【作者】 杨晓东；

【导师】 崔有斌；

【作者基本信息】 吉林大学 ， 外科学（专业学位）， 2016， 硕士

【摘要】 目的:研究下段食管癌瘤体及周围毗邻组织的三维重建在食管癌诊治中的应用,分析各种不同影响因素下食管癌瘤体的三维重建特点,为食管癌的诊疗方案的确定,提供一种更好的术前评估方式。材料与方法:选取自2014年1月至2015年8月间,就诊于吉林大学白求恩医学院第一医院胸外科患者,纳入标准:1)病理诊断明确为食管癌患者;2)行左开胸一切口食管癌根治术患者;3)术前行肺二期增强CT及胃二期增强CT,且影像学资料完备者;4)术后病理结果完备者。排除标准:1)病历资料中缺乏胃镜报告单者;2)影像学资料不齐全者;3)影像学资料伪影较重,重建效果差者;4)术后病理结果为肉瘤者;5)术后病理结果提示为胃底病变者。收集患者的影像学资料,采用面重建的技术完成食管癌瘤体及周围毗邻组织的三维重建,对其形态参数进行计算,对比不同条件下食管癌三维重建结果的差异。结果:1.研究对象36例,其中男35例,女1例。年龄为60.4±8.9岁,最大年龄82岁,最小年龄45岁。胃镜测得病变距中切牙距离平均为33.11±3.79cm,最大42cm,最小30cm。2.内镜可通过组24例,不可通过组12例;通过组胃镜测量病变长度为4.5±1.93cm,病理测量结果3.57±1.21cm,三维测量长度5.06±1.63cm。总体组病理测量长度3.92±1.63cm,总体组三维测量长度5.36±1.94cm。三维测量长度与内镜测量长度和病理结果相比较均存在统计学差异,三维测量长度结果与内镜测量长度结果无统计学差异3.T1组瘤体体积5.39±2.92 cm3,三维长度3.36±0.91 cm,三维厚度0.85±0.22 cm。T2组组瘤体体积31.82±20.74cm3,三维长度5.32±1.23cm,三维厚度1.89±0.83cm。T3组组瘤体体积30.73±16.05cm3,三维长度5.99±2.09cm,三维厚度1.78±0.52cm。T1组瘤体重建的体积、厚度及长度与T2、T3组之间均存在统计学差异,T2、T3组之间的三维重建测量结果无统计学差异4.阳性组淋巴结CT值70.48±10.75Hu,长径23.54±5.00mm,短径14.48±3.94mm,体积2299.83±1590.32mm3。阴性组淋巴结CT值19.52±3.04Hu,长径8.84±0.66mm,短径5.56±0.87mm,体积101.44±7.60mm3。阳性淋巴结的重建测量数据中,其长径、短径、体积、CT值与阴性组淋巴结得重建测量结果均存在统计学差异。结论:1.食管癌的三维重建较传统上消化道造影而言更有助于明确食管癌的具体病变位置、毗邻及长度,可以用于制定食管癌的治疗策略。2.食管癌的三维重建可用于明确早期食道癌的术前诊断。3.三维重建技术可用于纵膈内阳性淋巴结的鉴别,阳性淋巴结体积多大于1000mm3,CT值多高于正常软组织,阴性淋巴结体积较小,CT值多正常。更多还原

【Abstract】 Objective:Study of the lower segment esophageal tumors to the organization of the application of 3D reconstruction in the diagnosis and treatment of esophageal cancer, analysis various influence factors of esophageal tumors had the characteristics of the 3D reconstruction, for the determination of esophageal cancer diagnosis and treatment plan, provide a better way of preoperative assessment. Materials and methods:Choose the patient be treated in first hospital of Jilin university between January 2015 and August 2015 with esophageal cancer. Inclusion criteria: 1) pathological diagnosis for patients with esophageal cancer; 2) with left incision of thoracotomy esophageal cancer resection; 3) checked enhanced lung CT and enhanced stomach CT, imaging data is completed; 4) complete the postoperative pathologic results. Exclusion criteria: 1) lack of gastroscopy report;2) image information is not complete;3) imaging data of artifact is worse, can’t use for reconstruction; 4) postoperative pathologic results is sarcoma; 5) postoperative pathologic results indicate gastric lesions. Collection the imaging data of patient, using the surface reconstruction technology to complete the reconstruction of esophageal tumors and adjacent structures, analyzes its shape and specific parameters calculation and comparison under different conditions of 3D reconstruction result. The results:1. The object of study of 36 cases, 35 cases of male and female in 1 case.Age was 60.4±8.9 years old, biggest 82-year-old age, minimum age 45.Gastroscope lesions can be measured from the average distance of incisor was 33.11±3.79 cm, the largest 42 cm, minimum 25 cm.2. Endoscopy can be through a group of 24 cases, not through the group of 12 cases;Group by gastroscope measure the lesion length was 4.5 ± 1.93 cm, 3.57 ± 1.21 cm, measurement results pathological three-dimensional measuring length 5.06±1.63 cm. Teeg pathological measuring length 3.92 ± 1.63 cm, teeg three-dimensional measuring length 5.36 ±1.94 cm.3. Group T1 tumors volume 5.39-2.92 cm3, 3 d 3.36±0.91 cm in length, the thickness of the 3 d 0.85±0.22 cm.T2 way tumors volume 31.82-20.74 cm3, 3 d 5.32±1.23 cm in length, the thickness of the 3 d 1.89±0.83 cm.T3 way tumors had 30.73-16.05 cm3 volume, 3D 5.99±2.09 cm in length, the thickness of the 3 d 1.78±0.52 cm.4. 3D reconstruction characteristics of different differentiation group no statistical difference.5. Positive lymph nodes on CT value of 70.48±10.75 Hu, diameter 23.54±5.00 mm long, short diameter 14.48±3.94 mm, the volume of 2299.83±1590.32 mm3.Lymph node negative group CT value of 19.52±3.04 Hu, length to diameter 8.84±0.66 mm, 5.56±0.87 mm, shorter diameter size 101.44±7.60 mm3. Conclusion:1. 3D reconstruction of esophageal help determine the exact location of the lesions of the cancer, adjacent to and length, can be used to make the treatment strategy of esophageal cancer.2. 3D reconstruction of esophageal cancer can be used to identify the diagnosis of early esophageal cancer and specific early lesion location.3. 3D reconstruction technology can be used in the mediastinum in the identification of positive lymph nodes, the volume of positive lymph nodes is more than 1000 mm3, CT value is much higher than that of normal tissue, negative lymph nodes are smaller and CT value is normal.更多还原