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兒童縱隔支氣管源性囊腫的臨床分析

時間:2019-06-26 來源:未知 作者:依依 本文字數:4687字

  摘 要

  目的:探討兒童縱隔支氣管源性囊腫(Mediastinal BronchogenicCysts)的臨床及影像學表現特點,為臨床術前診斷、治療提供可靠的影像學依據。

  方法:收集重慶醫科大學附屬兒童醫院 2008 年 7 月?2018 年 5月經手術和病理證實的30例縱隔支氣管源性囊腫患兒的臨床及影像學資料進行回顧性分析。

  結果:

  1.臨床癥狀

  8 例(26.7%)患兒因健康體檢發現,無伴隨癥狀。22 例(73.3%)伴臨床癥狀,其中咳嗽最多見,有 19 例(63.3%)。其他癥狀包括;吼喘 10 例(33.3%)、發熱 7 例(23.3%)、喉間痰響 2 例(6.7%)、胸悶1 例(3.3%)、咳痰 1 例(3.3%)、咳血 1 例(3.3%)、吞咽困難 1 例(3.3%)、頭痛 1 例(3.3%)。17 例(56.7 %)患兒有 2 個及 2 個以上臨床癥狀。

  癥狀和診斷之間的間隔從 2 天到 2 年不等,中位數為 20.0 天。這些癥狀部分以一種漸進的方式出現,4 例(13.3%)患兒后期癥狀有加重。

  2.影像學表現

  囊腫位于中縱隔 16 例(53.3%)、后縱隔 6 例(20.0%)、同時跨中后縱隔 8 例(26.7%),無發生于前縱隔的囊腫。位于氣管旁 11 例(36.7%)、肺門區 8 例(26.7%)、脊柱旁溝 6 例(20.0%)、氣管隆突下區域 4 例(13.3%)、食管旁 1 例(3.3%)。

  囊腫軸位最大徑范圍 19.5mm?59.0mm,平均(34.39±10.85)mm。

  有臨床癥狀組囊腫大小與無臨床癥狀組囊腫大小差異分析無統計學意義(P >0.05)。23 例(76.7%)呈類圓形或橢圓形;7 例(23.3%)形態不規則; 3 例(10.0%)可見分隔,為多房。

  22 例(73.3%)氣管支氣管不同程度受壓、推移、變窄改變;8 例(26.7%)食管受壓、推移。7 例(23.3%)伴少許胸膜病變;2 例(6.7%)鄰近血管受壓(肺血管及上腔靜脈);1 例(3.3%)伴脊柱側彎。

  CT 掃描 29 例,其中 CT 增強掃描 25 例。囊腫 CT 值范圍為 3.3HU?45.5HU。增強掃描 24 例囊內容物未見明顯強化,囊壁強化,其中 1例囊壁厚薄不均;1 例囊內容物輕度強化,囊壁不確定。CT 表現呈 1a型 16 例(55.2%)、1b 型 2 例(6.9%)、2a 型 10 例(34.5%),2b 型 1例(3.4%),未見 3 型囊腫。1 型 MBC 的臨床癥狀與 2 型 MBC 的臨床癥狀差異分析均無統計學意義。

  MRI 掃描 11 例,其中 MRI 增強掃描 7 例。11 例(100.0%)T2WI均呈均勻高信號,類似腦脊液信號(Cerebrospinal Fluid,CSF)。6 例(54.5%)T1WI 呈均勻低信號,4 例(36.4%)TIWI 信號呈均勻等信號,1 例(9.1%)TIWI 信號不均,可見等低信號。7 例增強掃描均可見囊壁強化,而囊內容物未見明顯強化。10 例囊腫同時行 CT 及 MRI掃描,包含 1a 型 7 例、1b 型 1 例、2a 型 1 例、2b 型 1 例。

  3.手術觀察

  手術中見 18 例(60.0%)囊內容物為流動液體,12 例(40.0%)為膠凍狀。流動液體組囊腫 CT 值與膠凍組囊腫 CT 值大小差異具有統計學意義,前者較后者。═ 值= -3.581,P<0.05)。

  4.組織病理學

  囊壁內襯( 假復層) 纖毛柱狀上皮 29 例、鱗狀上皮 1 例;囊壁上見支氣管粘液腺13例(43.3%)、平滑肌10例(33.3%)、軟骨9例(30.0%)、囊壁上及周圍見炎癥細胞浸潤 9 例(30.0%)、伴出血壞死 2 例(6.7%);鈣化 1 例(3.3%)。

  結論:

  1. 支氣管源性囊腫是罕見的肺芽異常萌發所導致的先天性疾病,發生于縱隔者多見。

  2. 支氣管源性囊腫的臨床表現變化大,可以無伴隨臨床癥狀,部分患兒有臨床癥狀,但均無特異性,其后期部分癥狀有加重。

  3. 大多數縱隔支氣管源性囊腫 CT 表現典型。但是,小部分縱隔支氣管源性囊腫表現不典型,如囊內容物密度增高、增強掃描囊內容物強化、囊壁增厚、囊壁不確定、囊腫邊界模糊,容易和其他疾病混淆,造成誤診。

  4. MRI 在確定支氣管源性囊腫的囊性本質方面更有優越性,故應優化影像學檢查的選擇方案,提高影像診斷準確率。

  關鍵詞:兒童;支氣管源性囊腫;體層攝影術;磁共振成像

臨床醫學碩士論文

  Abstract

  Objective: To explore the clinical and imaging characteristics ofMediastinal Bronchogenic Cysts in children to provide reliable imagingbasis for preoperative diagnosis and treatment.

  Methods: Clinical and imaging data of 30 children with mediastinalbronchiogenic cyst who were confirmed by surgery and pathology from July2008 to May 2018 in Children's Hospital Affiliated to Chongqing MedicalUniversity were retrospectively analyzed.

  Results:

  1. Clinical manifestation.

  No accompanying symptoms were found in 8 cases (26.7%) due tophysical examination.22 cases (73.3%) were associated with clinicalsymptoms, of which cough was the most common, with 19 cases (63.3%).

  Other symptoms include:10 cases (33.3%) of roar asthma, 7 cases of fever(23.3%), 2 cases (6.7%) of interlaryngeal sputum noise, 1 case of chesttightness (3.3%), 1 case of expectoration (3.3%), 1 case of hemoptysis(3.3%), 1 case of dysphagia (3.3%), and 1 case of headache (3.3%).17cases (56.7%) had two or more clinical symptoms. The interval betweensymptoms and diagnosis ranged from two days to two years, with a median of 20.0 days.Some of these symptoms appear in a gradual way, 4 cases(13.3%) of these symptoms exacerbated later.

  2. Imaging findings.

  16 cases (53.3%) were located in middle mediastinum, posteriormediastinum in 6 cases (20.0%) and 8 cases (26.7%) involved in middleand posterior mediastinum. None occurred in the anterior mediastinum.

  The cysts were located in paratracheal region in 11 cases (36.7%), hiluspulmonis region in 8 cases (26.7%), Paravertebral space in 6 cases (20.0%),subcarinal angle in 4 cases (13.3%) and paraesophageal in 1 case (3.3%).

  The maximum cyst axial diameter was 19.5mm ~ 59.0mm, average(34.39±10.85)mm. There was no statistically significant differencebetween the size of the cyst in the symptomatic group and thenon-symptomatic group (P >0.05). 23 cases (76.7%) were round or oval. 7cases (23.3%) were irregular. 3 cases (10.0%) were visible separated formultiple rooms.

  In 22 cases (73.3%), bronchial trees were compressed, displaced andnarrowed. The esophagus was compressed and displaced in 8 cases(26.7%).7 cases (23.3%) had pleural lesions.Compression of adjacentvessels (pulmonary vessels and superior vena cava) in 2 cases (6.7%);1case (3.3%) was associated with scoliosis.

  CT scan was performed in 29 cases, including CT enhanced scan in 25cases. The cyst CT value ranged from 3.3~45.5HU. In contrast-enhanced scan, 24 cases had no enhancement of cystic contents and cystic wallenhanced, 1 case had uneven thickness of cyst wall. 1 cases of cysticcontents were slightly strengthened and the wall was not definite. CTmanifestations were 1a type in 16 cases (55.2%), 1b type in 2 cases (6.9%),2a type in 10 cases (34.5%), 2b type in 1 case (3.4%) and no type 3 cystwas found. There was no statistically significant difference between theclinical symptoms of type 1 MBC and type 2 MBC.

  MRI scan was performed in 11 cases, including MRI enhanced scan in7 cases. 11 cases (100.0%) of T2WI showed homogeneous hyperintensity,similar to CSF. 6 cases (54.5%) showed homogeneous hypointense on T1WI,4 cases (36.4%) showed homogeneous isointensity on TIWI, and 1 case(9.1%) showed heterogeneous signal on TIWI. The enhancement of thecystic wall was seen in all 7 cases, but no significant enhancement wasobserved in the contents of the cyst. CT and MRI scan were performed in 10cases, including 7 cases of type 1a, 1 case of type 1b, 1 case of type 2a and 1case of type 2b.

  3.Intraoperative observation.

  18 cases (60.0%) of the cyst contents were fluid and 12 cases (40.0%)were gelatinous. The CT value of the cyst of the fluid group wassignificantly different from that of the gelatinous contents group (T =-3.581, P<0.05).

  4. Histopathology.

  There were 29 cases of ciliated columnar epithelium and 1 cases ofsquamous epithelium. There were 13 cases (43.3%) of bronchial glands, 10cases (33.3%) of smooth muscle, 9 cases (30.0%) of cartilage, 9 cases(30.0%) of inflammatory cell infiltration, 2 cases (6.7%) with hemorrhageand necrosis and 1 case of calcification (3.3%).

  Conclusions:

  1.Bronchogenic cyst is a rare congenital disease caused by abnormalgermination of lung buds. It occurs mostly in mediastinum.

  2.The clinical manifestations of bronchogenic cysts vary greatly andmay not be accompanied by clinical symptoms. Some children haveclinical symptoms, but none of them are specific, Some of the them areaggravated in the later.

  3.CT findings of most mediastinal bronchogenic cysts are typical.however, a small number of mediastinal bronchogenic cysts are not typical,such as increased cyst content density, cyst content enhancement,thickening of the cyst wal, uncertain cyst wall, blurred cyst boundary,easily confused with other diseases, resulting in misdiagnosis.

  4.MRI is more advantageous in determining the cystic nature ofbronchogenic cysts, so the selection scheme of imaging examination shouldbe optimized to improve the accuracy of image diagnosis.

  Keywords: children; Bronchogenic cyst; Tomography; Magnetic resonance imaging.

  目錄

  1 材料與方法

  1.1 研究對象

  收集我院 2008 年 7 月至 2018 年 5 月期間經手術及病理確診的縱隔支氣管源性囊腫 30 例,男女比例為 14:16,年齡范圍從 1 月至 11 歲 3 月,平均年齡為 3.55±3.06 歲,中位數為 3.0 歲。

  1.2 影像學檢查

  1.2.1 X 線

  采用 GE Deffinium8000 DR 機,參數:管電壓 60kV,管電流 1~2.5mAs。

  1.2.2 CT(Computed Tomography,CT)掃描:

  采用 GE LightSpeed 64 排 VCT64 排螺旋 CT 機或 Phlips Brilliance iCT256 排螺旋 CT 機。主要掃描參數為: 管電壓 80~120kV,管電流 35~85mAs,螺距 0.984:1,層厚、層距同為 5.00mm,必要時以 MSCT 薄層重建圖像輔助觀察,圖像重建層厚 0.625mm,視野 160~240mm,矩陣為 512×512 或 1024×1024。增強掃描采300mgI/ml 或 270mgI/ml 非離子型對比劑,劑量為 2ml/kg,用高壓注射器經靜脈團注,注射速率為 0.6~3.0ml/s。

  1.2.3 MRI(Magnetic Resonance Imaging)掃描:

  利用 GE 1.5T HD 掃描儀,常規行 T1WI 及 T2WI 加脂肪抑制序列掃描,增強掃描采用釓噴酸葡胺(Gd-DTPA)對比劑,劑量為 0.2ml/kg,用高壓注射器經靜脈注射后行軸位、矢狀位掃描。

 【由于本篇文章為碩士論文,如需全文請點擊底部下載全文鏈接】

  1.2 影像學檢查
  1.3 影像學分析
  1.4 分型及分類方法
  1.5 統計學方法

  2 結果

  2.1 臨床癥狀
  2.2 影像學表現
  2.3 手術觀察
  2.4 組織病理學

  3 討論

  3.1 支氣管源性囊腫概述
  3.2 發病部位
  3.3 臨床表現分析
  3.4 影像學特點分析
  3.5 鑒別診斷
  3.6 結語
  全文總結

  參考文獻
  

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