CT引导下经皮穿刺活检食管占位性病变的有效性及安全性

目的 观察CT引导下经皮穿刺活检食管占位性病变的有效性及安全性。方法 回顾性分析37例接受CT引导下经皮穿刺活检的食管占位性病变患者（37个病灶）,统计取材成功率、穿刺病理诊断率及诊断准确率（以术后病理诊断或随访诊断为最终诊断）和术中、术后并发症。结果 37个病灶均穿刺取材成功并获明确病理诊断,32个病理结果为阳性（肿瘤性病变）、5个为阴性（炎性病变或正常组织）,穿刺病理诊断率100%。32个阳性病变穿刺病理诊断与最终诊断结果均一致;5个穿刺阴性病变中,3个与最终诊断一致,2个术后病理均为胃肠间质瘤,穿刺诊断准确率为94.59%（35/37）,假阴性率40.00%（2/5）。术后2例出现少量气胸、3例穿刺针道少量出血,1周后均自然吸收,并发症发生率13.51%（5/37）。结论 CT引导下经皮穿刺食管占位性病变安全、有效。     

心脏占位性病变多模态影像学诊断研究进展

心脏占位性病变常发生于心脏各腔室及其相通大血管,来源复杂,分型繁多,多数起病隐匿、发作急骤,严重威胁患者生命。在心脏占位性病变的诊断、治疗及预后评估中,多模态影像学起到重要作用。本文主要对多模态影像学诊断心脏占位性病变的研究进展进行综述。     

超声造影对肝脏局灶性病变误诊分析

目的 探讨肝脏局灶性病变的CEUS误诊原因.方法 回顾性分析与病理结果不符的40例肝脏病变的CEUS特征,分析其误诊原因.结果 40例CEUS误诊病例中,14例病理诊断为肝细胞性肝癌(HCC),其中4例误诊为局灶性结节增生,3例误诊为血管瘤,4例误诊为肝硬化结节,1例误诊为肝脓肿,2例误诊为良性病变,其中1例肝转移性腺癌,误诊为炎性病灶;1例胆管细胞癌误诊为良性病变.24例病理诊断为良性病灶,其中21例CEUS误诊为恶性肿瘤,3例误诊为其他良性病变.结论 加深对肝脏病变病理、组织形态特点的理解,仔细观察CEUS图像特征,紧密结合临床,可提高CEUS对肝脏病变的诊断正确率.     

超声引导下经皮细针穿刺抽吸及穿刺活检诊断胰腺占位性病变

目的 观察超声引导下经皮细针穿刺抽吸(FNA)及穿刺活检(CNB)诊断胰腺占位性病变的价值。方法 回顾性分析112例接受超声引导下FNA和/或CNB的胰腺占位性病变患者、共114组穿刺病理,根据穿刺方式将其分为FNA组(n=53)及CNB组(n=61)。以手术病理或临床随访为金标准,对比组间患者一般资料、穿刺及诊断效能差异,分析影响穿刺并发症发生的因素,评价FNA及CNB的价值。 结果 114组病理中,113组(99.12%,113/114)取材满意;FNA组取材满意率为98.11%(52/53),CNB组为100%(61/61)。穿刺过程中38例出现轻、中度疼痛、1例一过性晕厥,未见严重并发症。FNA组并发症及疼痛发生率均低于CNB组(P均<0.05),FNA诊断胰腺占位性病变的准确率和敏感度亦低于CNB(P均<0.05)。logistic回归分析显示,年龄和穿刺方式是并发症的独立影响因素。结论 超声引导下经皮FNA及CNB均可安全有效地诊断胰腺占位性病变;CNB诊断准确率及敏感度较高,而FNA并发症率较低。     

术前盆腔对比增强MRI评估子宫内膜癌子宫肌层浸润程度

目的 探讨术前盆腔对比增强MRI对子宫内膜癌子宫肌层浸润程度的诊断价值。方法 回顾性分析89例经手术病理确诊的子宫内膜癌患者,术前均以盆腔对比增强MRI评估肌层浸润程度,并与术后病理结果进行比较,评价术前对比增强MRI对子宫内膜癌肌层浸润程度的诊断效能。结果 术前盆腔MRI示病变区子宫内膜均呈不均匀中-高信号强度,子宫肌层内边缘不清,结合带中断,受累肌壁呈不均匀高信号。术前对比增强MRI诊断62例浅肌层浸润,27例深肌层浸润;术后病理诊断浅肌层浸润63例,深肌层浸润26例。术前对比增强MRI诊断浅肌层浸润的敏感度90.48%（57/63）,特异度80.77%（21/26）,阳性预测值91.94%（57/62）,阴性预测值77.78%（21/27）,准确率87.64%（78/89）;诊断深肌层浸润敏感度80.77%（21/26）,特异度90.48%（57/63）,阳性预测值77.78%（21/27）,阴性预测值91.94%（57/62）,准确率87.64%（78/89）。结论 术前盆腔对比增强MRI评估子宫内膜癌子宫肌层浸润程度的效能较高。     

CT引导下经皮穿刺二次活检诊断肺部病变的可行性及安全性

目的 评价CT引导下经皮二次穿刺活检用于明确诊断肺部病变的可行性及安全性。方法 回顾性分析40例接受2次肺穿刺活检患者的临床、影像学及随访资料,根据最终诊断结果,比较2次活检的诊断准确率,分析并发症及初次活检误诊的危险因素。结果 40例中,17例初次活检诊断结果与最终诊断一致(确诊组)、23例诊断不一致(误诊组),诊断准确率为42.50%(17/40),并发症发生率为27.50%(11/40);39例二次活检诊断结果与最终诊断一致,诊断准确率为97.50%(39/40),并发症发生率为25.00%(10/40)。二次活检诊断准确率明显提高,并发症发生率与初次活检差异无统计学意义(P＞0.05)。组间病灶性质和气胸发生率差异均有统计学意义(P均＜0.05)。结论 CT引导下经皮二次穿刺活检用于明确诊断肺部病变安全、可行。     

超声造影诊断乳腺占位性病变影响因素

目的 分析超声造影（CEUS）诊断乳腺占位性病变出现假阳性、假阴性结果的影响因素。方法 回顾性分析349例接受常规超声（US）、CEUS及乳腺X线摄影（MG）的女性乳腺单发占位性病变患者,以病理结果为金标准,将CEUS诊断结果分为真阳性、真阴性、假阳性和假阴性。采用单因素及多因素Logistic回归分析筛选CEUS出现假阳性、假阴性结果的影响因素。结果 349个乳腺病变中,良性病变205个,恶性病变144个。CEUS正确诊断127个恶性、170个良性病变,诊断敏感度为88.19%（127/144）,特异度82.93%（170/205）,准确率85.10%（297/349）,假阳性率17.07%（35/205）,假阴性率11.81%（17/144）。单因素及多因素Logistic回归分析结果显示,年龄、病变至乳头距离（DtP）、合并高危病变是CEUS假阳性的影响因素（P均<0.05）;而年龄、病灶最大径（LMD）与CEUS假阴性有关（P均<0.05）。结论 乳腺占位性病变患者年龄、DtP、是否合并高危病变与CEUS假阳性有关;年龄、病灶最大径与CEUS假阴性有关。     

超声诊断新生儿胆道闭锁

目的 观察超声诊断新生儿胆道闭锁(BA)的价值。方法 收集64例因黄疸接受超声检查的BA患儿,23例接受首次超声检查时日龄≤28天(新生儿组),41例＞28天(非新生儿组);比较组间首次超声诊断BA正确率的差异,记录新生儿组误诊、漏诊病例的随访超声复查结果。结果 新生儿组首次超声诊断BA正确率78.26%(18/23),非新生儿组92.68%(38/41),组间差异无统计学意义(P=0.124)。新生儿组4例首次超声误诊为婴儿肝炎综合征,后经多次超声复查结合临床症状及实验室检查诊断BA;漏诊1例,经多次超声复查结合临床症状及实验室检查仍未明确诊断BA。结论 超声可有效诊断新生儿BA,结合临床及实验室检查有助于提高准确率。     

罕见肝良恶性占位性病变42例诊断与治疗

目的总结罕见肝良恶性占位性病变的诊治体会,以提高该类疾病的诊治水平。方法回顾性分析42例罕见肝良恶性占位性病变的影像学检查、治疗方法及预后等临床资料。结果术前10例影像学诊断与术后病理诊断一致,诊断准确率为23．8％;B超、CT、磁共振成像（Mill）诊断准确率分别为14．3％、19．4％和22．2％。32例罕见肝良性占位手术切除后无复发,7例罕见肝恶性占位性病变术后2例已分别存活18和36个月,余5例术后平均存活7．5个月。结论罕见肝良恶性占位性病变术前确诊困难,B超、CT、Mill三者联合检测可提高诊断准确率,良性占位性病变术后无复发,恶性占位性病变手术可延长患者生命。     

床旁经胸超声心动图分析心脏直视手术后低心排血量综合征病因

目的 观察采用床旁经胸超声心动图分析成人心脏直视手术后低心排血量综合征（LCOS）病因的价值。方法 回顾性分析16例心脏直视手术后出现LCOS患者的床旁经胸超声心动图及临床随访资料。结果 16例中,床旁经胸超声心动图发现4例心脏压塞,表现为心包腔内混杂低回声团块,其中3例经剑突下心包开窗、1例经原胸骨正中切口清除血肿后血压回升;4例左心室流出道动力性梗阻,表现为心肌肥厚伴左心室流出道高速血流信号,减少正性肌力药物的使用并缓慢扩容调节内环境后,左心室流出道压差下降;8例心肌缺血,表现为左心室壁弥漫性或节段性室壁运动异常,射血分数减低,经主动脉球囊反搏或给予正性肌力药物治疗后,7例心脏功能恢复,1例因合并人工瓣膜不匹配而死亡。结论 采用床旁经胸超声心动图可分析心脏直视手术后出现LCOS病因,指导治疗并观察预后。     

肝脏少见良性占位性病变的临床特征与诊治：附43例报告

背景与目的:随着医学影像学技术的发展进步以及居民体检保健意识不断增强,临床上肝脏良性肿瘤的检出率逐渐提高。因其体积不随时间变化而明显改变,一般不需要治疗。然而大部分肝脏少见良性占位术前往往难以明确其病变性质,有时不易与肝脏恶性肿瘤相鉴别。因此需要适时的临床干预。本研究旨在探讨肝脏少见良性肿瘤的诊断、治疗,以及不同肿瘤的临床特点、影像学特征、病理特征、发展与演变,以减少误诊、制定合理的治疗方案,尤其是明确外科手术指征,进而避免过度治疗。方法:回顾南昌大学第一附属医院2014年5月—2019年5月收治的43例肝脏少见良性肿瘤病例(肝脏局灶性结节性增生20例,肝脏血管平滑肌脂肪瘤14例,肝细胞腺瘤4例,炎性假瘤2例,肝脏纤维瘤、肝脏神经鞘瘤、肝脏髓脂肪瘤各1例)临床资料,分析临床诊断及治疗效果。结果:患者术前临床症状缺乏特异性,11例患者出现相关的临床症状,以腹痛腹胀,压迫胃肠道引起的恶心呕吐最为常见。术前影像学检查总体诊断准确率为51.2%(22/43),最易误诊为肝癌。手术方式包括开腹手术和腹腔镜手术(开腹手术31例,腹腔镜手术12例)。手术平均时间(195.5±80.3)min,手术平均出血量(419.7±362.3)mL。7例(16.3%)术后输血,平均输血4 U。术后3例(7.0%)出现并发症(1例胆汁漏,1例肺部感染并双侧胸腔积液,1例感染发热),无再手术及手术死亡病例。术后住院时间3~17 d。与开腹手术患者比较,腹腔镜手术患者术中出血量明显降低(468.4 mL vs.287.5 mL,P=0.027)、术后住院时间明显更短(7.7 d vs.6.2 d,P=0.040),其余指标差异无统计学意义(均P>0.05)。术后随访17.6~77.5个月,期间未见肿瘤复发,11例术前有症状患者中10例症状消失或缓解。结论:肝脏少见良性占位性病变临床症状缺乏特异性,术前诊断多依赖影像学检查,诊断正确率较低,最易误诊为肝癌,影像组学可提高诊断准确性。应充分认识肝脏少见良性占位性病变的临床特点及特征,避免误诊。外科手术是最有效的治疗方法,推荐使用腹腔镜肝切除。应严格把握手术指征,避免过度治疗,根据患者具体情况做出个体化治疗选择,提高肝脏良性肿瘤的外科诊治水平。     

A rare case of a intracardiac lipoma

IntroductionPrimary tumors of the heart are exceedingly rare, accounting for less than 5% of all cardiac tumors; the remaining 95% of tumors are metastatic tumors to the heart. The most common primary cardiac tumors in adults are myxomas (usually occurring in the left atrium) followed by papillary fibroelastomas and lipomas with rhabdomyoma the most common in children.Presentation of caseWe are presenting a case of a 74-years-old female who initially presents with dizziness. No other associated symptoms reported and initial labs were in normal range. Echocardiogram was done as part of the dizziness/syncope work up which demonstrated a large right atrial mass. Due to the size of the mass and patient being symptomatic the mass was surgically resected with complete resolution of her symptoms and pathology consistent with a lipoma.DiscussionCardiac lipomas are benign and may be associated with a spectrum of symptoms which depends upon the size and location of the lipoma; although most cardiac lipomas are found incidentally and are asymptomatic. The best radiologic study to identify and help differentiate cardiac lipoma is echocardiogram. Cardiac computerized tomography (CCT) and cardiac magnetic resonance imaging (CMR) also place a role in differentiating cardiac lipomas from other cardiac tumors/lesions.ConclusionCardiac lipomas are benign primary tumors which have no defined age or sex distribution and present with a wide range of symptoms. Echocardiography is first line diagnosis method with CCT/CMR for better imaging before surgical intervention. Surgical resection of the symptomatic cardiac lipomas remains the mainstream treatment.     

Fine-needle aspiration cytology and core needle biopsy in the preoperative diagnosis of desmoid tumors

Background?Desmoid tumors have a tendency to recur locally, and traditionally they have been treated surgically. No treatment is sometimes indicated, however; this requires a morphological diagnosis that is not based on a surgical specimen. In this study we aimed to identify the diagnostic accuracy of needle and core biopsy for the morphological diagnosis of desmoid.

Methods?We compared the diagnostic accuracy of fine-needle aspiration (FNA) and core needle biopsy (CNB) in 69 and 26 patients, respectively, who had had surgical resections for desmoid. We also reviewed 15 additional cases that had been incorrectly diagnosed as desmoid on FNA but which had different diagnoses after surgery.

Results?FNA-based diagnoses of desmoid/fibromatosis were rendered in 35 of 69 cases, and other benign spindle cell proliferations in 26 cases and spindle cell sarcoma in the remaining 4 cases. All 26 CNBs were either suggested to correspond to desmoid (24) or other benign spindle cell lesions (2). Of the 15 FNAs incorrectly diagnosed as desmoid, 2 were found to be sarcomas.

Interpretation?FNA is fairly reliable for recognition of the benign nature of desmoids. Occasional over- and under-diagnosis of malignancy can occur, however. CNB appears to be more reliable.     

锥体束CT引导下纵隔占位性病变穿刺活检的临床应用

目的探讨锥体束CT(CBCT)引导下穿刺活检纵隔占位性病变的可行性及安全性。方法回顾性分析31例纵隔占位性病变患者的资料。与临床最终诊断结果对照,评价CBCT引导下纵隔占位性病变穿刺活检的诊断效能,并分析穿刺相关并发症情况。结果对31例患者共行穿刺活检31次,技术成功率100%(31/31)。30例穿刺病理结果与临床最终诊断结果一致,1例穿刺病理检查未能定性。CBCT引导下穿刺活检的诊断敏感度、特异度及准确率分别为96.30%(26/27)、100%(4/4)和96.77%(30/31)。本组出现气胸、血胸各1例,并发症发生率为6.45%(2/31)。结论 CBCT引导下穿刺活检定性诊断纵隔占位性病变准确率较高,且并发症较少。     

Does a retrorectal tumour remain a challenge for surgeons?

Background: Retrorectal tumours are lesions with a wide range of histological differentiation that are often diagnostic and clinical challenges due to their rare occurrence. Many cases of this pathology are treated in regional hospitals, which results in serious complications because physicians fail to recognize this pathology. We present our experience in treating these tumours.

Methods: A retrospective analysis of a prospectively maintained database was performed using the Vilnius University Hospital Santaros Clinics patient database. Thirty-five cases were identified.

Results: Occurrence of retrorectal tumours was higher in women than in men and accounted for 82.86% and 17.14%, respectively. Computer tomography and magnetic resonance imaging were the main methods used to confirm diagnosis and plan surgical treatment. We have used a laparotomy, perineal or combined approach for tumour extirpation. The laparotomy approach was the most used, followed by perineal extirpation. The most common histological type was cystic hamartoma, accounting for 20% of cases. In 80% of cases, the histological findings greatly varied. Hospital stays varied from 3 to 21 days with a mean of 11.6?±?5.83 days. The postoperative complication rate was 17.14% and was present in six cases. Overall survival was 85.17%, with an average follow-up period of 71.83 months. There were no recurrent tumours diagnosed during follow-up.

Conclusion: Retrorectal tumours are a very rare pathology with high histological heterogeneity and problematic diagnostics. Patients should be referred to a tertiary centre that has experience and diagnostic capabilities for the best diagnostic and treatment options.     

超声内镜在胰腺及壶腹周围占位术前评估中的临床作用

目的评估超声内镜(EUS)对胰腺及壶腹周围占位的诊断及术前TNM分期的作用。方法回顾性分析34例壶腹部占位患者术前EUS资料,并与术后病理结果比较,评估EUS术前诊断准确性。结果 EUS对胰腺占位病灶显示率92.31%,诊断准确率84.62%,T分期判断准确性为76.92%,N分期判断准确性为53.85%;对壶腹部占位病灶显示率为93.75%,诊断准确率93.75%,T分期判断准确性为62.50%,N分期判断准确性为68.75%。结论 EUS对胰腺及壶腹周围占位的诊断及术前TNM分期具有一定作用。     

脾脏占位性病变的诊治

目的探讨脾脏占位性病变的临床特点和诊治原则。方法回顾性分析2004年1月至2013年12月收治我院的47例肝脏占位性病变的临床资料。结果47例均行手术治疗,并经病理证实。其中良性病变26例,恶性肿瘤21例。开腹行脾脏切除术30例,腹腔镜下行脾脏切除术17例。结论脾脏占位性病变的诊断主要依靠临床表现和影像学检查,治疗以手术治疗为主的综合性治疗。     

心脏肿瘤的外科手术治疗分析

目的探讨心脏黏液瘤及其他原发肿瘤的外科手术治疗的特点。方法回顾性分析自1984年1月至2004年12月手术治疗的95例原发性心脏肿瘤患者的病例资料和随访结果。结果所有患者术前均经彩超明确诊断。94例在体外循环下切除肿瘤,89例痊愈出院,5例死亡。经病理证实黏液瘤83例,其他肿瘤11例。共获随访68例(黏液瘤63例),1例黏液瘤患者术后14个月复发;与心脏有关后期死亡4例。结论原发性心脏肿瘤多为黏液瘤,一旦明确诊断,应急诊手术;恰当的手术技巧是手术治疗成功的关键。     

第二眼超声诊断乳头状甲状腺癌131I治疗后颈部SPECT/CT异常摄碘灶性质

目的探讨第二眼超声诊断乳头状甲状腺癌131I治疗后颈部SPECT/CT显像中异常摄碘灶性质的价值。方法对41例颈部SPECT/CT中见异常摄碘灶的131I治疗后乳头状甲状腺癌患者行SPECT/CT引导下第二眼超声扫查,判断其良恶性,根据细针穿刺细胞学检查(FNAC)或随访结果进行确诊。结果对11例行FNAC:7例确诊为淋巴结转移,第二眼超声诊断其中6例为淋巴结转移、1例为良性,4例FNAC确诊为良性,第二眼超声均诊断为良性。对30例持续随访:8例第二眼超声诊断为正常淋巴结,其中6例随访诊断为良性,2例随访诊断为淋巴结转移;7例第二眼超声诊断为转移淋巴结,其中3例随访诊断为良性,4例随访诊断为复发或转移;15例第二眼超声未见病灶,随访诊断为良性。结论SPECT/CT引导下第二眼超声可提高诊断甲状腺癌131I治疗后淋巴结转移或复发的准确率。