B超引导下穿刺活检术对儿童实体肿瘤的诊断价值探讨

目的 探讨超声导向穿刺活检术在诊断儿童实体肿瘤中应用的可行性和可靠性。方法采用自动同步负压活检取样装置在B超引导下行穿刺活检术。结果15例均获成功，取材成功率100％。组织标本符合病理学检查14例，穿刺检出阳性率为93．3％。无一例出血、感染及肿瘤破溃等并发症。结论超声引导自动活检术是一种安全准确，快速可靠的病理诊断方法。     

B超引导下经皮穿刺活检术在小儿实体肿瘤中的应用体会

目的 介绍B超引导下经皮穿刺活检技术在小儿实体肿瘤中应用的体会.方法 复旦大学附属儿科医院2009年5月至2010年5月期间,穿刺活检组17例,开腹活检组15例,分别就肿块部位,影像学特点,成功率,切口情况、病理,麻醉方式、手术时间、术后恢复情况、手术费用等方面进行回顾分析和比较.结果 穿刺活检多见于腹膜后,而开腹活检在盆腔肿块应用较多.术前评估均无法Ⅰ期切除.两组均取到足够量的标本,获得明确的病理诊断,并与最终根治手术获得的病理一致.穿刺活检组无切口,而开腹活检组平均切口长(5.6±1.1) cm.穿刺活检组的麻醉和手术时间(32.0±7.3)min,明显低于开腹活检组(52.3±14.9) min (P=0.000)；术后恢复时间(7.1±4.3)h明显短于开腹活检组(75.2±12.3)h(P=0.000)；手术费用穿刺活检组(1021.2±113.2)元,明显低于开腹活检组(3047.2±237.6)元(P=0.000).结论 穿刺活检具有操作简单、创伤小、时间短、费用低、出血少、感染风险低、恢复快的特点,一个穿刺点的多个方向的多次取材,可以保证标本量；B超引导下的活检更具有靶向性、准确性和安全性,值得应用和推广.     

超声引导下经皮肾活检的安全性、成功率及并发症

目的评价、分析儿童肾活检的安全性、成功率及并发症。方法肾脏病患儿100例在B超引导下经皮穿刺活检,用20g/L利多卡因逐层局部麻醉至肾包膜,不能配合者应用氯硝西泮,镇静后进行。B超定位后,用皮钻或手术刀片于穿刺点皮肤切开0·3～0·5cm切口,在B超监视下将穿刺针逐层进针到达肾脏被膜时,在平静呼吸时嘱患儿屏住呼吸(肾脏位置较高的患儿需深吸气后屏住呼吸),开枪切割,快速拔出穿刺针。术者用手掌压迫穿刺部位10～15min,腹带、沙袋加压包扎。结果99例获得足够肾组织,平均肾小球7～52个[(23.1±12.1)个],满足了光镜、电镜、免疫荧光三镜的需要,并作出完整的病理诊断,1例虽穿刺成功,但全为髓质组织,无肾小球,总成功率99%。其主要并发症:均有疼痛,一过性肉眼血尿3/100例,腰部不适15/100例。无肾周血肿、感染、休克等严重并发症发生。结论超声引导下经皮儿童肾活检安全可靠,成功率高,并发症少,其病理诊断对临床治疗及预后评价具有明确的指导意义。     

完全快速镇静镇痛术下CT定位穿刺活检小儿实体肿瘤

目的探讨儿童实体肿瘤在完全快速镇静镇痛术下CT引导立体定位穿刺活检的可行性。方法穿刺前先予芬太尼后异丙酚静脉注射,待进入睡眠状态、肌肉松弛、睫毛反射消失后开始穿刺,术中若患儿躁动酌情追加异丙酚至镇静满意。活检针用同轴穿刺针(弹簧内芯切割针),根据CT显示屏上所确立的定位点,标记出进针穿刺点。待患儿呼吸平稳后,按预定的进针角度方向及深度穿刺到所要求的部位。根据取材效果,切割1～3次,100 mL.L-1甲醛10 mL固定后,送病理检查。结果芬太尼联合异丙酚静脉注射给药能达到较好的镇静、镇痛状态,整个操作过程能控制在较好的无躁动状态。病理结果:肾母细胞瘤9例,肝母细胞瘤5例,神经母细胞瘤3例,病理难以确诊1例。结论异丙酚联合小剂量芬太尼应用于儿童实体肿瘤穿刺活检的镇静镇痛,效果满意,起效快,清醒快,非麻醉专业医师也容易掌握其用法用量。     

超声引导穿刺活检诊断儿童肝脏肿瘤的准确性及安全性研究

目的探讨超声引导穿刺活检诊断儿童肝脏肿瘤的准确性和安全性。方法回顾性分析2012年6月至2014年12月上海交通大学医学院附属新华医院收治的38例经超声引导粗针穿刺活检的肝脏肿瘤患儿资料。其中男23例,女15例,平均年龄(24. 11±26. 09)个月,血AFP均高于正常范围。每例患儿均使用Bard 18G粗针穿刺6～9条组织。统计穿刺病理诊断阳性率,并记录分析出血、感染、穿刺针道肿瘤种植等并发症情况。结果穿刺组织术中冰冻病理检查结果诊断为肝母细胞瘤37例,诊断为肝脏恶性肿瘤1例。37例肝母细胞瘤中有28例作出亚型诊断,9例未能作出亚型诊断。37例肝母细胞瘤患儿中,25例化疗后行手术切除肿瘤,大体标本病理诊断与穿刺病理诊断结果均一致。穿刺后均未发生大出血、伤口感染、肿瘤穿刺通道种植转移等并发症。结论超声引导粗针穿刺活检诊断儿童肝脏肿瘤安全、准确。     

超声引导下穿刺活检在小儿实体瘤诊治中的应用价值

目的 探讨超声引导下小儿实体瘤穿刺活检的应用价值.方法 对21例无法手术完整切除的实体瘤患儿在超声引导下进行肿瘤穿刺活检,根据病理检查结果予以化疗,待瘤体缩小后行手术切除,并将穿刺病理检查结果与手术病理组织学检查结果进行对照分析.结果 21例均穿刺活检获成功,5例病理检查结果出来后家长放弃治疗,16例患儿行化疗,其中15例手术切除,1例正在术前化疗中.穿刺病理检查结果与术后病理组织学检查结果相比较,14例结果一致,1例不符合,符合率为93.3%.结论 超声穿刺活检诊断小儿实体瘤准确性高,能为小儿实体瘤的诊断与治疗提供可靠依据.     

高频超声引导下儿童浅表肿块穿刺活检的临床价值

目的探讨高频超声引导下穿刺活检在儿童浅表组织肿块诊断中的应用价值。方法在高频超声引导下对38例小儿浅表软组织肿块进行穿刺活检,取得组织条送病理检查。结果穿刺获取病变组织成功率为100%,无1例并发症。38例患儿通过高频超声引导穿刺活检,均得到明确的病理诊断。结论高频超声引导下对儿童浅表肿块进行穿刺活检是安全、可靠的早期诊断方法,对指导临床手术和治疗有重要的应用价值。     

新生儿腹部实体肿瘤

目的通过总结我院收治的25例新生儿腹部实体肿瘤的临床资料，探讨新生儿腹部实体肿瘤的诊治经验。方法回顾分析1980年1月-2003年12月治疗25例新生儿腹部实体肿瘤，男15例，女10例，年龄从出生后3～30d，出生前经B超诊断胎儿腹部占位性病变9例，占36．0％，恶性实体瘤13例，占52．0％。肝母细胞瘤7例，肝错构瘤2例，神经母细胞瘤5例，先天性中胚层肾瘤2例，腹膜后良性畸胎瘤4例，胃恶性畸胎瘤1例，卵巢囊肿2例，肾上腺错构瘤1例，肾上腺腺瘤1例。肿瘤完整切除20例，肿瘤部分切除1例，仅行肿瘤活检4例。结果肝母细胞瘤存活2例，死于化疗毒副反应1例，失访4例，肝错构瘤生存2例，神经母细胞瘤生存4例，死于化疗毒副反应1例。除1例胃恶性畸胎瘤术后失访外，其余病例均长期生存。结论新生儿腹部实体肿瘤罕见，但通过产前B超可早期发现．出生后小儿外科医师应早期介入，根据病种采取合理检查及治疗手段，包括早期手术，术后合理、规范的化疗，可提高患儿的救治率。     

芯针活检在儿科肿块性疾病病理诊断中的应用

目的评价芯针活检在儿科肿块性疾病病理诊断中的价值及提高病理诊断准确性并作出具体分类的对策。方法用光镜、免疫组织化学技术观察201例儿科肿块性疾病穿刺组织的形态和免疫组织化学表型，个别病例同时作透射电镜观察，并对其诊断价值作分析。结果201例患儿穿刺后有诊断价值的178例（88．6％）；123例恶性肿瘤中常规染色能分类仅60例（48．8％），结合免疫组化结果有99例（80．5％）得到分类及分型；无法分类的13例进行了电镜检查，5例找到诊断性的超微结构。92例最终作肿块手术切除或手术活检，病理诊断前后完全符合的82例（89．1％）。结论儿童肿块性疾病芯针活检简便易行、准确率高，对正确制定治病方案具有重要的指导作用。但病理诊断时要结合临床和影像资料，多做鉴别诊断；并选择适当的足够的抗体作免疫组化分析，必要时作透射电镜检查才能提高诊断正确性。     

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目的分析1000例儿童肾活检的成功率及并发症。方法收集2005-01-01—2012-1-31在成都市妇女儿童中心医院儿童肾内科就诊的肾脏病患儿1000例,在B超引导下经皮穿刺活检,分析取材长度、活检针数与成功率及并发症的关系。结果 962例获得足够肾组织,平均肾小球(24.1±12.3)个(5～53个),满足光镜、电镜、免疫荧光检查的需要,并做出了完整的病理诊断;10例虽然穿刺成功,但全为髓质组织,没有肾小球;28例肾小球数少于5个,未做出病理诊断;总成功率96.2%。其主要并发症:患者术后出现并发症17%,其中一过性肉眼血尿85例,占8.5%(85/1000例),部分患儿有腰部不适75例,占7.5%(75/1000例),肾周血肿10例,占1%,无感染、休克、动静脉瘘等严重并发症发生。结论超声引导下儿童肾活检成功率高、并发症少,是安全可靠的。     

Ultrasound-guided core needle biopsy in the diagnosis of neuroblastic tumors in children: a retrospective study on 83 cases

Aim

Ultrasound-guided biopsy technique with the large-core needle has widely been applied in the diagnosis of adult abdominopelvic cavity, thyroid, and neck tumors. There are few reports on ultrasound-guided biopsy using large-core needle in pediatric abdominopelvic cavity tumors. This study was to evaluate the ultrasound features and the diagnostic value of ultrasound-guided core needle biopsy for pediatric neuroblastic tumors.

Methods

The pediatric patients with neuroblastic tumor that underwent ultrasound examination and ultrasound-guided core needle biopsy from January 2009 to November 2015 were reviewed. A minimum of two cores in each case was obtained. The biopsy results were confirmed by subsequent surgical histopathology. The ultrasound features and the diagnostic accuracy of ultrasound-guided core needle biopsy were evaluated.

Results

Eighty-three patients were enrolled into the study. Conventional ultrasound examination showed irregular hypoechoic or mixed echo masses and calcification and liquefied necrosis. The diagnostic accuracy of ultrasound-guided core needle biopsy was 96.4% (80/83). Three cases were misdiagnosed because of inadequate tissue sample. No serious complication, infection, or needle track seeding occurred.

Conclusions

Ultrasound-guided core needle biopsy seems to be an accurate, minimally invasive, and safe diagnostic method of pediatric neuroblastic tumor.

     

The role of magnetic resonance cholangiography in the management of children and young adults after liver transplantation

We reviewed the results of 50 magnetic resonance (MR) cholangiograms to evaluate their usefulness in directing clinical management in young patients after liver transplantation (LTx). Thirty-two patients underwent 50 MR cholangiograms on a 1.5-T unit. Studies were performed from 1 week to 16 yr after LTx. Indications included biochemical abnormalities with (n = 19) or without (n = 16) biopsy evidence for chronic rejection, sepsis (n = 14), and intractable ascites (n = 1). Original interpretations were compared to laboratory and ultrasound findings, and clinical outcome. Of 19 studies performed on 14 patients with biopsy evidence of chronic rejection, 16 were abnormal on MR (but only one was abnormal on ultrasound), resulting in corrective surgery (n = 1), re-Tx (n = 1), and endoscopic dilatation (n = 1). Of 16 studies on 16 patients with biochemical abnormalities without evidence of chronic rejection on biopsy, 14 were abnormal on MR (but only five of 13 on ultrasound), leading to corrective surgery (n = 3) and re-listing for Tx (n = 3). Thirteen of 14 studies on six patients with sepsis were abnormal on MR (five of nine were abnormal on ultrasound), identifying surgically correctable strictures (n = 2), and leading to re-Tx (n = 1) and percutaneous biliary drainage procedures (n = 2). The one patient with ascites had a normal study. We advocate usage of MR cholangiography for the detection of biliary complications after LTx, particularly in those patients who present with biochemical abnormalities that are not easily explained by acute cellular rejection or viral infection and in those with biliary sepsis.     

Percutaneous image-guided needle biopsy in children – summary of our experience with 57 children

Background: Percutaneous image-guided needle biopsy in children has been slower to gain acceptance than in adults where it is regarded as the standard clinical practice in screening suspicious masses. Objectives: To report our experience with percutaneous image-guided needle biopsy in the pediatric population and assess its clinical use, efficacy and limitations. Material and methods: Sixty-nine percutaneous image-guided needle biopsies were performed in 57 children. The age of the children ranged from 4 days to 14 years (mean 5.6 years). We used 16- to-20-gauge cutting-edge needles. Sixty-two biopsies were core-needle biopsies and 7 fine-needle aspiration biopsies. Results: There were 50 malignant lesions, 10 benign lesions and 2 infectious lesions. In 55 (88.7 %) lesions the needle biopsy was diagnostic. In 7 (11.3 %) the biopsy was non-diagnostic and the diagnosis was made by surgery. Core-needle biopsy was diagnostic in 47 of 50 (94 %) of the malignant solid tumors. In 3 out of 5 children with lymphoma, an accurate diagnosis was obtained with needle aspiration. Seven children underwent a repeated core-needle biopsy, (5 for Wilms' tumor and 2 for neuroblastoma) that was diagnostic in all cases. All the biopsies were performed without complications. Conclusion: Percutaneous image-guided needle biopsy is a simple, minimally invasive, safe and accurate method for the evaluation of children with suspicious masses. These data suggest that image-guided needle biopsy is an excellent tool for diagnosing solid tumors in the pediatric population. Negative studies should be considered nondiagnostic and followed by excisional surgical biopsies when clinical suspicion of malignancy is high. Received: 8 August 2000 Accepted: 8 May 2001     

Ultrasound-guided core needle biopsy in diagnosis of abdominal and pelvic neoplasm in pediatric patients

Background

Ultrasound-guided core needle biopsy of abdominal and pelvic masses in adults has gained tremendous popularity. However, the application of the same treatment in children is not as popular because of apprehensions regarding inadequate tissues for the biopsy and accidental puncture of vital organs.

Methods

Data of the application of ultrasound-guided core needle biopsy in 105 pediatric patients with clinically or ultrasound-diagnosed abdominopelvic masses were reviewed. Diagnostic procedures were conducted in our institution from May 2011 to May 2013.

Results

The biopsies were conducted on 86 malignant lesions and 19 benign lesions. 86 malignant tumors comprised neuroblastomas (30 cases), hepatoblastomas (15 cases), nephroblastomas (11 cases), and primitive neuroectodermal tumors/malignant small round cells (6 cases). Among malignant tumor cases, only a pelvic primitive neuroectodermal tumor did not receive a pathological diagnosis. Therefore, the biopsy accuracy was 98.8 % in malignant tumor. However, the biopsies for one neuroblastomas and one malignant small round cell tumor were inadequate for cytogenetic analysis. Therefore, 96.5 % of the malignant tumor patients received complete diagnosis via biopsy. 19 benign tumors comprised mature teratoma (10 cases), hemangioendothelioma (3 cases), paraganglioma (2 cases), and infection (2 cases). The diagnostic accuracy for benign neoplasm was 100 %. Five patients experienced postoperative complications, including pain (2 patients), bleeding from the biopsy site (2 patients), and wound infection (1 patient).

Conclusion

Ultrasound-guided core needle biopsy is an efficient, minimally invasive, accurate, and safe diagnostic method that can be applied in the management of abdominal or pelvic mass of pediatric patients.     

Percutaneous fine needle biopsy in pediatrics

We performed 25 percutaneous fine needle biopsies (PFNB) on pediatric patients during a 3-year period. Of 17 patients with proven malignancies, PFNB was true positive in 16 and false negative in one. In nine patients with benign or inflammatory disorders, there were three true positives and six false negatives. There were no complications either from PFNB or larger caliber core biopsies, which were also performed in selected cases. All procedures were performed with ultrasound and/or fluoroscopic guidance. General anesthesia was not required, except in cases where PFNB was performed together with a surgical procedure. PFNB is as accurate and safe in pediatric patients as in adults. It should be considered prior to any open surgical procedure performed for biopsy alone.     

婴儿中枢神经系统肿瘤的生存和预后影响因素多中心回顾性队列研究

背景 婴儿期起病的中枢神经系统(CNS)肿瘤临床罕见,国内少见报道.目的 探讨婴儿期起病的CNS肿瘤患儿的临床特征、病理类型、治疗结局及预后的影响因素.设计回顾性队列研究.方法 以2011年6月至2019年12月婴儿原发CNS肿瘤病例为队列起点,采用多学科诊疗模式手术联合化疗,以2020年3月31日为随访终点,采集性别...     

腹腔镜与开腹手术治疗小儿大网膜囊肿的对比研究

目的 探讨腹腔镜手术治疗小儿大网膜囊肿的安全性及临床效果.方法 回顾性分析2003年11月至2012年2月我们实施手术的12例大网膜囊肿患儿临床资料.将患儿分成腹腔镜手术组（6例）和开腹手术组（6例）,比较两组患儿手术时年龄、手术时间、术后完全恢复饮食时间、术后住院时间及术后并发症的发生率等指标.采用SPSS 13.0软件对收集的数据进行统计学分析.结果 12例大网膜囊肿患儿临床表现为腹部膨隆8例（占66.7%）,纳差8例（占66.7%）,腹痛5例（占41.7%）,恶心呕吐4例（占33.3%）,腹胀3例（占25%）.女性患儿多于男性患儿（女∶男为8：4）.均为单发囊肿,囊肿大小为（1 283.37±701.85）cm3,囊肿内出现分隔10例（占83.3%）,无分隔2例（占16.7%）.两组患儿性别、手术时年龄、体重、临床表现、囊肿一般情况及囊肿大小比较,差异均无统计学意义（P〉 0.05）.腹腔镜手术组无一例中转开腹手术,手术时间（66.33±23.71）min,开腹手术组手术时间（82.50±25.04）min,差异无统计学意义（P〉0.05）.腹腔镜手术组术后完全恢复饮食时间（1.00±0.00）d、术后住院时间（3.33±0.52）d,开腹手术组分别为（2.17±0.75）d、（7.00±0.00）d,两组差异有统计学意义（P〈0.05）.两组患儿术后均恢复满意,无出血、感染、梗阻、肠瘘等近期并发症发生,腹腔镜手术组随访时间5个月至4年10个月;开腹手术组随访时间5年9个月至8年8个月,患儿均无囊肿复发、肠梗阻等远期并发症.结论 腹腔镜技术治疗大网膜囊肿安全,有效,可行,为儿童大网膜淋巴管瘤提供了新的手术途径.     

甲基丙二酸血症合并癫痫27例临床特点及预后分析

总结甲基丙二酸血症（MMA）合并癫痫的临床特点及预后。方法　对1997年1月至2009年12月北京大学第一医院儿科住院确诊的27例MMA合并癫痫发作患儿的临床资料、辅助检查结果、随访资料进行分析。结果　27例患儿除癫痫发作外,合并其他神经系统受损表现包括：智力运动发育落后或倒退22例、发作性嗜睡10例、肌张力增高8例、肌张力减低8例、反复呕吐4例、震颤和共济失调各2例、姿势异常1例。癫痫首次发作年龄为生后8d至11岁,发作类型包括部分性发作21例、全面强直阵挛发作5例、强直发作3例、肌阵挛发作3例,痉挛发作2例;5例患儿同时有2～3种发作类型。脑电图（EEG）检查有22例异常,包括：背景节律慢17例,局灶或多灶性痫样放电16例、广泛性痫样放电4例、高度失律2例和爆发抑制1例。头颅MRI检查24例显示脑萎缩14例,脑白质异常信号12例,胼胝体发育不良2例,双侧基底节病变2例和小脑萎缩1例。维生素B12有效型较维生素B12无效型患儿预后好。结论　癫痫是MMA的常见症状,部分性发作较其他发作类型更常见。对不明原因的癫痫患儿若伴其他神经系统症状,应进行尿有机酸分析,早期明确病因诊断,改善预后。     

Ultrasound guidance. For interventional and intraoperative techniques in infants and children

Since the advent of improved realtime ultrasound (US) imaging and the availability of the needle biopsy attachment, US-guided percutaneous biopsy and the drainage procedure can be performed safely in the pediatric patient. The authors review their experience over 3 years using US-guided interventional techniques in 96 children aged 5 days to 21 years. A wide variety of procedures were performed and included renal biopsy, nephrostomy tube placement, renal mass biopsy, puncture of bladder sinus tract and pancreatic pseudocyst, ventriculoperitoneal shunt placement and intraoperative localization of brain or renal tumor and renal calculi. No complication occurred. US can be safely and accurately used as guide for interventional procedures in children as long as the area of interest can be clearly demonstrated and the depth and necessary angle of needle insertion can be predetermined as feasible.     

肺脏超声对新生儿肺炎诊断价值的Meta分析

目的　采用 Meta 分析方法来评价肺脏超声对新生儿肺炎的诊断价值。方法　检索PubMed、Cochrane library、Embase、CNKI 和万方数据库,按照诊断性试验的纳入和排除标准,获取符合本研究要求的文献,检索时间为建库至 2018年9月。共检索到907篇文献,选取其中8篇进一步分析,并对文献质量进行QUADAS2标准评价,采用Q检验和I 2统计量进行异质性检验,采用 Meta-Disc 1.4 软件进行统计学分析,评价肺脏超声对新生儿肺炎的诊断价值。 结果　共纳入8篇文献、1078例。采用随机效应模型对纳入的研究进行统计分析,合并敏感度为0.96（95%CI：0.95～0.98）,合并特异度为0.98（95%CI：0.95～0.99）,合并阳性似然比为19.52（95%CI：5.00～76.15）,合并阴性似然比为0.04（95%CI：0.01～0.16）,合并诊断优势比为565.45（81.80～3908.58）,拟合ROC 曲线下面积0.9950。结论　肺脏超声诊断新生儿肺炎的敏感度和特异度较X线高。鉴于其相对容易操作、实时可用、低成本和无电离辐射,目前的证据支持超声作为新生儿肺炎诊断的替代手段。