NGHIÊN CỨU ĐẶC ĐIỂM HÌNH ẢNH CẮT LỚP VI TÍNH ĐA DÃY ĐẦU THU NGỰC TRONG CHUẨN ĐOÁN UNG THƯ PHỔI NGUYÊN PHÁT Ở NGƯỜI LỚN

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NGHIÊN CỨU ĐẶC ĐIỂM HÌNH ẢNH CẮT LỚP VI TÍNH ĐA DÃY ĐẦU THU NGỰC TRONG CHUẨN ĐOÁN UNG THƯ PHỔI NGUYÊN PHÁT Ở NGƯỜI LỚN

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B GIO DC V O TO B QUC PHềNG VIN NGHIấN CU KHOA HC Y DC LM SNG 108 CUNG VN CễNG NGHIÊN CứU ĐặC ĐIểM HìNH ảNH CắT LớP VI TíNH ĐA DãY ĐầU THU NGựC TRONG CHẩN ĐOáN UNG THƯ PHổI NGUYÊN PHáT NGƯờI LớN LUN N TIN S Y HC H NI - 2015 B GIO DC V O TO B QUC PHềNG VIN NGHIấN CU KHOA HC Y DC LM SNG 108 CUNG VN CễNG NGHIÊN CứU ĐặC ĐIểM HìNH ảNH CắT LớP VI TíNH ĐA DãY ĐầU THU NGựC TRONG CHẩN ĐOáN UNG THƯ PHổI NGUYÊN PHáT NGƯờI LớN CHUYấN NGNH: CHN ON HèNH NH Mó s: 62.72.01.66 LUN N TIN S Y HC NGI HNG DN KHOA HC: GS.TS PHM MINH THễNG 2.TS INH VN CM H NI - 2015 LI CM N Tụi xin cam oan õy l cụng trỡnh nghiờn cu ca riờng tụi Cỏc s liu, kt qu nghiờn cu nờu lun ỏn l hon ton trung thc vafchuwa tng c cụng b bt k mt cụng trỡnh no khỏc Tỏc gi Cung Vn Cụng LI CM N Vi tt c lũng chõn thnh v bit n sõu sc, tụi xin trõn trng cm n: - Ban giỏm c, Phũng sau i hc Vin nghiờn cu khoa hc Y Dc lõm sng 108 - Ban giỏm c Bnh vin Phi trung ng - Khoa Chn oỏn hỡnh nh Bnh vin Phi trung ng ó cho phộp v to mi iu kin cho tụi c hc tp, nghiờn cu v hon thnh lun ỏn ny - GS.TS Phm Minh Thụng, TS inh Vn Cm Hai ngi Thy hng dn khoa hc ó rt tn tỡnh giỳp tụi hon thnh lun ỏn ny - Cỏc Thy B mụn Chn oỏn hỡnh nh Vin nghiờn cu khoa hc Y Dc lõm sng 108 ó to mi iu kin tt nht cho tụi quỏ trỡnh hc v úng gúp nhiu ý kin qỳi bỏu giỳp tụi hon thnh lun ỏn ny - TS.Nguyn Trng Giang, TS.ng c Nhu, BS.Nguyn Hong Thnh ó rt nhit tỡnh úng gúp ý kin, c kt qu ct lp vi tớnh v giỳp tụi x lý s liu ca lun ỏn ny - Xin by t lũng bit n n B, M, Anh, Em, V v cỏc Con ó tn ty, ng viờn, chm lo cho tụi sut thi gian hc - Xin chõn thnh cm n s giỳp , ng viờn ca ng nghip, bn bố thõn hu MC LC DANH MC CH VIT TT DANH MC HèNH DANH MC BNG DANH MC BIU T VN CHNG 1: TNG QUAN TI LIU.4 1.1 NGUYấN Lí CHP V CC CA S HèNH NH TRấN CT LP VI TNH LNG NGC.4 1.1.1 Nguyờn lý chp ct lp vi tớnh 1.1.1.1 Nguyờn lý chung 1.1.1.2 Nguyờn lý chp ct lp vi tớnh a dóy5 1.1.2 Cỏc ca s nh c bn ca ct lp vi tớnh ngc6 1.1.2.1 t ca s .6 1.1.2.2 Ca s nhu mụ phi 1.1.2.3 Ca s trung tht9 1.1.2.4 Ca s xng 10 1.2 NHC LI MT S VN V DCH T, LM SNG, Mễ BNH V IU TR UNG TH PHI .10 1.2.1 Dch t hc ung th phi 10 1.2.2 Du hiu lõm sng 11 1.2.3 Mụ bnh hc ung th phi 12 1.2.4 iu tr ung th phi 15 1.2.4.1 Phu thut 15 1.2.4.2 Húa cht 16 1.2.4.3 X tr 17 1.2.4.4 Quang ụng 17 1.2.4.5 t nhit cao tn .18 1.2.4.6 iu tr ớch .19 1.3 CC K THUT CHN ON HèNH NH S DNG TRONG UNG TH PHI .19 1.3.1 X Quang phi chun 19 1.3.2 Chp ct lp vi tớnh lng ngc 21 1.3.3 Chp cng hng t ngc 25 1.3.4 Chp ghi hỡnh phúng x PET v PET/CT 26 1.3.5 Siờu õm lng ngc 29 1.4 H THNG PHN LOI TNM TRONG UNG TH PHI V VAI TRề CA CHP CT LP VI TNH .29 1.4.1 H thng phõn loi TNM cho ung th 29 1.4.2 Phõn loi TNM cho ung th phi 30 1.4.3 Phõn loi giai on TNM cho ung th phi phiờn bn . 31 1.4.3.1 Phõn T 31 1.4.3.2 Phõn N 35 1.4.3.3 Phõn M 35 1.4.3.4 Cỏc thay i ch yu so sỏnh TNM6 v TNM7 35 1.4.3.5.nh hng ca cỏc thay i phõn loi TNM7 36 1.4.4 Vai trũ ca ct lp vi tớnh ỏnh giỏ giai on ung th phi 36 1.4.4.1 Kớch thc U 37 1.4.4.2 ỏnh giỏ mc xõm ln trung tht, thnh ngc, c honh 38 1.4.4.3 ỏnh giỏ di cn hch 39 1.5.TèNH HèNH NGHIấN CU TRONG V NGOI NC V VAI TRề CT LP VI TNH TRONG NG TH PHI 40 1.5.1 Tỡnh hỡnh nghiờn cu trờn th gii 40 1.5.2 Tỡnh hỡnh nghiờn cu ti Vit Nam 41 CHNG 2: I TNG V PHNG PHP NGHIấN CU 45 2.1 I TNG NGHIấN CU 45 2.1.1 Tiờu chun la chn 45 2.1.2 Tiờu chun loi tr 45 2.1.3 a im nghiờn cu 45 2.2 PHNG PHP NGHIấN CU 45 2.2.1 Thit k nghiờn cu 45 2.2.2 Chn mu nghiờn cu .45 2.3 NI DUNG V CC BIN S NGHIấN CU 45 2.3.1 Phng tin nghiờn cu .45 2.3.2 Cỏc bc tin hnh nghiờn cu 46 2.3.3 Cỏc bin s nghiờn cu ..48 2.3.3.1.U nguyờn phỏt, s lng, v trớ, kớch thc, th tch u nguyờn phỏt 48 2.3.3.2 c im hỡnh nh u nguyờn phỏt 49 2.3.3.3 c im xõm ln ca u nguyờn phỏt ..53 2.3.3.4 c im xp phi .55 2.3.3.5 c im hch trung tht 55 2.3.3.6 c im ca cỏc nt v tinh v cỏc tn thng khỏc 59 2.3.3.7 Phõn loi giai on tn thng 60 2.3.3.8 Thng kờ cỏc kt qu gii phu bnh 61 2.4 X Lí S LIU 66 2.4.1 Thu thp s liu 66 2.4.2 X lý s liu 66 2.5 O C NGHIấN CU .66 CHNG 3: KT QU NGHIấN CU 67 3.1 C IM CHUNG 67 3.1.1 Tui v gii .67 3.1.2 Cỏc type mụ bnh hc 68 3.1.3 Phõn b v trớ u nguyờn phỏt 69 3.2 C IM HèNH NH U NGUYấN PHT 72 3.2.1 c im ng b v mt ca u nguyờn phỏt .72 3.2.2 c im v kớch thc v th tớch u nguyờn phỏt 74 3.2.3 c im ngm thuc cn quang ca u nguyờn phỏt 76 3.2.4 Cỏc du hiu hỡnh nh khỏc trờn phim ct lp vi tớnh .79 3.2.5 c im xp phi kt hp 82 3.2.6 c im xõm ln trung tht, thnh ngc 85 3.3 C IM HèNH NH HCH TRUNG THT 87 3.3.1 c im hỡnh nh hch ln trung tht cú kh nng l hch th phỏt.87 3.3.2 c im s lng, kớch thc hch ln trung tht cú kh nng l hch th phỏt 89 3.3.3 Giỏ tr chn oỏn hch trung tht th phỏt trờn ct lp vi tớnh 92 3.4 C IM HèNH NH CC TN THNG TH PHT .92 3.5 PHN LOI GIAI ON UNG TH PHI TRấN CT LP VI TNH NGC 94 3.5.1 Phõn T 94 3.5.2 Phõn N 95 3.5.3 Phõn M 96 3.5.4 Giai on chung 97 CHNG 4: BN LUN 99 4.1.C IM CHUNG.99 4.1.1 Tui 99 4.1.2 Gii. 100 4.1.3 Cỏc type mụ bnh hc .100 4.2 C IM HèNH NH U NGUYấN PHT .102 4.2.1 ng kớnh ln nht u 102 4.2.2 Th tớch u 103 4.2.3 V trớ u 105 4.2.4 c im ng b u 107 4.2.5 c im v mt u 108 4.2.6 c im ngm thuc ca u 111 4.2.7 Cỏc du hiu khỏc phi hp 113 4.2.7.1 Cỏc du hiu ph qun .113 4.2.7.2 Cỏc du hiu mng phi 113 4.2.7.3 Xp phi 114 4.2.7.4 Di cn bch mch 117 4.2.7.5 Cỏc du hiu xõm ln 117 4.3 C IM HèNH NH HCH TRUNG THT 118 4.3.1 Hỡnh thỏi v kớch thc hch 118 4.3.2 Phõn b v trớ nhúm hch 120 4.4 C IM TN THNG TH PHT 121 4.5 CHN ON GIAI ON UNG TH PHI TNM 123 4.5.1 Phõn T .123 4.5.2 Phõn N .124 4.5.3 Phõn M 126 4.5.4 Thay i giai on u phi gia TNM v TNM .127 4.6 SO SNH C IM HèNH NH CT LP VI TNH GIA UNG TH PHI TYPE BIU Mễ VY V BIU Mễ TUYN127 4.6.1 c im v hỡnh nh 127 4.6.1.1 V trớ u 127 4.6.1.2 ng b v mc ngm thuc cn quang 129 4.6.2 c im hch th phỏt kt hp ..129 4.6.3 Khỏc bit v giai on TNM trờn ct lp vi tớnh ngc 130 KT LUN 131 KIN NGH CC CễNG TRèNH NGHIấN CU CễNG B Cể LIấN QUAN N LUN N TI LIU THAM KHO MU BNH N NGHIấN CU DANH SCH BNH NHN NGHIấN CU DANH MC CH VIT TT Phn vit tt Phn vit y BN CLVT Bnh nhõn Ct lp vi tớnh CHT GPB Cng hng t Gii phu bnh STXTN UTP 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