预后案例分析

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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13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个刀”之主诉于2014年3刀16日收住我科。查休：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，触之中等硕度，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

2、杲形细胞，血尿常规、生化检验无异常。初步诊断右上颌骨恶性肿瘤，侵犯上颌窦。于2014年3刀13日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。由修复科行上颌麽复休修复，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O：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)：PubMcdCl

3、inicalQueries主要內容：Perineuralspreadofadenoidcysticcarcinomaintheoralandmaxillofacialregions:evaluationwithcontrast-enhancedCTandMRIObjectives:Theobjectiveofthisstudywastocomparetheaccuracyofcontrast-enhancedCT(CECT)andcontrast-enhancedMRI(CEMRI)inthedetectionofperineuralspread(PNS

4、)ofadenoidcysticcarcinoma(ACC)intheoralandmaxillofacialregions.Methods:Thisstudyconsistedof13ACCsfrom13patients,allofwhichwerehistopathologicallydiagnosed・BothCECTandCEMRIwereperformedinallpatientsbeforethetreatment.Theimagesofeachpatientwereretrospectivelyevaluatedforthedetectio

5、nofPNS.ThedefinitionsofPNSincludedabnormaldensity/signalintensity,contrastenhancementorwideningofthepterygopalatinefossa,palatineforamen,incisivecanal,mandibularforamenandmandibularcanal,andenlargementorexcessivecontrastenhancementofanerve・Results:11outof13caseswereproventoexhibi

6、tPNShistopathologically.8ofthe11casesforwhichPNSwashistopathologicallyprovenexhibitedPNSonMRimages・SixoftheeightcasesforwhichPNSwasexhibitedonMRimagesalsoexhibitedPNSonCTimages・Thesensitivity,specificityandaccuracyforthedetectionofPNSwere55%,100%and62%onCTimagesand73%,100%and77%o

7、nMRimages,respectively.AlthoughtheaccuracyofPNSonMRimageswasslightlysuperiortothatonCTimages,therewerenostatisticallysignificantdifferencesbetweenthedetectionofPNSonCTimagesandonMRimages・Conclusions:CTandMRimagesarcequallyusefulforthedetectionofPNSofACCintheoralandmaxillofacialre

8、gions.证据评价(Appraisal)证据等級：DWorksheet:一、标