循证医学诊断案例分析.docx

. . 整理文档 整理文档 循证医学实践 教学案例分析 2014 年 2 月 18 日修訂科別: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 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、生化检验无异常。初步诊断右上颌骨恶性肿瘤，侵犯上颌窦。于 2014 年 3 月 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。由修复科行上颌赝复体修复，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 O:诊断正确率的评价 检索最有用的证据 (Acquire) 关键词 ( Key word ) ： oral adenoid cystic carcinoma， CT or MRI 数据库来源 ( Database )：PubMed Clinical Queries 主要內容： Perineural spread of adenoid cystic carcinoma in the oral and maxillofacial regions: evaluation with contrast-enhanced CT and MRI Objectives: The objective of this study was to compare the accuracy of contrast-enhanced CT (CECT) and contrast-enhanced MRI (CEMRI) in the detection of perineural spread (PNS) of adenoid cystic carcinoma (ACC) in the oral and maxillofacial regions. Methods: This study consisted of 13 ACCs from 13 patients, all of which were histopathologically diagnosed. Both CECT and CEMRI were performed in all patients before the treatment. The images of each patient were retrospectively evaluated for the detection of PNS. The definitions of PNS included abnormal density/signal intensity, contrast enhancement or widening of the pterygopalatine fossa, palatine foramen, incisive canal, mandibular foramen and mandibular canal, and enlargement or excessive contrast enhancement of a nerve. Results: 11 out of 13 cases were proven to exhibit PNS histopathologically. 8 of the 11 cases for which PNS was histopathologically proven exhibited PNS on MR images. Six of the eight cases for which PNS was exhibited on MR images also exhibited PNS on CT images. The sensitivity, specificity and accuracy for the detection of PNS were 55%, 100% and 62% on CT images and 7