超声引导PTC在恶性梗阻性黄疸诊断中的应用

目的总结经皮肝穿刺胆道造影(PTC)对恶性梗阻性黄疸的诊断价值并将超声引导经皮肝穿刺胆道造影(U—PTC)和常规(X—PTC)进行比较。方法将该院2001年7月～2004年3月间进行的U—PTC(12例)同X一PTC(31例)进行比较。结果二者均对恶性梗阻性黄疸的诊断提供较为丰富的信息，但U—PTC较PTC更具有优点。结论PTC在恶性梗阻性黄疸的诊断中具有自身的优势，U—PTC较PTC具有具有操作时间短、成功率高、并发症少、病人痛苦小等优点，值得在临床推广。     

三种神经阻滞麻醉用于胸腔镜肺癌根治术镇痛效果比较

目的:比较超声引导下竖脊肌平面阻滞（erector spine plane block,ESPB）、前锯肌平面阻滞（serratus anterior plane block,SAPB）和胸椎旁神经阻滞（thoracic paravertebral nerve block,TPVB）用于胸腔镜肺癌根治术患者围术期镇痛效果。方法:择期行胸腔镜肺癌根治术的患者105例,美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级Ⅰ-Ⅱ级,年龄25~78岁,体质量指数（body mass index,BMI）18~24 kg/m2。所有患者随机分为三组:ESPB组（E组）、SAPB组（S组）和TPVB组（T组）,每组35例。麻醉诱导前,在超声引导下E组行患侧ESPB,S组行患侧SAPB,T组行患侧TPVB,均注入0.375%罗哌卡因30 mL。术毕三组患者均给予静脉自控镇痛（patient-controlled intravenous analgesia,PCIA）,曲马多补救镇痛,维持静息时视觉模拟评分（visual analogue scale,VAS）≤3分或咳嗽时VAS≤5分。比较三组患者术中丙泊酚、瑞芬太尼和芬太尼的消耗量,48 h PCIA芬太尼消耗量,PCIA有效按压次数,补救镇痛率;记录三组患者术中血管活性药物的使用量及术后低血压、心动过缓的发生情况;比较三组患者不同时点的VAS静息和VAS咳嗽;比较三组患者围术期肺功能的变化。结果:三组患者术中丙泊酚、瑞芬太尼和芬太尼的消耗量无明显差异。与T组比较,E组和S组患者术后48 h PCIA芬太尼消耗量、PCIA有效按压次数和术后补救镇痛率及术中血管活性药物的使用量明显减少,同时术后低血压和心动过缓的发生率明显下降（P＜0.05）。术后12 h,E组和S组患者的VAS静息和VAS咳嗽明显低于T组（P＜0.05）,而E组和S组比较差异无统计学意义。三组患者术后动脉氧分压（PaO2）均呈下降趋势,动脉二氧化碳分压（PaCO2）呈上升趋势,但差异无统计学意义（P＞0.05）。结论:超声引导下竖脊肌平面阻滞、前锯肌平面阻滞和胸椎旁神经阻滞均能为胸腔镜肺癌根治术患者提供良好的镇痛效果,但竖脊肌平面阻滞和前锯肌平面阻滞较胸椎旁神经阻滞的术后镇痛效果更持久,围术期血流动力学更稳定,而前两者之间的效果相似。     

Endoscopic ultrasound appearance of pancreatic serotonin-staining neuroendocrine neoplasms

Background/Objectives

The pancreatic localization of serotonin-staining neuroendocrine neoplasms is extremely rare. This is a retrospective study aimed at analyzing the endoscopic ultrasound appearance of pancreatic serotoninoma.

Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure,technical details and review of the literature

Endoscopic ultrasound(EUS) guided drainage of pancreatic fluid collections(PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis.     

Convex probe endobronchial ultrasound: applications beyond conventional indications

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is maturing and gaining acceptance by more and more clinicians for lymph node staging of lung cancer and diagnosis of mediastinal and hilar masses or lymph node enlargement by convex probe endobronchial ultrasound (CP-EBUS). The application of CP-EBUS, however, is not limited to conventional indications. Diagnostically, elastography is a new technology for the differentiation of benign and malignant lymph nodes before aspiration. CP-EBUS can also be used for pulmonary vascular diseases, such as pulmonary embolism (PE) and non-thrombotic endovascular lesions (NELs). Therapeutically, CP-EBUS can be used for cyst drainage and drug injections. CP-EBUS is not limited to observation and aspiration of mediastinal masses and lymph nodes, but is also suitable for exploration of other tissues external to the central airway, which necessitates unprecedented skills for the bronchoscopist.     

内镜超声引导下细针穿刺活检术对腹腔占位病灶的诊断价值

目的探讨内镜超声引导下细针穿刺活检术(EUS-FNA)对腹腔占位病灶的诊断价值和安全性。方法收集2009-05～2011-06因腹腔占位行EUS-FNA的患者19例,回顾性分析EUS-FNS病理的阳性率及EUS-FNA与手术后病理的符合率。结果 19例患者穿刺病理结果,腺癌11例,假性乳头状瘤1例,胰腺导管内乳头状黏液瘤(IPMT)1例,炎性改变6例,穿刺检查阳性率为68.4%。其中7例行手术治疗,术后病理与穿刺标本病理或细胞学结果符合6例,符合率为86.0%。本组19例患者EUS-FNA术后无出血、穿孔、感染及急性胰腺炎等并发症。结论 EUS-FNA是一项准确而安全有效的技术,对腹腔占位病灶尤其是胰腺肿瘤的定性诊断及进一步治疗方案的确定具有重要的临床价值。     

超声引导组织活检对甲状腺病变的诊断价值简

目的评价超声引导组织活检（core—needle biopsy,CNB）对甲状腺病变的诊断价值。方法选取2004年11月至2011年6月在北京协和医院就诊的117例进行CNB、有完整手术病理或随访资料的甲状腺病变患者,回顾性分析其甲状腺病灶的CNB及病理结果。结果CNB结果显示,117例甲状腺病变中良性85例,恶性28例,可疑恶性2例,取材不满意2例,取材成功率98．3％;弥漫性病变37例,甲状腺结节80例。29例手术患者术后病理显示恶性24例（22例乳头状癌,2例淋巴瘤）,其中5例CNB为良性（假阴性）;良性5例。80例甲状腺结节中小于1cm者2例,1—2cm者21例,大于2cm者57例。结论超声引导CNB取材成功率高,安全可靠,可作为超声引导细针抽吸活检（fine needle aspiration,FNA）的有效补充手段,并可用于特殊甲状腺病理类型,如淋巴瘤的首选诊断方式。     

薄层液基细胞学涂片在超声引导下甲状腺细针抽吸活检的应用简

目的探讨薄层液基细胞学涂片技术在超声引导下甲状腺穿刺中的应用价值。方法2008年1月至7月57例患者的57个甲状腺病变进行超声引导下细针抽吸细胞学检查并同时进行薄层液基细胞学涂片。其中14例获得手术病理,其余病例全部进行临床随访,随访时间5年至5年6个月。细胞学及组织学诊断结果分为四类：良性、恶性、可疑恶性及涂片不满意,将其与手术病理及临床随访结果进行对照分析,分析薄层液基细胞学涂片的细胞学特征及对甲状腺结节的诊断价值。结果薄层液基细胞学涂片与常规细胞学涂片特征有一定差异,主要表现在背景血细胞明显减少、细胞量较多、集中,胶质量少或浓集、核较深染、细胞皱缩更常见、常见细胞质碎片及裸核。57个甲状腺病变中,经手术病理及临床随访证实恶性6个,良性51个。薄层液基细胞学涂片诊断良性48个（84．2％）,恶性4个（7．0％）,涂片不满意5个（8．8％）。该技术诊断甲状腺恶性结节的敏感性66．7％,特异性100％,准确率94．5％,阳性预测值100％,阴性预测值96．2％。与常规细胞学涂片诊断结果相似。结论薄层液基细胞学涂片细胞学特征与常规涂片有一定差异,诊断准确性与常规涂片相似,在甲状腺结节细针抽吸细胞学检查中有较好的应用价值。