上分别对对照组和研究组及研究组治疗前和治疗后的儿童腺样体厚度和腺样体指数进行测量比较,所得数值采用t检验及秩和检验进行统计学分析。结果:35例对照组儿童腺样体表现为连续的凹面向下的带状软组织影,其表面光滑,自上而下,顶壁厚度薄于后壁厚度;研究组中则表现为凸面向下的软组织影,有圆弧状23例,有波浪状、分叶状者19例,气道明显变窄,甚至是闭塞。对照组、研究组儿童的腺样体厚度和腺样体指数分别为9.53±3.56mm、15.11±2.75mm,t=8.15(P0.05)和0.47±0.11、0.82±0.09,t=15.88(P0.05),对照组腺样体厚度及腺样体指数均小于研究组,差别有统计学意义。研究组儿童治疗前后腺样体指数分别是0.82±0.09、0.70±0.10,t=10.61(P0.05)。研究组儿童经临床治疗后腺样体明显缩小,差别有统计学意义。结论:鼻咽部侧位相DR平片能够清晰直观地显示腺样体的轮廓、厚度、边缘等形态特征及相应部位的气道,并且能够通过测量腺样体厚度和计算腺样体指数(A/N)准确地判断腺样体肥大程度,又可以对病变患儿的临床治疗效果作客观的评估,并且DR摄片简单、易行又实用,容易为患儿及医生所接受和采用。因此,利用鼻咽部侧位DR平片测算A/N比值在诊断腺样体肥大中有着重要的地位,可作为腺样体肥大诊断中的常规检查手段。
[Abstract]:Background & AIM: adenoid is a mass of lymphoid tissue located at the top wall of nasopharyngeal cavity, the base of sphenoid bone and the outside of clival occipital bone. There are various kinds of lymphocytes in different developmental stages, and about one-third of the lymphocytes are T cells. These cells have immunomodulatory effects on specific antigens, viruses, and bacteria, and are important defensive immune organs in the human body, but when they are repeatedly stimulated by inflammation for a long time, they can lead to adenoid hypertrophy. Adenoid hypertrophy is the etiology and important related factors of obstructive sleep apnea hypopnea syndrome, chronic sinusitis, secretory otitis media, lower respiratory tract infection and cor pulmonale. "Adenoid faces" can occur, and in severe cases they can lead to pulmonary heart disease. Therefore, early and accurate diagnosis of adenoid hypertrophy and timely and correct clinical treatment to prevent or reduce complications are of great clinical significance. Children with shortness of breath, open mouth breathing or even nocturnal suffocating and waking examination need a clear diagnostic standard for accurate diagnosis of adenoid hypertrophy after taking lateral nasopharynx films. In addition, whether there is adenoid hypertrophy in normal children without clinical symptoms, and whether the degree of adenoid hypertrophy is related to the severity of clinical symptoms, although there have been previous studies in this area, But the relationship between adenoid hypertrophy and clinical symptoms is not clear. The purpose of this study was to investigate the diagnostic value of direct digital radiography of lateral phase of nasopharynx on adenoid hypertrophy. Methods: 35 cases of normal adenoid hypertrophy were selected. Children (referred to as control group) and 50 cases of clinical diagnosis. All the children with adenoid hypertrophy (known as study group) were examined with Dr in nasopharyngeal standard lateral phase, and the morphologic characteristics of adenoids in control group and study group were observed and analyzed. The adenoid thickness and adenoid index of children in control group and study group before and after treatment were measured and compared on Siemens computer workstation. T test and rank sum test were used to analyze the values. Results the adenoids of 35 children in the control group showed a continuous concave downward band soft tissue shadow with a smooth, top-down, apical wall thickness thinner than that of the posterior wall, while in the study group, it showed a downward projection of the soft tissue shadow. There were 23 cases with arc shape, 19 cases with wavy shape and lobular shape. The airway became narrow or even occluded obviously. The adenoid thickness and adenoid index were 9.53 卤3.56 mm ~ 15.11 卤2.75 mm ~ (-1) and 0.47 卤0.11 卤0.82 卤0.09 ~ (15.88) P _ (0.05), respectively. The adenoid thickness and the adenoid index in the control group were lower than those in the study group, and the adenoid thickness and the adenoid index in the control group were lower than those in the study group, and the adenoid thickness and the adenoid index in the control group were lower than those in the study group. Before and after treatment, the adenoid index of children in the study group was 0.82 卤0.09 ~ 0.70 卤0.10 ~ (10) t ~ (-1) (P _ (0.05)). After clinical treatment, the adenoids in the study group were obviously reduced, and the difference was statistically significant. Conclusion: the lateral phase Dr plain film of nasopharynx can clearly and intuitively display the outline, thickness, edge and other morphological features of adenoid and the airway of the corresponding area. By measuring adenoid thickness and calculating adenoid index (A / N), adenoid hypertrophy can be judged accurately, and the clinical therapeutic effect of children with pathological changes can be evaluated objectively. Dr film is simple, practical and practical. It is easy to be accepted and used by children and doctors. Therefore, the measurement of A / N ratio by lateral nasopharynx Dr plays an important role in the diagnosis of adenoid hypertrophy, and can be used as a routine examination method in the diagnosis of adenoid hypertrophy.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766

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