脉络膜黑色素瘤的彩色多普勒血流成像与组织病理学相关性研究  

Study on the correlation between color Doppler flow imaging and histopathology of choroidal melanoma

作　　者：燕玉清 赵红[1] Yan Yuqing;Zhao Hong(Tianjin Eye Hospital,Nankai University Affiliated Eye Hospital,Clinical College of Ophthalmology of Tianjin Medical University,Tianjin Eye Institute,Tianjin Key Laboratory of Ophthalmology and Visual Science,Tianjin 300020,China)

机构地区：[1]天津市眼科医院、南开大学附属眼科医院、天津医科大学眼科临床学院、天津市眼科研究所、天津市眼科学与视觉科学重点实验室,天津300020

出　　处：《中华眼科杂志》2025年第3期189-194,共6页Chinese Journal of Ophthalmology

摘　　要：目的探讨脉络膜黑色素瘤(CM)的彩色多普勒血流成像(CDFI)特点与组织病理学表现的相关性。方法回顾性病例系列研究。收集2004年2月至2022年3月在天津市眼科医院行眼球摘除术的49例(49只眼)CM患者临床资料和组织病理学资料。患者均行CDFI检查和组织病理学检查测量肿瘤血管数。分析CDFI显示的血流信号与肿瘤内部血流特征、肿瘤体积、临床分期、肿瘤向巩膜外蔓延分级和细胞类型之间的关系。使用Adler半定量法比较CDFI与组织病理学结果的一致性。采用配对Wilcoxon符号秩检验和Hodges-Lehman法进行统计分析。结果 49例CM患者中, 男性28例(57.1%), 女性21例(42.9%);年龄为(52.1±11.0)岁, 均为单眼发病。CDFI检查肿瘤形状:蘑菇形26例(53.1%), 圆顶形11例(22.4%), 扁平弥漫形12例(24.5%)。49例患者中, 血流信号分级Ⅰ级9例(18.4%), Ⅱ级16例(32.7%), Ⅲ级24例(48.9%)。肿瘤内部血流丰富的位置在颞上方19例(39.6%), 肿瘤外周部血流多于中央部34例(69.4%)。大肿瘤13例(26.5%), 其中6例为Ⅰ级血流信号;中等体积肿瘤36例(73.5%), 其中20例(55.6%)为Ⅲ级血流信号。眼内期38例(77.6%), 其中20例(52.6%)为Ⅲ级血流信号;青光眼期4例, 其中3例为Ⅰ级血流信号;眼外蔓延期6例, 其中4例为Ⅰ级血流信号;全身转移期1例, 表现为Ⅲ级血流信号;肿瘤向巩膜外蔓延分级Ⅰ级(肿瘤细胞累及巩膜)31例(63.3%), 其中17例(54.8%)为Ⅲ级血流信号。混合细胞型32例(65.3%), 其中17例(53.1%)为Ⅲ级血流信号。组织病理学检查显示血管数为9.0(6.5, 11.0)个, CDFI测量的血管数为7.0(4.0, 9.0)个, 差值为2.0(1.0, 4.0)个(95%CI:1.5~3.0), 差异有统计学意义(Z=4.376, P<0.001)。CDFI与组织病理学结果的一致性分析显示, 共40例(81.6%)患者分级一致, 8例(16.3%)患者不一致。结论 CM患者的CDFI特点与组织病理学检查的相关性较高, 但前者不能完全替代后者测量肿瘤内部的血管Objective:To explore the correlation between the characteristics of color Doppler flow imaging(CDFI)and histopathological manifestations of choroidal melanoma(CM).Methods:This was a retrospective case series study.The clinical and histopathological data of 49 patients(49 eyes)with CM who underwent enucleation at Tianjin Eye Hospital from February 2004 to March 2022 were collected.All patients underwent CDFI examination and histopathological examination to measure the number of tumor blood vessels.The relationships between the blood flow signals shown by CDFI and the internal blood flow characteristics of the tumor,tumor size,clinical stage,extra-scleral extension grade of the tumor,and cell type were analyzed.The consistency between CDFI and histopathological results was compared using the Adler semi-quantitative method.Paired Wilcoxon signed-rank test and Hodges-Lehman method were used for statistical analysis.Results:Among the 49 CM patients,28 were male(57.1%)and 21 were female(42.9%).The age was(52.1±11.0)years old,and all cases were unilateral.Regarding the tumor shape detected by CDFI,26 cases(53.1%)were mushroom-shaped,11 cases(22.4%)were dome-shaped,and 12 cases(24.5%)were flat and diffuse-shaped.Among the 49 patients,9 cases(18.4%)had blood flow signal gradeⅠ,16 cases(32.7%)had gradeⅡ,and 24 cases(48.9%)had gradeⅢ.The location with abundant blood flow inside the tumor was in the superotemporal quadrant in 19 cases(39.6%).The blood flow in the peripheral part of the tumor was more than that in the central part in 34 cases(69.4%).There were 13 large-sized tumors(26.5%),among which 6 cases had gradeⅠblood flow signal;36 medium-sized tumors(73.5%),among which 20 cases(55.6%)had gradeⅢblood flow signal.There were 38 cases(77.6%)in the intraocular stage,among which 20 cases(52.6%)had gradeⅢblood flow signal;4 cases in the glaucoma stage,among which 3 cases had gradeⅠblood flow signal;6 cases in the extra-ocular extension stage,among which 4 cases had gradeⅠblood flow signal;1 case in the syste

关 键 词：脉络膜肿瘤 黑色素瘤 超声检查 多普勒 彩色 血流速度 局部血流 

分 类 号：R65[医药卫生—外科学]