肝囊性包虫病的CT影像与临床病理学的相关性分析

发布时间：2018-12-27 07:21

【摘要】：目的：探讨肝囊性包虫病的CT特征性影像与临床病理改变的相关性，并通过该病的影像学依据了解其自然病程。方法：对CT诊断并经手术病理证实的558例共691个肝包囊的CT表现及术中所见进行回顾性分析。结果：1各分型母囊CT值差异有统计学意义（P0.001）。随着包虫从CL型向CE5型演变，肝包囊母囊内CT值逐渐增大。母囊与子囊的CT值差异有统计学意义（P0.001）。 2四组反映不同囊内容物性状（液性，胶胨样，干酪样，钙化）CT值差异有统计学意义（P0.001）。 3术中证实294例中330个囊肿发生胆瘘。各型包虫胆瘘发生率差异有统计学意义（P0.001）。其中CL型和CE1型，CE3型和CE4型，CE4型和CE5型三组包虫胆瘘发生率差异无统计学意义（P0.05）。随着包虫分型演变，胆瘘的发生率逐渐增高。 4胆瘘的病例中，肝内胆管扩张36例，发生率12.24%；外囊“月牙样”突起67例，发生率为20.30%；囊内结石25例，发生率为7.58%；“同心圆征”29例，发生率为8.79%；气─液平面24例，，发生率为7.27%；子囊偏心性排列42例，发生率12.72%。 5肝内破裂：158囊，发生率22.9%，CT示病灶形似“葫芦”，囊壁薄厚不均，突出部分较薄；肝外破裂：92囊，发生率13.3%，CT示包囊突出肝外生长，突出部分形状不规则、囊壁较厚、内可见条索状高密度分割影。 6454个突出肝外或邻近肝缘生长的肝包囊中267个出现“肝包膜环形凹陷”的CT表现，发生率58.81%。各型包虫肝包膜环形凹陷发生率差异有统计学意义（P0.001）。其中CL型和CE1型，CE1型和CE2型，CE4型和CE5型三组包虫肝包膜环形凹陷发生率多重比较差异均无统计学意义（P0.003125）随着包虫分型演变，突出肝外或邻近肝缘生长的包囊中肝包膜环形凹陷的发生率逐渐增高。 7单囊囊肿组合子囊囊肿组中各型包虫肝包囊平均直径分别比较差异有统计学意义（P0.001）。随着包虫分型演变，肝包囊逐渐变小，且单囊囊肿缩小的趋势要大于多囊囊肿。 8273个囊肿发生不同程度的钙化，钙化率38.4%。单囊囊肿组与多囊囊肿组仅囊壁钙化或仅囊内钙化的发生率分别比较差异有统计学意义(P0.001)；同时钙化的发生率差异无统计学意义(P0.05)。单囊囊肿组囊内发生钙化与多囊囊肿组囊壁发生钙化分别所对应分型钙化程度差异有统计学意义（P0.001）。 9根据肝包囊退行性变的程度和变化趋势分为退行性变前期、囊液浓缩期、实体包块期和钙化期四个时期。结论: CT影像在反映肝囊性包虫病自然病程中不同时期囊内容性状、包虫活性、体积缩小与钙化趋势等临床病理改变，以及判断肝包囊是否发生胆瘘、破裂，预测包虫的生长状态等方面有着重要价值；为认识其自然病程，选择干预措施提供影像学依据。
[Abstract]:Objective: to investigate the correlation between CT characteristic imaging and clinicopathological changes of hepatic cystic hydatid disease and to understand its natural course. Methods: the CT findings and intraoperative findings of 691 hepatic cysts diagnosed by CT and confirmed by operation and pathology were retrospectively analyzed. Results: 1 there was significant difference in CT value of each type of maternal sac (P0. 001). With the evolution of hydatid from CL type to CE5 type, the CT value increased gradually. There was significant difference in CT between mother and daughter (P0. 001). (2) there were significant differences in CT values among the four groups (liquid, peptone, cheese and calcification). 3Bile fistula was found in 330 cysts of 294 cases. The incidence of hydatid fistula was significantly different among different types of hydatid fistula (P 0.001). There was no significant difference in the incidence of hydatid fistula between CL type and CE1 type, CE3 type and CE4 type, CE4 type and CE5 type (P0.05). With the development of hydatid type, the incidence of biliary fistula increased gradually. (4) in the cases of biliary fistula, there were 36 cases of intrahepatic bile duct dilatation (12.2445%), 67 cases of crescent-like protuberance (20.30%), 25 cases of intracystic stones (7.58%) and 7.58 cases of intrahepatic cholangiectasis. There were 29 cases of concentric circle sign with an incidence rate of 8.79, 24 cases of gas-liquid plane with an incidence rate of 7.27, and 42 cases of eccentricity of oocysts with an incidence rate of 12.72%. 5Intrahepatic rupture: 158 bursa, the incidence of 22. 9% CT showed that the lesion was similar to "gourd", the wall of cyst was uneven and the projecting part was thin; Extrahepatic rupture: 92 bursa, the incidence of 13. 3% CT showed that the cyst protruded extrahepatic growth, prominent part of irregular shape, thicker cystic wall, can be seen in the high density segmenting stripe. Of the 6454 hepatic cysts with extrahepatic herniation or adjacent hepatic marginal growth, 267 had "hepatic capsule annular indentation", the incidence of which was 58.81. There were significant differences in the incidence of hepatic capsule ring depression among different types of hydatid (P 0.001). There was no significant difference in the incidence of hepatic capsule ring depression between CL type and CE1 type, CE1 type and CE2 type, CE4 type and CE5 type (P0.003125). The incidence of annular indentation of the hepatic capsule in extrahepatic or adjacent hepatic bursa increased gradually. 7 there were significant differences in the mean diameters of hepatic hydatid cysts in the group of single cyst combined with oocyst cyst (P0.001). With the development of hydatid type, the hepatic cyst becomes smaller and the single cyst shrinks more than polycystic cyst. 8273 cysts had different degrees of calcification, and the calcification rate was 38.4%. There was significant difference between single cyst group and polycystic cyst group in the incidence of calcification of the cyst wall or only in the cyst (P0.001), while there was no significant difference in the incidence of calcification between the single cyst group and the polycystic cyst group (P0.05). The degree of calcification in single cyst group was significantly different from that in polycystic cyst group (P0.001). 9 according to the degree and change trend of hepatic cyst degeneration, there are four stages: predegenerative phase, cystic fluid concentration stage, solid mass stage and calcification stage. Conclusion: CT images can reflect the changes of cystic contents, hydatid activity, volume reduction and calcification in different stages of the natural course of hepatic cystic hydatid disease, as well as determine whether the hepatic cyst has biliary fistula or rupture. It is of great value to predict the growth state of hydatid. In order to understand the natural course of disease, choose the intervention measures to provide imaging basis.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R532.32;R816.5

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