- 學位論文
超音波在多形性腺瘤及Warthin's tumor鑑別診斷上之運用
Ultrasonography in Differentiation of Pleomorphic Adenoma and Warthin’s Tumor
摘要
研究目的：本研究旨在分析多形性腺瘤及Warthin’s tumor在超音波下可用於鑑別診斷之變因。輔以細針穿刺細胞學檢查，針對疑似多形性腺瘤個案採取腮腺切除手術，而疑似Warthin’s tumor個案採取保守治療或單純腫瘤摘除手術，減少執行非必要的腮腺切除，減少顏面神經麻痺發生的機會。 研究方法及資料：本研究採回溯性研究，收集彰化基督教醫院於民國100年5月至104年12月間進行的腮腺切除手術，其病理報告結果為多形性腺瘤或Warthin’s tumor，且手術前有執行超音波檢查之全部病例。分析病例之基本資料、超音波判讀資料等，進行卡方檢定、多樣本中位數差異檢定、雙尾獨立樣本t檢定，最後再利用邏輯迴歸針對單變項分析有意義的變項進行多變項分析，找出更具意義之變因。 研究結果：單變項分析結果，病例基本資料部份年齡、性別具顯著差異。超音波判讀下腫瘤形狀、血流豐富程度、囊狀成份、腫瘤長度及長深比值等具統計顯著差異。多變項分析結果，則血流豐富程度與腫瘤長度並無顯著差異，而年齡(p=0.0002)、性別(p=0.0001)、腫瘤形狀(p=0.0006)、多囊狀成份(p=0.0326)及腫瘤長深比值(p=0.0163)依然存在統計顯著差異。 結論與建議：超音波檢查下如果腫瘤沒有深葉侵犯，且細針穿刺之細胞學檢查為良性，可依據超音波檢查結果判讀，建議分葉狀腫瘤且長深比值較小傾向多形性腺瘤的患者進行腮腺切除手術，或建議多囊狀組成且長深比值較大傾向Warthin’s tumor的患者持續觀察或單純進行腫瘤摘除手術即可，以減少非必要的術後顏面神經麻痺產生。
並列摘要
Objective：The purpose of this study is to identify the ultrasonographic feature helpful in differentiation of pleomorphic adenoma and Warthin’s tumor. In combination with fine needle aspiration cytology, we could suggest those suspicious for pleomorphic adenoma to receive parotidectomy, and those suspicious for Warthin’s tumor to receive conservative treatment or simple enucleation to reduce the risk of facial nerve palsy. Methods and Materials：A retrospective study was conducted. All the histologically proven pleomorphic adenoma or Warthin’s tumor since May 2011 to December 2015 in Changhua Christian Hospital with available preoperative ultrasonography were included. We analyze the demography and ultrasonographic features. Chi Sqaure, Kruskal-Wallis H test, 2-tailed independent t test were done. Logistic regression for multivariate analysis was done as well to find out more meaningful variable. Results：Univariate analysis showed that, in demography, age and gender were statistically significant. In ultrasonographic features, tumor shape, blood flow, cystic component, tumor length, and length/depth ratio were statistically significant. In multivariate analysis, blood flow and tumor length were not statistically significant. Age(p=0.0002)、Gender(p=0.0001)、Tumor shape(p=0.0006)、Multicystic component(p=0.0326)and length/depth ratio (p=0.0163) remained statistically significant. Conclusion and Suggestion： If there are no deep lobe involvement and the fine needle aspiration cytology showed benign, we could suggest those cases with lobulated and low length/depth ratio, which are preferred as pleomorphic adenoma, to receive parotidectomy, and those with multicystic component and high length/depth ratio, which are preferred as Warthin’s tumor, to receive conservative treatment or simple enucleation.