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目的探讨中耳和乳突不同病变组织术前诊断和鉴别诊断方法。方法回顾分析106例慢性化脓性中耳炎(含胆脂瘤中耳炎)患者颞骨薄层 CT 显示的病变组织,并进行183次 CT 值测量,与术中发现、术后病理进行对比分析,得出不同病变组织的 CT 值范围。从中随机抽取60例,由同一组医师根据不同病变组织 CT 值及周围组织破坏的情况,重新分析做出诊断,将其诊断符合率与放射科常规诊断报告进行比较。根据临床表现和颞骨薄层 CT 扫描结果对9例慢性化脓性中耳炎患者行预测性诊断,以验证本研究结果对于中耳、乳突不同病变组织术前诊断与鉴别诊断的价值。结果胆脂瘤、肉芽组织、胆脂瘤并肉芽组织、炎性渗出、硬化或钙化组织、黏膜增厚并息肉样变组织的 CT值分别为:(46.6±10.3)Hu、(26.6±7.4)Hu、(42.1±11.4)Hu、(-24.6±9.2)Hu、(223.6±63.7)Hu、(23.8±8.5)Hu。根据不同病变组织 CT 值大小及周围组织的破坏情况对60例患者重新分析诊断,诊断符合率从68.3%提高至81.7%(x~2=3.96,P<0.05)。根据临床表现和颞骨薄层 CT 扫描所见进行预测性诊断,诊断符合率达90.0%。结论 CT 值虽不能作为诊断和鉴别诊断中耳、乳突不同病变组织惟一可靠的依据,但不失为一种很有意义的线索;根据临床表现、颞骨薄层 CT 扫描所见对中耳各种病变进行综合分析,可显著提高中耳、乳突病变诊断和鉴别诊断的准确率。
Objective To investigate the preoperative diagnosis and differential diagnosis of different lesions in middle ear and mastoid. Methods A retrospective analysis of 106 cases of chronic suppurative otitis media (including cholesteatoma otitis media) showed temporal bone thin layer CT showed lesions and 183 CT values were measured with the intraoperative findings, postoperative pathology were compared and analyzed, come to different lesions Tissue CT range. Sixty cases were randomly selected from the same group of physicians according to different lesion CT value and the surrounding tissue damage situation, re-analysis to make a diagnosis, the diagnosis of coincidence rate and radiology routine diagnostic report for comparison. Nine patients with chronic suppurative otitis media were prospectively diagnosed according to the clinical manifestations and thin-slice CT scan of the temporal bone to verify the value of this study for preoperative diagnosis and differential diagnosis of different lesions of middle ear and mastoid. Results The CT values of cholesteatoma, granulation tissue, cholesteatoma and granulation tissue, inflammatory exudation, sclerotic or calcified tissue, mucosal thickening and polypoid tissue were (46.6 ± 10.3) Hu and (26.6 ± 7.4), respectively ) Hu, (42.1 ± 11.4) Hu, (-24.6 ± 9.2) Hu, (223.6 ± 63.7) Hu, (23.8 ± 8.5) Hu. Sixty patients were reanalyzed and diagnosed according to the CT value of different lesion tissues and the destruction of surrounding tissues. The diagnostic coincidence rate increased from 68.3% to 81.7% (x ~ 2 = 3.96, P <0.05). According to the clinical manifestations and temporal bone thin-section CT scan seen in predictive diagnosis, the diagnostic accuracy rate of 90.0%. Conclusion Although CT value can not be used as the only reliable basis for the diagnosis and differential diagnosis of different lesions of the middle ear and mastoid, it is a very meaningful clue. According to the clinical manifestations, Comprehensive analysis, can significantly improve the middle ear, papilla lesions diagnosis and differential diagnosis accuracy.