1病历简介病人女性,56岁,因'无明显诱因突然出现上腹部胀痛,疼痛呈持续性,进行性加重,伴恶心、呕吐,呕吐物为所进食物,未见宿食及粪样物',于2013-11-21急诊入院。既往无类似病史。40年前曾行阑尾切除术。入院体检:体温36.2℃,脉...1病历简介病人女性,56岁,因'无明显诱因突然出现上腹部胀痛,疼痛呈持续性,进行性加重,伴恶心、呕吐,呕吐物为所进食物,未见宿食及粪样物',于2013-11-21急诊入院。既往无类似病史。40年前曾行阑尾切除术。入院体检:体温36.2℃,脉搏58次/分,呼吸29次/分,血压115/74 mm Hg。神志清,表情痛苦。头、颈、胸部未见异常。腹部略膨隆,未见胃肠型及蠕动波,上腹部压痛,不伴反跳痛及肌紧张,未触及包块,无移动性浊音,肠鸣音8次/min。展开更多
To determine the relative accuracy of CT or MR imaging in the detection of inoperable tumor sites prior to cytoreductive surgery in a large series of patients with newly diagnosed primary epithelial ovarian cancer. On...To determine the relative accuracy of CT or MR imaging in the detection of inoperable tumor sites prior to cytoreductive surgery in a large series of patients with newly diagnosed primary epithelial ovarian cancer. One hundred thirty- seven women with newly diagnosed primary epithelial ovarian cancer underwent CT (n = 91) or MR imaging (n = 46) prior to cytoreductive surgery. The following imaging criteria were used to identify inoperable tumor sites: (1) peritoneal implants greater than 2 cm in maximum diameter in the porta hepatis, intersegmental fissure, gall bladder fossa, subphrenic space, gastrohepatic ligament, gastrosplenic ligament, lesser sac, or root of the small bowel mesentery; (2) retroperitoneal adenopathy greater than 2 cm in maximum diameter above the renal hila; (3) hepatic metastases or abdominal wall invasion. Imaging results were compared with operability at surgery. Cytoreductive surgery was suboptimal in 21 of the 137 (15% ) patients. Sixteen of these patients had inoperable tumor on preoperative imaging, while one additional patient had apparently inoperable tumor on imaging but was optimally debulked at surgery. The sensitivity, specificity, positive predictive value, and negative predictive value of preoperative imaging for the prediction of suboptimal debulking were 76% (16/21), 99% (115/116), 94% (16/17), and 96% (115/120), respectively. CT and MR imaging were equally effective (P = 1.0) in the detection of inoperable tumor. Preoperative CT and MR imaging are equally accurate in the detection of inoperable tumor and the prediction of suboptimal debulking in newly diagnosed epithelial ovarian cancer. This suggests imaging may help select patients who might be more appropriately managed by neoadjuvant chemotherapy.展开更多
文摘1病历简介病人女性,56岁,因'无明显诱因突然出现上腹部胀痛,疼痛呈持续性,进行性加重,伴恶心、呕吐,呕吐物为所进食物,未见宿食及粪样物',于2013-11-21急诊入院。既往无类似病史。40年前曾行阑尾切除术。入院体检:体温36.2℃,脉搏58次/分,呼吸29次/分,血压115/74 mm Hg。神志清,表情痛苦。头、颈、胸部未见异常。腹部略膨隆,未见胃肠型及蠕动波,上腹部压痛,不伴反跳痛及肌紧张,未触及包块,无移动性浊音,肠鸣音8次/min。
文摘To determine the relative accuracy of CT or MR imaging in the detection of inoperable tumor sites prior to cytoreductive surgery in a large series of patients with newly diagnosed primary epithelial ovarian cancer. One hundred thirty- seven women with newly diagnosed primary epithelial ovarian cancer underwent CT (n = 91) or MR imaging (n = 46) prior to cytoreductive surgery. The following imaging criteria were used to identify inoperable tumor sites: (1) peritoneal implants greater than 2 cm in maximum diameter in the porta hepatis, intersegmental fissure, gall bladder fossa, subphrenic space, gastrohepatic ligament, gastrosplenic ligament, lesser sac, or root of the small bowel mesentery; (2) retroperitoneal adenopathy greater than 2 cm in maximum diameter above the renal hila; (3) hepatic metastases or abdominal wall invasion. Imaging results were compared with operability at surgery. Cytoreductive surgery was suboptimal in 21 of the 137 (15% ) patients. Sixteen of these patients had inoperable tumor on preoperative imaging, while one additional patient had apparently inoperable tumor on imaging but was optimally debulked at surgery. The sensitivity, specificity, positive predictive value, and negative predictive value of preoperative imaging for the prediction of suboptimal debulking were 76% (16/21), 99% (115/116), 94% (16/17), and 96% (115/120), respectively. CT and MR imaging were equally effective (P = 1.0) in the detection of inoperable tumor. Preoperative CT and MR imaging are equally accurate in the detection of inoperable tumor and the prediction of suboptimal debulking in newly diagnosed epithelial ovarian cancer. This suggests imaging may help select patients who might be more appropriately managed by neoadjuvant chemotherapy.
