目的 分析化疗联合促性腺激素释放激素激动剂(GnRHa)对于乳腺癌患者化疗后月经恢复的情况,并探讨GnRHa的应用对患者的潜在副作用.方法 本研究是一项单中心,双盲,随机对照临床试验.共纳入了141名年龄从14～45岁的女性乳腺癌早、中期患者并采用SPSS软件生成随机码把患者随机分为干预组(n=69)和对照组(n=72).随访在中山大学孙逸仙纪念医院进行,从2008年8月到2021年12月结束.使用Logistic回归来研究GnRHa对化疗结束后患者月经恢复的疗效,线性回归研究GnRHa与肝功能指标和卵泡计数的关系,Cox回归分析月经恢复与否对于患者预后的影响.结果 化疗结束六个月后,干预组患者有69.2％恢复月经,同比对照组为75.9％,差异无统计学意义(P>0.05).多因素logistic回归显示使用GnRHa与否对月经恢复无显著影响(OR=0.19,95％CI:0.03～1.14);对丙氨酸转氨酶、窦卵泡计数均无显著副作用(P>0.05).Cox回归显示月经恢复与否死亡,转移和复发无显著联系(P>0.05),右侧卵巢容积与转移呈显著负相关(HR=0.76;P=0.046).Log-rank test结果显示干预组与对照组的无转移生存期(MFS)和无复发生存期(RFS)无显著差异(P>0.05).结论 在乳腺癌患者化疗中配合使用GnRHa对化疗后月经恢复率无显著影响,使用GnRHa安全性较高,无显著肝脏毒性.

目的 建立术中预测模型并评估前哨淋巴结阳性及全乳切除的乳腺癌患者非前哨淋巴结(NSLN)转移的风险.方法 回顾性收集在国内三甲医院行全乳切除术的601例乳腺癌患者资料,其中建模组221例,内部验证组189例,外部验证组191例.通过Logistic回归分析挖掘影响建模组患者NSLN转移的风险因素,建立多因素模型并进行内外验证.同时比较本研究模型与现有的3个NSLN转移术后预测模型(MSKCC模型、TENON模型及MDA模型)在本研究人群中的应用效果.结果 建模组、内部验证组、外部验证组的NSLN转移率分别是32.6％、32.3％和50.3％.多因素分析显示,建模组中年龄(OR=0.968,95％CI:0.941～0.996)、孕激素受体(PR)状态(OR=0.484,95％CI:0.247～0.951)、肿瘤大小(OR=1.491,95％CI:1.151～1.932)、SLN阳性数量(OR=1.868,95％CI:1.278～2.730)、SLN阴性数量(OR=0.763,95％CI:0.631～0.922)是NSLN转移的影响因素.根据上述指标建立的NSLN转移预测模型在建模组的校准度(Hosmer-Lemeshowχ2=8.309,P=0.404)及区分度[受试者工作特征(ROC)曲线下面积(AUC)=0.752,95％CI:0.685～0.819]均较好.该模型在内部验证组和外部验证组的AUC分别为0.751(95％CI:0.676～0.825)和0.681(95％CI:0.606～0.757).本模型和MSKCC模型、TENON评分系统的预测价值相当,略优于MDA模型.结论 针对全乳切除术且SLN阳性的早期乳腺癌患者建立的NSLN转移术中预测模型的内外验证结果均较好,准确度与现有术后预测模型相当.

Objective:To investigate the risk factors of recurrence and metastasis in breast cancer patients after breast conserving surgery.Methods:This was a retrospective cohort study. According to inclusion and exclusion criteria, clinical and pathological data of 2 167 breast cancer patients who underwent breast conserving surgery in the Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University from January 2000 to December 2018 were analyzed. The Kaplan-Meier method was used to analyze recurrence-free survival and distant metastasis-free survival. Cox proportional risk regression models were used to study the risk factors of recurrence and metastasis after breast conserving surgery.Results:Among 2 167 patients receiving breast conserving surgery, there were 320 patients with neoadjuvant chemotherapy and 1 847 patients with adjuvant chemotherapy. During the follow-up of median 60 months, there were 105 cases of recurrence and 137 cases of distant metastasis. In all patients, the 5-year recurrence-free survival and distant metastasis-free survival were 95% and 93%, respectively and the 10-year recurrence-free survival and distant metastasis-free survival were 91% and 89%, respectively. The 5-year and 10-year recurrence-free survival was 91% and 85% in patients with neoadjuvant chemotherapy, 95% and 92% in patients with adjuvant chemotherapy. The 5-year and 10-year metastasis-free survival of was 88% and 74% in patients with neoadjuvant chemotherapy, 94% and 91% in patients with adjuvant chemotherapy. The factors affecting postoperative recurrence included pathological stage of lymph nodes (pN) (pN3vs pN0, HR=4.773, 95%CI: 1.614-14.116, P=0.005) and ER status (ER-negative vs ER-positive, HR=2.302, 95%CI: 1.095-4.841, P=0.028). Factors affecting distant metastasis included clinical stage of lymph nodes (cN) (cN1vs cN0: HR=1.799, 95%CI: 1.154-2.805, P=0.010) and pathological stage of lymph nodes (pN2vs pN0: HR=2.304, 95%CI: 1.148-4.624, P=0.019; pN3vs pN0: HR=8.156, 95%CI: 4.433-15.007, P<0.001).Conclusions:The breast cancer patients with pathologically positive lymph nodes and ER negative after breast conserving surgery show a higher recurrence rate. Patients with clinically positive and pathologically positive lymph nodes are more likely to have distant metastasis after breast conserving surgery.

Objective:To explore the factors related to surgical decision conflict and decision satisfaction of breast cancer patients.Methods:This retrospective study enrolled 121 patients with breast cancer in the Breast Tumor Center of Sun Yat-sen Memorial Hospital, Sun Yat-sen University from June to December 2018 and analyzed their general data (including age, marital status, education, number of children, occupational status, family income and religious belief), decision conflict and decision satisfaction. The analysis of variance and linear regression were used to analyze the factors concerning to decision conflict and decision satisfaction.Results:(1) Totally 117 patients had complete general information, decision conflict, and decision satisfaction scores. The recovery rate of valid questionnaires was 96.7% (117/121). The decision conflict score of 117 patients was 2.68 ± 2.55, and the satisfaction score was 4.03 ± 2.73. (2) The comparison of decision conflict scores among breast cancer patients with different characteristics showed that marital status was related to decision conflict scores (F=3.778, P=0.013). Multivariate analysis showed that patients’ marital status and religious belief were related to their decision conflict scores. Married, divorced or widowed patients had a significantly lower decision conflict score compared with unmarried patients (B=-2.794, 95%CI: -4.837--0.750, t=-2.709, P=0.008; B=-4.189, 95%CI: -6.823--1.546, t=-3.140, P=0.002). The decision conflict score of patients without religious belief was significantly lower than that of patients with religious belief (B=-1.482, 95%CI: -2.776--0.189, t=-2.271, P=0.025). (3) The comparison of decision satisfaction among breast cancer patients with different clinical characteristics showed that marital status and family income were related to decision satisfaction scores (F=2.736, 5.339, P=0.047, 0.006). Multivariate analysis shows that marital status and religious belief status were related to decision satisfaction scores. Divorced or widowed patients had a significantly lower decision satisfaction score compared with unmarried patients, and the patients without religious belief had a significantly lower decision satisfaction score compared with those with religious belief (B=-3.905, 95%CI: -6.749--1.061, t=-2.721, P=0.008; B=-1.793, 95%CI: -3.185- -0.401, t=-2.553, P=0.012).Conclusions:Unmarried patients and patients with religious belief are more likely to have decision conflict and lower decision satisfaction. In clinical practice, we should pay more attention to these patients and give decision aids, so as to reduce decision conflict and increase decision satisfaction.

近年来,人工智能技术发展突飞猛进,全球各国都将其上升到国家战略层面加以重视.人工智能在临床肿瘤领域更是已经有了广泛的应用.根据人工智能与常规人类所能达到的能力水平的相对差异,可将人工智能划分为Ⅰ类人工智能(与人类能力水平相近)和Ⅱ类人工智能(超越人类能力水平).此外,人工智能在临床肿瘤领域应用的关键性基础建设问题,包括数据与隐私问题、法律与监管问题等.

乳腺癌是导致女性第二性征丢失的最主要原因.乳腺外科医师在探索保留乳房的同时,也开始为乳房切除患者探索重建乳房的方法,其中包括假体乳房重建、自体乳房重建和外负压抽吸的脂肪填充乳房重建等.本文从乳房分型、手术决策、假体选择、手术切口及层次、胸大肌处理及术后护理等方面的热点问题展开讨论,并提供"一步法"硅胶植入乳房重建的可执行、可重复手术方案.

目的:探讨灯盏细辛对缺血性脑卒中(IS)患者血清溶血磷脂酸(LPA)、同型半胱氨酸(Hcy)、单核细胞趋化蛋白(MCP-1)水平的影响.方法:纳入280例IS患者为受试对象,随机分成研究组和对照组各140例.对照组予以常规治疗,研究组在对照组基础上联合使用灯盏细辛.比较两组患者治疗前及治疗2周后中医症状积分(肢体麻木、头晕目眩、心烦易怒)、血管内皮细胞损伤标志物(LPA、Hcy、MCP-1)、血液流变学指标[全血高切黏度(HSV)、全血低切黏度(LSV)、血浆黏度(PSV)、红细胞压积(HCT)]、血清指标[缺氧诱导因子-1α(HIF-1α)、胱天蛋白酶(Caspase-3)、血尿酸(UA)]水平变化.结果:治疗2周后,两组患者头晕目眩、肢体麻木及心烦易怒各项中医症状积分、Hcy、MCP-1、HSV、LSV、PSV、HCT、HIF-1α、Caspase-3、UA水平均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05);两组LPA水平均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05).结论:灯盏细辛应用于IS患者,可有效改善其疾病症状,优化患者体内血管内皮细胞损伤标志物、血液流变学及血清水平.

Objective To analyze the prognosis and related factors of patients with giant breast tumors, whose chest wall defects was repaired by autologous tissue flaps after tumor resction. Methods The clinical data of 46 giant breast tumor patients in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from April 2012 to May 2018 were retrospectively analyzed. They all underwent the resection of gaint breast tumor and defect repair by autologous tissue flap. Then the subgroup analysis was performed according to different pathological types, distant metastasis status, therapeutic responses and negative margin. Log-rank test was used to analyze the progression-free survival (PFS) and OS of different subgroups. Univariate and multivariate Cox proportional hazard regression models were used to analyze the related factors of PFS and OS. Results Among the 46 patients, 7 patients had malignant mesenchymal tumors of the breast, and the other 39 patients had breast cancer (18 luminal B, 11 HER-2 positive, and 10 triple negative). Univariate analysis showed that: (1) the median PFS and OS were 28.5 months (18.1-38.7 months) and 28.5 months (18.1-38.9 months) in patients with malignant mesenchymal tumors, 17.2 months (14.1-20.3 months) and 25.1 months (13.7-36.6 months) in luminal B breast cancer, 15.6 months(12.9- 51.2 months)and 35.8 months(19.8-71.8 months)in HER-2 positive breast cancer, 8.6 months (4.6-12.5 months) and 18.5 months (5.8-43.5 months) in triple negative breast cancer. There were significant differences in median PFS and OS among the four types of malignant tumors (PFS: χ2=16.645, P=0.001; OS: χ2=8.617, P=0.035). (2) The patients with T4 lesions alone (n=25) presented no significant differences in median PFS and OS compared with the patients with T4 lesions and distant metastases (n=21) [PFS: 17.2 months (7.3-27.0 months) vs 9.8 months (8.6-11.1 months), χ2=1.369, P=0.242; OS: 28.5 months (14.1-42.9 months) vs 20.2 months (14.4-25.9 months), χ2=1.779, P=0.182]. (3) The median PFS and OS in patients with negative margin (n=35) were 22.1 months (10.8-33.4 months) and 22.2 months (11.3-33.2 months), respectively, significantly better than those in patients with positive margins(n=11)[5.1 months (3.0-7.2 months) and 10.2 months (5.4-15.0 months)] (PFS: χ2=17.794, P< 0.001; OS: χ2=6.192, P=0.013). (4) The median PFS and OS in patients with good response to systemic treatment were significantly higher than those in patients with poor response [PFS: 23.1 months (5.9-40.4 months) vs 8.7 months (7.8-9.8 months), χ2=9.868, P= 0.001; OS: 46.7 months (25.5-68.0 months) to 14.3 months (9.9-18.9 months), χ2=8.994, P=0.002]. The above-mentioned factors were included in the multivariate Cox proportional hazards regression model and the result showed that these factors were not independent prognostic factors affecting the PFS and OS of breast cancer patients. Conclusion The prognosis of the patients with giant malignant breast tumors is related to pathological types of tumors, negative margin and the response to systemic treatment, but none is an independent prognostic factor. Key words: Breast neoplasms; Reconstructive surgical procedures; Surgical flap; Thoracic wall

Breast cancer is the most common malignant tumor in women,and surgery is an important part of breast cancer treatment.Surgical methods have undergone a continuous development process,and BCS (breast conserving surgery) has become the standard procedure for early stage patients.The standard procedure of BCS mainly contains the American procedure and European procedure,and the previous one is more suitable for Chinese patients.Negative margin is required for BCS.The modified method for cavity margin assessment first performed by our breast tumor center has been proved to be safe and effective and can be strongly recommended because it's suitable for Chinese conditions.BCS has great progress in recent years and there is a recent consensus on the negative margin of BCS.The ASBS recommended CSM (cavity shave margins) technique to significantly reduce reoperation rate.Breast plastic surgery (Oncoplastic) could be an option for those without satisfied cosmetic result of surgery.BCS is still not popular in China.MDT (multidisciplinary treatment) and breast department specialty construction can enhance the BCS rate and further improve the prognosis of patients,which should be promoted in our country.

膝骨关节炎为临床常见疾病,其病理性改变主要为软骨损伤及退变.膝骨关节炎可引起膝关节疼痛及运动功能障碍.随着病情进展,当出现肢体功能障碍,持续疼痛,无法缓解时,多数患者需采取手术治疗.因此,减轻患者疼痛、延缓膝关节退变的非手术治疗成为目前膝骨关节炎研究领域的一大热点.近年来,体外冲击波疗法作为一种新的无创性物理治疗手段,被运用于膝骨关节炎的治疗,现就体外冲击波疗法对膝骨关节炎的治疗现状进行综述.

目的:探讨乳腺癌化疗患者发生输液港血栓的高危因素,通过干预治疗,减少输液港血栓的发生,尽可能避免因血栓所导致的不良后果.方法:回顾性分析212例乳腺癌患者完成静脉化疗后进行输液港拆除术的临床资料,探讨与输液港血栓发生可能有关的52个临床因素进行统计学分析处理.结果:本次研究212例患者中发生血栓的例数为34例,几率为16.04％.通过单因素分析,本研究筛出对输液港血栓发生影响有统计学意义的6个变量,即肿瘤大小、白细胞总数、荧光原位杂交技术(fluorescence in situ hybridization,FISH)检测结果、化疗方案、化疗类型、乙肝,结合国内外关于血栓的临床危险因素的研究报导,加入年龄、BMI、凝血功能、高血压、糖尿病、输液港存留时间、输液港位置等临床因素,通过逐步Logistic回归对其进行多因素分析,发现白细胞总数、乙肝阳性、纤维蛋白原、FISH阳性及不确定、其它方案化疗的患者差异有统计学意义(P<0.05);白细胞总数、纤维蛋白原的OR值分别是1.584、0.192,乙肝阳性的乳腺癌患者发生输液港血栓的风险是乙肝阴性的乳腺癌患者人群的13.253倍,FISH阳性及不确定的乳腺癌患者发生输液港血栓的风险是FISH阴性的乳腺癌患者人群的37.056、64.632倍,使用其它方案化疗的乳腺癌患者发生输液港血栓的风险是使用蒽环类化疗的乳腺癌患者人群的9.482倍.结论:白细胞总数高、乙肝阳性、纤维蛋白原低、FISH阳性及不确定、其它方案化疗的乳腺癌患者进行输液港置管后,应定期进行颈部血管彩超检查,必要时考虑抗凝治疗,以减少输液港血栓的发生率.

Objective To explore the clinical value of female chest low﹣dose spiral CT (LDCT) in lung cancer and breast cancer screening. Methods Two thousand three hundred and eighty﹣eight physical examination persons underwent chest LDCT and 4 876 persons underwent chest digital radiography (DR), 2 388 femal physical examina﹣tion persons mentioned above underwent breast LDCT and brest ultrasonography(US) at the same time. The leison de﹣tection rate and coincidence rate were compared respectively. Results Seven hundred and ninety﹣two lung leisons and 27 lung cancer patients were detected by LDCT, the detection rate and coincidence rate was 33.17% and 1.13%, which was 19.26%and 0.33%by DR accrodingly. LDCT was better than DR in detection rate by lung cancer screen﹣ing (both P<0.01). One hundred and nigety brest leisons and 26 breast cancer patients were detected by LDCT, the detection rate and coincidence rate was 7.96%and 1.09%; which was 8.50%and 0.79%by US accrodingly. LDCT was better than US in breast cancer coincidence rate (P=0.039),but there was no different in detection rate in brest leison(P=0.066). Conclusion LDCT was better in detection rate than DR for lung cancer screening while it′s close to US in detection rate for breast cancer screening. It was useful to improve the detection rate in lung and breast can﹣cer screening,to reduce the radiological dose and to cut the cost in female physical examination persons by chest LD﹣CT .It was worth to popularizing and applying.

目的 分析前哨淋巴结(SLN)阳性原发乳腺癌患者腋窝非前哨淋巴结(NSLN)转移的预测因子.方法 回顾性分析212例SLN阳性并接受腋窝淋巴结清扫术的患者资料.获取的SLN均按示踪剂浓度排序并测量浸润灶大小.对各种临床及病理组织学因素数据进行单因素分析,纳入单因素分析有意义(P＜0.05)的预测因素进行logistic多因素分析.结果 多因素分析提示NSLN转移与SLN转移率(P＜0.001)、SLN阴性个数(P=0.02)、染色剂浓度最小SLN转移(P=0.02)、SLN最大转移灶大小(P＜0.001)有关.全部SLN转移者NSLN转移可能性较非全部SLN转移者大;随SLN阴性个数增加,NSLN转移率下降;染色剂浓度越大SLN转移机会越大,浓度最小SLN转移者较浓度最小SLN无转移者SLN,其NSLN转移几率更高;最大转移灶＞2 mm者出现NSLN转移可能性比SLN最大转移灶≤2 mm者大.结论 SLN转移率(P＜0.001)、SLN阴性个数(P＝0.02)、染色剂浓度最小SLN转移(P=0.02)、SLN最大转移灶大小(P＜0.001)是NSLN转移的独立预测因子.

目的 探讨结合伪彩成像提高胸部CT平扫乳腺癌检出率的价值.方法 搜集经病理证实的乳腺癌患者30例(共60只乳腺),由两名医师分别独立阅读胸部CT平扫纵隔窗图像判断是否存在乳腺癌病灶,2周后应用胸部平扫CT图像结合伪彩成像技术阅片判断是否存在乳腺癌病灶.采用Kappa方法计算两名医师的一致性,采用卡方检验验证结合伪彩成像技术可否提高胸部CT平扫乳腺癌检出率.结果 纤维腺体松散分布的乳腺(Ⅰ类,13例)中,乳腺癌灶的CT值平均值高于正常腺体的CT值平均值[(21.0±13.0)HU vs(-28.1 ±32.8)HU](P ＜0.001),纤维腺体致密分布的乳腺(Ⅱ类,17例)中亦如此[(34.3 ±12.5)HU vs (1.9 ±21.7)HU](P＜0.001).在Ⅱ类乳腺中,两名医师在CT平扫图像下阅片的评价结果具有高度一致性(Kappa=0.852,P＜0.001),采用CT平扫结合伪彩成像阅片方式的评价结果具有较高一致性(Kappa=0.798,P＜0.001).单纯CT平扫阅片方式及平扫结合伪彩成像阅片方式在Ⅰ类乳腺中检测乳腺癌的敏感性均为100％(13/13),平扫结合伪彩在Ⅱ类的乳腺中检测肿瘤的敏感性高于平扫阅片(94.1％ vs.64.7％,P＜0.05).结论 CT平扫结合伪彩成像技术较之传统CT阅片可以提高纤维腺体致密分布的乳腺内癌灶的检出率.

Objective:Knee Osteoarthritis(KOA) is associated with age-related loss of homeostatic balance.Our previous clinical studies have indicated that KOA is a kind of serious problem for most elder women.The aim of the present study is to establish a new rat knee osteoarthritis model via ovariectomy combined with excessive exercise in order to further determine its mechanism.Methods:Twenty-four 8-month female SD rats were randomly divided into blank group,sham-operated group(Sham Group)and ovariectomized group(OVX Group).OVX group received bilateral ovariectomy,while only fat around the ovary was removed in the Sham group.Rats in all groups received downhill treadmill training for 5 weeks,200 minutes per day and 6 days per week.After 7 weeks,all rats were killed for observation of morphological change of the femoral condyle,tibial plateau and patella cartilage as well as immunological analysis.Results:OVX group showed mild osteoarthritic changes.Compared to blank group,the serum level of iNOS in OVX group was significantly increased(P0.05),and SOD significantly decreased(P0.05).The increase of serum iNOS was more obvious compared to SHAM group.Conclusion:The rat KOA model is successfully established by the method of bilateral ovariectomy combined with excessive exercise,which is stable and is in accordance with the osteoarthritic pathology of menopausal women.

Objective Spinal cord ischemia/reperfusion injury( SCIRI) is a focus of research in the medical field. The methods to establish SCIRI models are varied and constantly improved,but none of them can yet satisfy the requirements of clinical treatment. This study investigated the establishment of an optimal SCIRI model in rabbits. Methods Artery casting specimens were made by injecting a casting agent into the proximal ascending aortas of rabbits followed by analysis of the run and distribution of the spinal cord vessels. SCIRI models were established in 12 standardized rabbits by blocking the abdominal aorta( group A) and lumbar arteries( group B) and identified by digital subtraction angiography. Spinal cord samples were obtained from the successfully identified SCIRI models for HE staining and analysis of the differences between groups A and B. Results The artery casting specimens clearly exhibited the systemic blood supply of the rabbits. SCIRI models were successfully made by blocking either the abdominal aorta or the lumbar artery. Swelling of and increased interspace between the neurons in the spinal cord were found in group A,and mild injury of spinal cord neurons observed in B. Conclusion Vessel casting technique can clearly reveal the systemic arterial blood supply in rabbits. Digital subtraction angiography is a good method to identify two different SCIRI models established by blocking the abdominal aorta and lumbar arteries. The SCIRI model made by blocking the lumbar artery is better than that established by the former method.

病例资料 患者 女，43岁，因“发现左大腿肿块3年”入院。患者于3年前始发现左大腿部一肿物，约花生米大小，按之无疼痛，不伴其他相关症状，未予特殊处理，肿物至今逐渐增大至鹅卵大小，按之有酸胀感，遂来我院就诊，外院彩超提示左大腿皮下实性肿物。为求进一步诊治，门诊拟以“左大腿肿块查因”收入院。起病来精神，胃纳、睡眠可，大小便正常，体重无明显变化。T 37.0℃，P 86次/分，R 20次/分，BP 153/92 mmHg，神志清楚，步入病房，查体合作。专科情况：左大腿见一肿物，约9 cm×6 cm大小，表面见静脉怒张，表面皮温增高，质稍韧，边界较清，活动度尚可，按之有酸胀感，末梢血运尚可，左下肢感觉无明显异常。

支气管异物多发生于3岁以下儿童,Siegel等[1]统计占79%,在美国发生率约为1.4/10万,发病峰值年龄为 1 ～2 岁[2],是耳鼻喉科的常见急诊之一,只要诊治及时不会造成严重后果.而成人支气管异物比较少见,相关报道文献并不常见,特别是隐匿性支气管异物经常性地发生漏诊和误诊.本文收集2007-12-2011-12诊治的成人慢性隐匿性支气管异物6例,对其临床、影像及纤维支气管镜检查情况进行回顾性分析,报告如下.

目的 CT引导下肺穿刺活检的辐射剂量研究。方法随机选取来我科做肺CT穿刺活检的患者50例,其中男性30例,女性20例,年龄37～82岁,中位年龄58.3岁;采用德国西门子公司生产Sensation 16层螺旋CT机;受检者卧于检查床上,根据肺部病灶的大小、部位,由介入科医生确定扫描体位,如仰卧、俯卧或侧卧,然后放置定位标记。先扫描一张定位相,再根据病灶的部位行病灶局部扫描,病灶扫描第一个序列为常规剂量,第二个序列起均为低剂量扫描。具体扫描参数为:常规剂量扫描管电压120 kV,管电流100 mAs;低剂量扫描管电压100 kV,管电流50mAs。球管旋转时间0.75 s/圈,准直器16×1.5 mm,螺距1.35,重建层厚2.0 mm,重建间隔1.0 mm,图像重建函数核肺窗B70S,very sharp,纵膈窗B30,medium smooth,Fov330 mm。扫描重建后的薄层图像传入3D重组,穿刺医生即时阅读、浏览,确定穿刺针进针的部位、方向、深度以及与病灶的三维关系。结果所有低剂量图像都能用于穿刺定位,噪声略高于常规扫描图像;低剂量扫描辐射剂量低,是常规法扫描的40.25%(平均值);本研究组共节省辐射剂量1 775.5 mGy。结论 CT引导下肺穿刺活检图像不需要很高的分辨率,低剂量扫描图像能够满足穿刺定位的要求。

Objective To determine the effect of reducing mAs on the diagnostic quality of images and the radiation dose in patients undergoing lumbar vertebrae MSCT.Methods 120 cases were divided randomly divided into two groups:expemental group(low dose group,100 mAs group,60 cases) and control group(200 mAs group,60 cases).The quality of imaging and radiation dose were compared among three groups.Results The CTDIvol of two groups were 5.72±0.32 and 11.45±0.76,respectively.There were significant differences among three groups(P0.05).However,the quality of images between two groups was not different(P0.05),the scores of image quality between two group were 1.07±0.82 and 11.30±0.79.Conclusion The low-dose scan mode could be used in routine examination of lumbar vertebrae using MSCT.