急性和快速进展性肾功能衰竭肾活检病理资料分析

目的:探讨肾活检对急性肾功能衰竭(ARF)和快速进展性肾功能衰竭(RPRF)的诊断意义。方法:对1992~2005年13年中ARF和RPRF患者,肾活检67例病理资料进行回顾性分析。结果:126例ARF患者,肾活检21例,以急性肾小管坏死、急性小管间质病多见;55例RPRF患者,肾活检46例;以肾小球病、小管间质病多见。结论:对病因不明,诊治困难的ARF、RPRF患者进行肾活检,对正确诊断、制定治疗措施有益。     

Diagnosis of bone marrow metastases in children with solid tumors and lymphomas. Aspiration, or unilateral or bilateral biopsy?

BACKGROUND: Malignancies are among the most common causes of death in children. The present study was undertaken to evaluate and compare bone marrow aspiration and unilateral biopsy to detect bone marrow metastases in pediatric patients, using bilateral biopsy as the gold standard. METHODS: During a 6-month period, 63 consecutive newly diagnosed children with confirmed malignant diseases other than leukemia were evaluated for bone marrow metastases or infiltration. Biopsies were obtained from both right and left posterior iliac crests whereas aspiration was performed only at the right crest. Interpretation to the right-side biopsy was considered as the unilateral biopsy result, whereas the bilateral biopsy result was as follows: positively was accepted if one or both of the two-side samples were qualified as positive, while a negative result was considered only if both sides were negative. The bilateral biopsy was considered the gold standard, and sensitivity, specificity, positive and negative predictive value, and false positive and negative rates were computed for the unilateral biopsy and aspiration procedure. RESULTS: We identified bone marrow metastases in 11 (17.5%) patients. The sensitivity was the only significant difference (p <0.05) observed between unilateral biopsy and aspiration. Finally, of the 63 patients, unilateral biopsy was reported as inadequate in one patient (1.6%), while aspiration was inadequate in two (3.2%). CONCLUSION: Unilateral biopsy was better than bone marrow aspiration. However, because bilateral biopsy is the gold standard, we recommend using this and bone marrow aspiration simultaneously to evaluate a pediatric patient with any malignancy potentially infiltrating bone marrow.     

无X线引导下经纤维支气管镜肺活检配合及护理体会

摘要:目的:探讨31例患者无X线引导下经纤维支气管镜肺活检的配合及护理.方法:回顾性分析2009年1月至2010年12月所做的31例肺部周围性病灶活检的手术配合及护理措施.结果:31例患者经纤维支气管镜肺活检成功.结论:术前充分做好准备工作,术中协助医生做好纤维支气管镜活检钳的定位、病变组织的活检,手术过程中的病情观察...     

CT与MRI认知融合影像在经腹会阴直肠切除术后患者经会阴前列腺靶向穿刺中的应用

目的 探究磁共振融合CT引导下经会阴前列腺靶向穿刺技术在无肛门患者中的应用。方法 对2例APR术后检查发现血清PSA异常升高的患者行磁共振融合CT引导下前列腺靶向穿刺技术。穿刺前先对2名患者进行多参数前列腺MRI,操作者通过目视估测,判断目标病灶位置。随后穿刺者对目测所得病灶靶向穿刺,其中患者1还进行了12针系统性穿刺,穿刺所取得的前列腺组织送病理检查,以病理结果为最终诊断。结果 患者1病理提示良性前列腺组织;患者2病理提示前列腺腺癌,Gleason评分3+4=7。结论 磁共振融合CT引导下经会阴前列腺靶向穿刺技术在无肛门患者中的应用是可行的,但这一技术的敏感性与特异性则有赖于进一步研究。     

超声引导下穿刺活检术与术中快速冰冻组织活检病理诊断乳腺肿块的临床应用比较

目的 观察超声引导下穿刺活检术与术中快速冰冻组织活检对于乳腺肿块性状诊断的准确性。 方法 以自2018年6月—2019年6月于温州市中医院就诊并接受手术治疗的138例乳腺肿块患者为研究对象,分别对所有研究对象进行超声引导下穿刺活检和术中快速冰冻组织活检,以术后石蜡病理学检查结果为金标准,比较超声引导下穿刺活检术与术中快速冰冻组织活检对乳腺肿块性状诊断效果差异情况。 结果 138例乳腺肿块患者经术后石蜡病理学检查,确诊恶性肿瘤62例(44.93%),良性肿瘤53例(38.41%),非肿瘤病变者23例(16.67%)。术中快速冰冻组织活检诊断特异性(96.05%)与超声引导下穿刺活检术水平(90.79%)差异无统计学意义(χ2=1.713,P=0.191),而术中快速冰冻组织活检诊断灵敏度(93.55%)和准确度(94.93%)均显著高于超声引导下穿刺活检术水平(80.64%和86.23%),且差异均具有统计学意义(χ2=4.593、6.114;P=0.032,0.013)。 结论 较超声引导下穿刺活检术,术中快速冰冻组织活检在降低乳腺恶性肿瘤漏检率和提高乳腺肿块性状诊断准确性方面更具优势,值得临床推广使用。      

Complications associated with percutaneous needle biopsy of the liver when one, two or three specimens are taken.

The diagnostic yield of blind percutaneous liver biopsy is improved when two or three specimens are taken during the procedure by redirecting the needle through a single entry-site, without exposing the patient to a greater risk of complications provided that standard precautions are taken. This study was designed to obtain further data on the safety of this procedure at King Edward VIII Hospital, Durban. During the period 1984-1990 (inclusive) a total of 2,646 biopsies were carried out: a single specimen was obtained in 834 patients, two specimens in 983 patients and three in 829 patients. Complications directly attributable to the procedure occurred in 24 patients who had one specimen, 20 who had two, and 19 who had three specimens taken during the biopsy. A single specimen had been obtained from three of the eight patients who had died, two specimens had been taken from another patient, and three specimens were obtained from the other four patients, i.e. patients in whom two or three specimens were taken did not have a higher incidence of pain, symptomatic hypotension, biliary peritonitis or death than those in whom one specimen was taken. Accordingly, when blind percutaneous needle biopsy of the liver is carried out, two specimens should be obtained by redirecting the needle through a single entry site as this improves the diagnostic yield without increasing complications. The morbidity and mortality associated with liver biopsy in this hospital is, however, high. Good technique, careful monitoring of patients after biopsy and prompt and aggressive resuscitation are essential if the mortality rate is to be reduced.     

超声造影引导浅表转移性淋巴结穿刺活检的临床价值

目的 探讨超声造影在引导颈部转移性淋巴结穿刺活检中的应用.方法 对32例有恶性肿瘤病史伴浅表淋巴结肿大的患者行淋巴结超声造影,根据病灶的微灌注情况,行超声引导下穿刺活检,分析取材成功率及诊断准确率.结果 32例患者的淋巴结组织病理学结果显示,转移性淋巴结26例,良性结节6例,后者行手术活检发现有2例转移性淋巴.取材成功...     

CT引导下同轴活检系统对肺部占位病变诊断的临床意义

目的:评价CT引导下同轴活检系统对肺部占位病变诊断的临床意义。方法:统计68例行CT引导下同轴定位针联合活检枪经皮肺穿刺活检结果,结合文献探讨CT引导下同轴活检系统对肺部占位病变诊断的临床意义。结果:68例患者100%取得病理标本,其中结核24例(35.3%),恶性肿瘤40例(58.8%),炎性假瘤4例(5.9%);并发症少(5.9%),2例出现少量气胸,2例出现少许痰中带血。结论:CT引导下同轴套管针联合活检枪经皮肺穿刺活检对肺部疾病诊断率高,具有重要的临床价值,安全可行,值得临床应用。     

经皮肝活检的临床应用问题探讨

肝活检在慢性肝病中有重要的作用,但在临床应用上存在不少争议。本文针对经皮肝活检的适应症、并发症、死亡率、选用活检的方式等一系列临床应用问题做一综述。     

Small bowel biopsy for malabsorption: comparison of the diagnostic adequacy of endoscopic forceps and capsule biopsy specimens

Biopsy specimens of the small bowel were obtained from 40 patients suspected of having malabsorption. Four different techniques were used at a single session--namely, endoscopic biopsy of the descending duodenum using paediatric and standard size forceps and suction capsule biopsy of the descending duodenum and the proximal jejunum. Specimens were compared for size, adequacy, and ability to confirm or exclude mucosal abnormality. Fourteen patients had villous atrophy. In all patients four biopsy specimens were obtained with paediatric endoscopic forceps and four with standard endoscopic forceps. No capsule biopsy specimen was retrieved from the duodenum in three patients and from the jejunum in five patients. Specimens were considered to be adequate in 36 patients when paediatric forceps were used, in 39 when standard forceps were used, in 28 on duodenal capsule biopsy, and in 32 on jejunal capsule biopsy. This study indicates that the most reliable method for diagnosing or excluding villous atrophy is endoscopic forceps biopsy of the descending duodenum, provided that at least four specimens are obtained with standard size forceps.     

Thoracoscopic lung biopsy for diffuse infiltrative lung disease

Thoracoscopic lung biopsy is becoming the procedure of first choice for the diagnosis of many localized and diffuse lung diseases. We have performed thoracoscopic lung biopsy for 17 patients with diffuse infiltrative lung disease, in Kurume University Hospital. There were 13 females and 4 males with a mean age of 48 years (range: 19-71 years). Thoracoscopic surgical biopsy was performed in the right lung in 12 and in the left lung in 5. Adequate lung tissue from each case was obtained for pathological examination. The mean surgical biopsy time was 49 min (range: 25-72 min) and bleeding was negligible. The mean duration for chest tube drainage was 2.6 days. No postoperative complication such as prolonged air leakage occurred. A specific diagnosis from the biopsy was achieved in 13 (76.4%) of the 17 cases. In only 6 (35.2%) of the 17 cases, the pathological diagnosis was the same as that from the thoracoscopic biopsy. In these 6 cases, the same diagnosis was obtained only in those with idiopathic interstitial pneumonitis or diffuse panbronchitis. Thoracoscopic lung biopsy was safe and useful for diagnosis for diffuse infiltrative lung disease.     

液基细胞学检测及阴道镜检查诊断宫颈病变的临床意义

目的探讨液基细胞学检测与阴道镜活检和病理学诊断在宫颈病变诊断中的临床意义。方法采用膜式超薄液晶细胞学检测系统(TCT)收集宫颈抹片6621例检测,报告结果使用TBS分类系统,其中细胞学筛查为异常结果共253例,对其行阴道镜检查及病理检查。结果细胞学检查ASC-US(意义不明的不典型鳞状细胞)共180例,病理结果其中CINⅠ(宫颈上皮内瘤样病变-轻度)37例,CINⅡ(宫颈上皮内瘤样病变-中度)13例,CINⅢ(宫颈上皮内瘤样病变-重度)1例,鳞癌4例。细胞学显示AGUS(意义不明的不典型腺细胞)共7例,其中病理结果证实CINⅠ1例。细胞学显示LSIL(低度鳞状上皮内病变)共46例,其中病理结果证实CINⅠ18例,CINⅡ1例,CINⅢ1例,浸润鳞癌2例。细胞学显示ASC-H(高度鳞状上皮病变不典型鳞状细胞)共17例,其中病理结果证实CINⅡ2例,CINⅢ3例,鳞癌2例,原位癌2例。细胞学显示HSIL(高度鳞状上皮内病变)共3例,均经病理结果证实为癌,其中2例为浸润性鳞癌,1例为高分化腺癌。结论1)应用TCT辅助阴道镜检查可提高宫颈癌前病变和癌变的检出率。2)单纯TCT检查不能诊断宫颈癌,只有病理学检查才能明确诊断。3)在临床中ASC-US可于3~6个月后复查,而本研究显示及时行阴道镜下活检可尽早诊断宫颈癌,争取手术时机。     

92例恶性淋巴瘤骨髓组织病理学分析

采用国产骨髓活检穿刺针和塑料包埋新技术对９２例恶性淋巴癌进行了骨髓检查。何杰金病（ＨＤ）４１例，非何杰金淋巴瘤（ＮＨＬ）５１例。骨髓穿刺活检同时作骨髓涂片检查。２５例有骨髓侵犯，总侵犯率为２３％。并对恶性淋巴瘤骨髓侵犯的组织病理学改变及影响骨髓侵犯的主要因素进行了分析和讨论。     

宫颈细胞学涂片联合阴道镜检查对宫颈病变的诊断价值

目的评价宫颈细胞学涂片联合阴道镜检查对宫颈病变的诊断价值。方法对2005-01~2006-12在哈尔滨医科大学附属第四医院妇科门诊检查的1 160例患者行宫颈细胞学涂片检查,对其中186例细胞学提示阳性或临床高度可疑的患者行阴道镜下活组织病理检查,以病理诊断为金标准,对结果进行分析。结果宫颈涂片检查1 160例中,异常涂片146例(12.59%),临床高度可疑的患者40例行阴道镜检查下活检。病理结果显示:CINⅠ38例,CINⅡ8例,CINⅢ2例,子宫颈鳞癌2例。宫颈涂片细胞学检查诊断宫颈病变符合率为84.0%,阴道镜检查对宫颈病变的诊断符合率为88.0%,两者比较差异具有显著性(P<0.05),两者联合病变检出率为98.0%。结论采用宫颈细胞学检查配合阴道镜下病理检查,可明显提高对宫颈病变诊断的准确率,能满足早期发现癌前病变。     

X线导向对骨病变穿刺抽吸活检价值

目的探讨x线导向对骨病变穿刺抽吸活检价值。材料与方法穿刺抽吸活检34例,通过观察x线平片或CT片,确定最佳穿刺活检部位,并在x线导向下行多靶点取材。结果34例中,穿刺成功率占100﹪,诊断准确率91.2﹪。无并发症发生。结论x线导向对骨病变穿刺抽吸活检过程中不受x线辐射影响,是一种简单、安全有效的诊断方法;强调准确的定位和选择最佳穿刺点是提高穿刺活检成功率的关键。     

阴道镜下宫颈活检和宫颈环形电切术后病理检查对宫颈病变的诊断价值

目的 探讨阴道镜下宫颈活检、宫颈环形电切术(LEEP)后组织病理检查及两者联合对宫颈癌前病变及宫颈癌的早期诊断价值.方法 对554例经宫颈细胞学检查和(或)人乳头状瘤病毒检测异常,或筛查正常而肉眼观察宫颈柱状上皮中重度外翻者,行阴道镜下宫颈活检及LEEP,比较LEEP手术前后病理诊断的变化.结果 阴道镜下宫颈活检诊断结果与LEEP术后病理诊断结果的总符合率为49.82％.宫颈活检诊断为子宫颈上皮内瘤变(CIN)Ⅰ级的病例中,LEEP术后诊断为CINⅡ/Ⅲ级的占14.36％;宫颈活检诊断为CINⅡ/Ⅲ级(含原位癌)的病例中,LEEP术后诊断为浸润癌的占3.89％.两种方法诊断CINⅡ/Ⅲ级的一致性比较,Kappa值为0.62;阴道镜下宫颈活检、LEEP术后组织病理诊断CINⅡ/Ⅲ级与两者联合后的最终诊断比较,Kappa值分别为0.80和0.84,均有很高的一致性;阴道镜下宫颈活检诊断的总准确率为81.77％,对CINⅡ/Ⅲ级的漏诊率为20.64％.结论 阴道镜下宫颈活检、LEEP术后组织病理检查是诊断CIN及宫颈微小浸润癌的有效方法,阴道镜宫颈活检可能漏诊高级别CIN及宫颈微小浸润癌,两者联合可提高诊断的准确性.     

MR扩散加权成像在CT引导下肺癌穿刺活检中的应用

目的探讨磁共振扩散加权成像（DWI）在CT引导下肺癌病灶细针穿刺活检中的应用价值。方法 30例影像学诊断为肺癌住院病人,先行胸部MR平扫检查,包括DWI序列,再根据DWI图及表观扩散系数（ADC）图预定穿刺针活检靶部位,然后行CT引导下肺部病变靶区细针穿刺活检术,分析穿刺诊断正确率。结果 30例病例选择穿刺靶点时,均避开病变坏死区及肺不张或阻塞性炎症区域,而选取肿瘤实性区域进行穿刺活检。穿刺病理均确诊为肺癌,穿刺阳性率为100%。结论在CT引导下肺癌穿刺活检中,对于病灶内有坏死时,或病灶远端合并肺不张及阻塞性炎症时,术前行MRI扩散加权成像检查指导穿刺靶点的选择具有一定的应用价值。     

胃镜活检病理诊断上皮内瘤变高级别的意义

目的探讨胃镜活检上皮内瘤变高级别的临床病理诊断意义。方法常规HE切片观察143例胃镜活检病理诊断为上皮内瘤变高级别病例的病理形态特点,并与60例手术切除和13例重复活检后的病理诊断相对照。结果60例手术切除标本中,6例术后标本未发现有癌变组织,其余54例均病理诊断证实为腺癌,进展期和早期癌各27例;其中高分化腺癌15例,中分化腺癌24例,低分化腺癌12例,黏液腺癌3例。13例重复活检的患者中,4例诊断为高分化腺癌,8例为上皮内瘤变低级别,1例为慢性炎。6例术后未发现有癌变的活检标本均有类似肠道腺瘤样的病理改变,其中5例无黏膜肌。9例活检组织中伴有纤维间质反应的病例,术后病理诊断均为腺癌。结论胃镜活检病理诊断上皮内瘤变高级别时90%已同时伴有腺癌,胃镜活检的部位和深度对病理诊断有很大影响,纤维间质反应是胃镜活检病理诊断胃癌的重要形态学指标。     

检测EB病毒VCA—IgA抗体对于发现鼻咽癌患者的探讨

作者对怀疑为患鼻咽癌的339例患者血清,用间接免疫荧光法进行EB病毒VCA-IgA 抗体检测,从中选出该抗体阳性而病理诊断阴性者29例。该29例中,经第二次鼻咽部活检诊断为鼻咽癌者19例,经第三次活检诊断为鼻咽癌者2例。从而论证了检测EB病毒VCA-IgA 抗体有助于发现鼻咽癌患者。     

Minimally invasive approaches for histological diagnosis of anterior mediastinal masses

Background Anterior mediastinal masses include a wide variety of diseases from benign lesions to extremely malignant tumors. Management strategies are highly diverse and depend strongly on the histological diagnosis as well as the extent of the disease. We reported a prospective study comparing the usefulness of core needle biopsy and mini-mediastinotomy under local anesthesia for histological diagnosis in anterior mediastinal masses. Methods Atotal of 40 patients with masses of unknown histology and located either at or near the anterior mediastinum received biopsy prior to treatment. The diagnostic methods were core needle biopsy in 28 patients and biopsy through mini-mediastinotomy under local anesthesia in 15 patients （including 3 patients for whom core needle biopsy failed to yield a definite diagnosis）. Results Histological diagnosis was achieved in 18 of the 28 patients receiving core needle biopsy. Of them, all 4 patients with pleural fibromas and 9 of the 12 patients （75%） with pulmonary mass were diagnosed definitively. In the remaining 12 patients with mediastinal mass, histological diagnosis was achieved in only 5 patients （41.7%）. In contrast, biopsy through a mini-mediastinotomy failed in only 3 patients. In the remaining 12 patients with huge mediastinal masses, who underwent mini-mediastinotomy, a definitive histological diagnosis was reached by pathological and/or immunohistochemical study （diagnostic yield 85.7% in 12 of 14 cases of mediastinal mass, P=0.038 vs core needle biopsy）. For the 9 patients with thymic epithelial tumors, the diagnostic yield was 40% （2 in 5 cases） for core needle biopsy and 83.3% （5 in 6 cases） for mini-mediastinotomy. There was no morbidity in patients receiving mini-mediastinotomy. In the 30 patients with biopsy-proven histological diagnosis, the results contributed to therapeutic decision making in 25 cases （83.3%）. Conclusions Core needle biopsy is effective in the diagnosis of pulmonary and pleural diseases. Yet its diagnostic yield in mediastinal mass is rather low. Superior to core needle biopsy, biopsy through a mini-mediastinotomy under local anesthesia is highly effective in the histological diagnosis of anterior mediastinal mass, and has a satisfactory diagnostic yield. The method is safe, minimally invasive, cost-effective, and useful in therapeutic decision making for anterior mediastinal masses.