循证医学诊断案例分析

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1、科別：口腔颌面外科住院号:38871入院日期:2014.3.6报告者姓名：职务：□住院医师□基地医师回实习医师完成时间:2014.4.11病例摘要患者，女，31岁。因“右上腭肿块2年余，伴胀痛3个月”之主诉于2014年3月16日收住我科。查体：患者一般情况良好，右眶下隆起，鼻道无异常分泌物，开口度：3.0cm,牙列完整无叩痛，右上腭部明显隆起，内界接近中线，后界达软腭前部，黏膜光滑无溃疡，触之中等硬度，无明显压痛，上颌瓦氏位片示，右上颌窦内有一半球形软组织阴影。MRI与CT扫描见右上颌窦内有一半球形软组织阴影，上颌窦底骨质无规则破坏。肿块穿刺液涂片发现异形细胞，血尿常规、生化检验无

2、异常。初步诊断右上颌骨恶性肿瘤，侵犯上颌窦。于2014年3月130在经鼻气管插管全麻下。行右上颌骨次全切除术。手术进行顺利，术后恢复良好。术后病理报告：腺样囊性癌。由修复科行上颌贋复体修复，恢复上颌形态及咀嚼功能，于2014年4月7日出院。提出可回答的临床问題(Asking)P:唾液腺腺样囊性癌患者I:CT或者MRI诊断C:病理诊断0:诊断正确率的评价检索最有用的证据(Acquire)关键词(Keyword)：oraladenoidcysticcarcinoma,CTorMRI数据库来源(Database)：PubMedClinicalQueries主要內容：Perineurals

3、preadofadenoidcysticcarcinomaintheoralandmaxillofacialregions:evaluationwithcontrast-enhancedCTandMRIObjectives:Theobjectiveofthisstudywastocomparetheaccuracyofcontrast-enhancedCT(CECT)andcontrast-enhancedMRI(CEMRI)inthedetectionofperineuralspread(PNS)ofadenoidcysticcarcinoma(ACC)intheoralandm

4、axillofacialregions.Methods:Thisstudyconsistedof13ACCsfrom13patients,allofwhichwerehistopathologicallydiagnosed・BothCECTandCEMRIwereperformedinallpatientsbeforethetreatment.TheimagesofeachpatientwereretrospectivelyevaluatedforthedetectionofPNS.ThedefinitionsofPNSincludedabnormaldensity/signali

5、ntensity,contrastenhancementorwideningofthepterygopalatinefossa,palatineforamen,incisivecanal,mandibularforamenandmandibularcanal,andenlargementorexcessivecontrastenhancementofanerve.Results:11outof13caseswereproventoexhibitPNShistopathologically.8ofthe11casesforwhichPNSwashistopathologicallyp

6、rovenexhibitedPNSonMRimages.SixoftheeightcasesforwhichPNSwasexhibitedonMRimagesalsoexhibitedPNSonCTimages.Thesensitivity,specificityandaccuracyforthedetectionofPNSwere55%,100%and62%onCTimagesand73%,100%and77%onMRimages,respectively.AlthoughtheaccuracyofPNSonMRimageswasslightlysuperiortothatonC

7、Timages,therewerenostatisticallysignificantdifferencesbetweenthedetectionofPNSonCTimagesandonMRimages.Conclusions:CTandMRimagesareequallyusefulforthedetectionofPNSofACCintheoralandmaxillofacialregions.证据评价(Appraisal)证据等級：DWorksheet:一、标准