镀银染色研究大鼠肠系膜淋巴结网状纤维支架

目的:研究淋巴结内网状细胞和网状纤维网的形态、密度、排列方式及其空间联系,探讨淋巴结基质的组织构筑与功能.方法:用镀银染色光镜观察法观察健康、成熟Wistar大鼠肠系膜淋巴结的基质网状结构.结果:淋巴结的基质结构主要由网状细胞和网状纤维组成,网状纤维由很多细束的原纤维组成.淋巴结内丰富的网状纤维互相交织,且与血管、淋巴窦和淋巴迷路管壁纤维网以及与被膜相延续,在整个器官内形成了三维、连绵不断的网状纤维网,构成淋巴结的结构支架.网状细胞和网状纤维网的形态、密度、排列方式及其空间联系等有区域性差别,大致可分为被膜及被膜下窦区、浅层皮质区、深层皮质区和髓质区.各个结构区间的纤维网互相连续.结论:淋巴结内网状纤维的排列与相关的网状细胞紧密相联,形成不同形式的网状纤维网,构成了淋巴结的结构支架,为细胞的居留和迁移提供结构支持和适宜的微环境.     

窦组织细胞增生伴巨大淋巴结病1例

1 病例介绍 男性,48岁,2004年3月无明显诱因出现颈部、腋下、腹股沟肿物并逐渐增大,无疼痛、发热等.4月行颈部、左腋下淋巴结活检术,病理报告:镜下见淋巴窦扩大,组织细胞增生,可见吞噬淋巴细胞现象,符合特发性窦组织细胞增生性巨大淋巴结病.     

鼻内镜上颌窦手术不同入路视野的差异与效果分析

目的:探讨分析鼻内镜上颌窦手术不同入路视野的差异与效果。方法:选择60例慢性鼻窦炎患者(男性为A患者,女性为B患者;A左侧上颌窦腔、A右侧上颌窦腔、B左侧上颌窦腔和B右侧上颌窦腔),都进行上颌窦腔的观察,然后对A右侧上颌窦腔进行前壁开窗术、中鼻道开窗术和下鼻道开窗术检查,并同时应用CT三维重建分析。结果:病例A的窦腔的容积、窦底深度明显多于B病例,同时气化良好、颧骨隐窝较深与泪前隐窝比较明显(P<0.05)。前壁开窗下前壁、后壁、外侧壁、顶壁、内壁、窦底、颧骨隐窝及泪前隐窝的视野都比较好,中鼻道开窗下外侧壁和颧骨隐窝有很好的视野,下鼻道开窗下内壁与泪前隐窝相对比较差,不同入路方式的总体视野对比有明显差异(P<0.05)。三维重建也显示前壁开窗入路对于上颌窦的暴露较中鼻道开窗和下鼻道开窗有明显优势(P<0.05)。结论:鼻内镜的应用有很好的应用优势,能清晰地显示腔道结构,经标准上颌窦前壁开窗的视野范围较大,从而有利于鼻窦窦病变彻底清除。     

鼻内窥镜术筛窦粘膜的不同处理对临床恢复影响的研究

目的 :比较内窥镜术中筛窦粘膜的保留与清除对其临床恢复过程的影响。方法 :鼻窦炎 30例术后随访 ,观察筛窦粘膜的上皮化进程、并发症的发生及临床疗效。结果 :保留筛窦粘膜侧其筛窦术腔囊泡、肉芽形成及窦口狭窄发生减少 ,上皮化时间亦明显缩短 ,两组比较差异有显著性 ( P<0 .0 5 )。结论 :鼻内窥镜术中应最大限度地保留窦腔粘膜     

窦汇及上矢状窦窦腔内结构的内窥镜及显微镜解剖学特点

目的：通过内窥镜及显微镜观察成年人上矢状窦、窦汇窦腔及其内的纤维索、蛛网膜颗粒结构的解剖学形态特征。方法：取新鲜成年人头颅标本5具，去除颅盖，完整取出上矢状窦、下矢状窦、窦汇、两侧横窦及其周边硬膜，应用内窥镜观察上矢状窦、窦汇窦腔内纤维索及蛛网膜颗粒的原始结构特征，并沿窦腔上壁中线纵行剖开管腔，显微镜下观察纤维索及蛛网膜颗粒的形态结构。结果：上矢状窦管腔内纤维索分3种类型：瓣膜状（47.1％）、小梁状（30.6％）、板层状（22.3％）。蛛网膜颗粒多集中于上矢状窦中段侧壁及静脉隐窝处呈指状突起突入窦腔。上矢状窦最后段近窦汇区有纵行板层状纤维索结构，将上矢状窦最后段管腔分为左右两个单独管道，有分流和支撑作用。窦汇区腔内亦存在少量板层状纤维索结构，直窦开口常偏向右侧。结论：内窥镜较常规解剖手段可以更直接地观察窦汇及上矢状窦腔内结构的完整形态特征。     

传统上颌窦根治术后上颌窦骨质增生瘢痕形成的临床观察

目的: 研究传统上颌窦根治术后上颌窦局部骨质增生与瘢痕形成的病理改变情况,并讨论其临床意义. 方法: 回顾性分析136例曾行传统上颌窦根治术,后因复发鼻窦炎或鼻息肉来我院就诊且需行手术治疗的患者,术前CT扫描分析上颌窦骨质增生及窦腔容积变化程度以及术中内镜下观察上颌窦腔及下鼻道开窗情况. 结果: 在136例中有48例(35%)术前CT检查发现上颌窦腔密度增高,明显骨质增厚. 手术发现窦腔明显缩小,腔内大量瘢痕. 在48例骨质增生患者中有22例(46%)下鼻道开窗闭锁. 在术前CT显示无上颌窦腔密度增高及骨质增厚的88例病例中,有26例(30%)术中发现有单纯性下鼻道开窗闭锁. 结论: 传统上颌窦根治术可引起上颌窦腔骨质增厚瘢痕形成,降低并发症的重要方法是严格掌握适应症.     

上颌窦窦腔造影对上颌窦病变的诊断意义

鼻窦疾病在X线平片上共性表现多,尤其是单个窦腔密度增高,常需进一步进行窦腔造影等检查。为探讨窦腔造影的价值,本文收集19例临床资料分析如下。(一)临床资料19例中男12例,女7例。年龄16～60岁,平均38岁。上颌窦造影采用直接穿刺法,注入40%碘化油(量以窦腔大小而定)后摄华氏位和侧位片,造影完毕将窦腔内造影剂尽量抽出。5例上颌窦慢性炎症X线平片均显示为窦腔密度均匀性增高,窦腔无扩大;造影片见高密度造影剂和窦壁致密骨衬托下显示周壁粘膜增厚之低密度带,低密度带边缘较光滑。2例上颌窦粘膜下囊肿及1例粘膜腺囊肿平片均显示窦腔下壁半圆形软组织块影,边缘光滑柔软;造影片显示窦腔外下壁半圆     

颈部肿块和瘢痕病变致颈动脉窦过敏综合征(附2例报告)

报告１例鼻咽癌颈淋巴结转移致颈动脉窦过敏综合征和１例全喉切除加颈淋巴结清扫术术后瘢痕形成出现颈动脉窦过敏综合征。对耳鼻咽喉科相关疾病引起的颈部肿块和瘢痕病变压迫颈动脉窦所致颈动脉窦过敏综合征的致病原因、临床表现及诊断、治疗原则进行了讨论。此类患者在临床上少见,易误诊,应引起重视。     

海绵窦区的形态学研究

目的：了解海绵窦区的结构特点，为颈动脉海绵窦瘘血管内治疗提供形态学依据。方法：对3例新鲜标本用15％ABS(丙烯氰、丁二烯、苯乙烯三元共聚塑料)环已酮溶液作铸型剂灌注，饱和次氯酸钠溶液浸泡海绵窦铸型标本。并制作石蜡组织切片，观察海绵窦的内外侧壁的层次，了解其显微结构。结果：海绵窦及其交通窦以及海绵窦内神经组织显示良好，微小血管显示完全。显微结构显示清晰。结论：海绵窦是由宽大的主腔及位于外侧壁的很多静脉腔所组成，海绵窦内有穿行的神经纤维及颈内动脉及其分支。这些结构与血管内治疗有密切关系。     

颈部肿块和瘢痕病变致颈动脉窦过敏综合征

报告１例鼻咽癌颈淋巴结转移致颈动脉窦过敏综合征和１例全喉切除加颈淋巴结清扫术术后瘢痕形成出现颈动脉窦过敏综合征。对耳鼻咽喉科相关疾病引起的颈部肿块和瘢痕病变压迫颈动脉窦所致颈动窦过敏综合征的致病原因,临床表现及诊断,治疗原则进行了讨论,此类患者在临床上少见,易误诊,应引起重视。     

纵隔淋巴结显色的实验研究

目的:观察叶绿酸显示液对纵隔淋巴结显色情况,为其进一步在科研和肺癌手术中的应用提供参考。方法:对6只狗(1只作为对照组,5只作为实验组)注射叶绿酸显示液前、后纵隔淋巴结的染色情况进行观察研究。结果:注射叶绿酸显示液后,纵隔各部淋巴结迅速染成墨绿色,与附近的血管、神经对比明显。光镜观察到叶绿酸颗粒位于淋巴结的被膜下窦和小梁周窦;随时间延长,亦进入髓质;透射电镜下皮、髓质内均出现叶绿酸颗粒,但未发现淋巴结细胞超微结构发生改变。结论:叶绿酸显示液能够迅速显色纵隔淋巴结,且无急性毒副作用。     

非小细胞肺癌患者淋巴结分子分期的临床病理研究

目的探讨逆转录聚合酶链反应（RT-PCR）检测非小细胞肺癌淋巴结微转移的可行性。方法术中将每枚淋巴结平均分成两半,一半淋巴结进行HE染色病理检查;另一半淋巴结,按区域混合,用于RT-PCR。如果一枚淋巴结HE染色证实有显性转移,该患者同一区域的其他淋巴结不再接受RT-PCR。结果（1）25例肺癌患者中共195枚淋巴结接受了HE染色检查,9例共30枚淋巴结中发现有显性转移,无一枚淋巴结检出微转移。（2）39组HE染色阴性的区域淋巴结混合组织中,11组RT-PCR呈阳性。（3）16例常规病理PN现了0期患者中,6例肺门淋巴结出现了微转移;另9例常规病理PN1期患者中,5例出纵隔淋巴结的微转移,差异有统计学意义（x^2=54．063,P=0．0043）。结论（1）HE染色病理能准确地检测出非小细胞肺癌淋巴结中的显性转移灶,而不易发现隐匿性微转移灶。（2）RT-PCR能提高非小细胞肺癌淋巴结微转移的检出率,并可对部分Ⅰ、Ⅱ期患者重新进行分子分期。     

胸段食管鳞癌淋巴结转移规律的临床研究

OBJECTIVE: To analyze the patterns of lymph node metastases of thoracic esophageal carcinoma and define the adequate range of lymph node dissection. METHODS: The clinical data of 217 patients with esophageal carcinoma undergoing radical surgical resection of the lymph nodes in three regions were retrospectively analyzed. RESULTS: Lymph node metastases were found in 136 of the 217 patients (62.6%) and skip metastases of the lymph nodes in 12 patients (5.5%). In 3 989 lymph nodes desected, metastases were identified in 454 lymph nodes (11.38%). The rates of lymph node metastasis were 31.7%, 21.2% and 12.1% in the neck, thoracic mediastinum and abdominal cavity, respectively, in upper thoracic esophageal carcinoma, 21.9%, 30.5% and 15.6% in middle thoracic carcinoma, and 9.75%, 12.7% and 34.5% in lower thoracic carcinoma. The degree of tumor differentiation, depth of tumor invasion and lymphatic vessel invasion were factors influencing lymph node metastases (P<0.05). CONCLUSION: Because of the upward, downward and skip metastasis of esophageal carcinoma cells to the lymph nodes, the operable patients with thoracic esophagus carcinoma should receive radical desection of the lymph nodes in the 3 regions to promote the patients' survival.     

超声技术诊断转移淋巴结的研究进展

淋巴结是否转移是一个评价恶性肿瘤患者分期及预后的最相关的指标,术前无创或微创准确预测淋巴结性质对恶性肿瘤患者非常重要.超声技术是临床目前最常用的术前淋巴结评判工具之一,转移淋巴结的二维灰阶超声诊断标准是淋巴结大小、皮质厚度、形状、边界、淋巴门及中心坏死区等评估,但淋巴结的血流分布及血管模式等对淋巴结疾病的鉴别有着重要的价值.本文综述了超声技术在转移淋巴结血流显像的研究进展.     

肺癌淋巴结微转移诊断的对比研究

目的探索检测非小细胞肺癌淋巴结微转移的新途径。方法术中将25例非小细胞肺癌患者共195枚淋巴结平均分成两半,一半淋巴结用于常规病理和免疫组织化学染色;另一半淋巴结,按区域混合,用于逆转录聚合酶链反应（RT-PCR）。如果一枚淋巴结常规病理证实有显性转移,该患者同一区域的其他淋巴结不再接受免疫组织化学染色或RT-PCR检测。结果135枚常规病理阴性的淋巴结接受了免疫组织化学染色,31枚淋巴结显现肿瘤微转移。39组常规病理阴性的区域淋巴结混合组织中,11组RT-PCR检测呈阳性。免疫组织化学染色和RT-PCR检测肺癌淋巴结微转移,结果间存在一致性（U=7．682,P=0．0001）。结论免疫组织化学染色能提高非小细胞肺癌淋巴结微转移的检出率,并可对部分Ⅰ、Ⅱ期患者重新进行TNM分期。RT-PCR在检测肺癌淋巴结微转移方面,与免疫组织化学染色价值相当。RT-PCR可以简化淋巴结微转移的检测。     

胸段食管鳞癌淋巴结转移规律的临床研究

目的 分析胸段食管癌淋巴结转移规律,探讨合理的淋巴结清扫范围.方法 对17例经"三区域"淋巴结清除根治术的食管癌患者的临床资料进行回顾性分析.结果 全组淋巴结转移率6.6%,转移度11.38%,淋巴结"跳跃性转移"率为5.5%.胸上、中、下段食管癌颈部、胸部和腹腔淋巴结转移率分别达到31.7%、1.9%、9.75%,1.%、30.5%、1.7%和1.1%、15.6%、34.5%.影响淋巴结转移的因素为肿瘤浸润深度、分化程度及有无淋巴管浸润(P<0.05).结论 胸段食管癌表现出上下"双向性"转移和跳跃性转移的特点,对胸段食管癌尤其是胸上、中段食管癌在条件具备时应施行"三区域"淋巴结清扫术,以提高患者的5年生存率.     

Clinical pathology of nodal micrometasteses in non-small cell lung cancer

ObjectiveTo explore whether the conventional pathologic stages of some non-small cell lung cancer (NSCLC) patients were underestimated.Methods195 lymph node samples were taken from 25 NSCLC patients during the operations. Firstly, each resulting tissue block was processed for routine paraffin embedding. Then the 6～10 serial sections were chosen, each 5 μm thick, from every paraffin block of the lymph node. Finally, the first and the second last sections of each lymph node were stained by hematoxylin eosin (HE), and the other serial sections were used for the immunohistochemical (IHC) staining examination with the monoclonal antibody against cyokeratin 19.ResultsWith HE staining, 30 of the 195 regional lymph nodes revealed dominant nodal metastases, and none showed micrometastases. IHC staining was performed on 135 lymph nodes that were identified as free of metastases by HE staining, 31 showed micrometastases; none showed gross nodal metastases. There was a significant difference between HE staining staging and IHC staining staging (P<0.05).ConclusionConventional HE staining can accurately detect gross nodal metastases in the lymph nodes of NSCLC patients, but is unfit for detecting lymph nodal micrometastases. IHC staining analysis can significantly facilitate the detection of occult micrometastatic tumor cells in lymph nodes, and its assessment of nodal micrometastases can provide a refinement of TNM stage for NSCLC patients. Our results provide a rationale for extensive lymph nodes sampling.     

Contribution of minute axillary lymph nodes to accurate staging for patients with breast cancer

Background Axillary lymph node metastasis is a very important metastatic pathway in breast cancer and its accurate detection is important for staging tumour and guiding therapy. However, neither the accuracy of routine detection of lymph node in surgical specimens nor the significance of minute lymph node with metastases in breast cancer is clear. A modified method for conveniently detecting minute lymph node in specimens of axillary dissections in patients with breast cancer was used to analyze their influence on staging breast cancer. Methods Lymph nodes in fresh, unfixed, specimens of axillary dissections from 127 cases of breast cancer were detected routinely. Then the axillary fatty tissues were cut into 1 cm thick pieces, soaked in Carnoy’s solution for 6 to 12 hours, taken out and put on a glass plate. Minute lymph nodes were detected by light of bottom lamp and examined by routine pathology. Results Lymph nodes (n= 2483, 19.6±8.0 per case) were found by routine method. A further 879 lymph nodes up to 6 mm (781 &lt; 3 mm, 6.9±5.3 per case, increasing mean to 26.5±9.7) were found from the axillary tissues after soaking in Carnoy’s solution. By detection of minute lymph nodes, the stages of lymph node metastasis in 7 cases were changed from pathological node (pN) stage pN(0) to pN(1) in 4 cases, from pN(1) to pN(2) in 2 and from pN(2) to pN(3) in 1. Conclusions The accurate staging of axillary lymph node metastasis can be obtained routinely with number of axillary lymph nodes in most cases of breast cancer. To avoid neglecting minute lymph nodes with metastases, small axillary nodes should be searched carefully in the cases of earlier breast cancer with no swollen axillary nodes. Treatment with Carnoy’s solution can expediently detect minute axillary nodes and improve the accurate staging of lymph nodes in breast cancer.     

左锁骨上淋巴结转移癌的病理分析

对23例左锁骨上淋巴结转移癌进行了病理分析。在23例病人中,胃癌7例,肺癌6例,食管癌5例。左锁骨上淋巴结肿瘤转移发生于手术前或手术后。8例左锁骨上淋巴结除实质内有癌组织外,输入淋巴管、被膜下窦和小梁周窦内含有癌细胞,2例左锁骨上淋巴结只在输入淋巴管和被膜下窦内含有癌细胞,而这些淋巴结的输出淋巴管内无癌细胞,这表明癌细胞是经输入淋巴管转移至左锁骨上淋巴结的。     

超声途径探讨甲状腺疾病时颈部淋巴结受累区域特点

目的:总结彩超探讨甲状腺疾病时颈部淋巴结受累区域分布特点。方法:按颈部解剖分别扫查下颌下三角、颏下三角、颈动脉三角、肌三角、颈外侧区包括枕三角与锁骨上窝,探查颈浅及颈深淋巴结,将400例甲状腺疾病时确诊受累的颈部淋巴结归入颈部淋巴结引流各分区,并分析总结不同甲状腺疾病时周边受累淋巴结区域分布。结果:400例甲状腺疾病大部分存在颈部淋巴结受累,其区域分布特点明显,主要是颈前、气管旁、颈深淋巴结,彩超可以较明确划归。结论:因颈部淋巴结引流特点及超声在颈部检查的优越性,彩超途径探讨甲状腺疾病的淋巴结受累区域分布特点方便而实用。