不同直径穿刺针对超声引导下经皮移植肾活检的影响

目的比较在超声引导下应用不同直径穿刺针行经皮移植肾活组织检查(活检)的效果。方法接受超声引导下经皮移植肾穿刺活检的患者82例,按所用穿刺针直径将其分成两组,18 G组(31例)和16 G组(51例)。比较两组活检效果及并发症的发生情况。结果与18 G组比较,16 G组的穿刺针数较少,且取得的肾小球数量较多(均为P0.01)。16 G组的取材合格率明显高于18 G组(P0.05)。两组患者术后并发症发生率比较差异无统计学意义(P0.05)。进一步分层比较,同为2针或3针穿刺时,两组的并发症发生率比较差异亦无统计学意义(均为P0.05)。结论在超声引导下行移植肾穿刺活检,采用16 G穿刺针和18 G穿刺针穿刺的安全性相近。在患者病情的允许下,采用16 G穿刺针较18 G穿刺针更具有优势,肾取材标本的质量较高。     

超声引导自动肝穿刺活检对AFP阴性肝占位病变的临床诊断价值

为探讨应用超声引导自动活检枪肝穿刺活检对血AFP阴性肝占位病变的临床诊断价值。笔者近3年来应用彩色超声引导下自动活检枪肝穿刺对２３例ＨＢsＡg及ＡＦＰ均为阴性的肝实性占位性病变患者行活组织病理检查。结果示23例患者均为B超、CT检查发现占位病变，无临床典型表现。肿瘤大小2~4cm，13例为单发结节,10例为多发结节。其中既往有肿瘤手术病史的11例，均无肝炎病史。经超声引导自动肝穿活检获得明确诊断。无腹壁针道肿瘤种植。提示彩超引导下自动活检枪肝穿刺活检病理检查对肝脏实性占位性病变，尤其是血AFP阴性、临床诊断有疑问的患者有确诊意义。     

仰角穿刺法在腹腔镜超声引导下肝癌射频消融的应用

目的探讨应用"仰角"穿刺法进行腹腔镜超声引导下肝脏Ⅶ、Ⅷ段肿瘤射频消融术(RFA)的安全性及可行性。 方法回顾性分析解放军总医院肝胆胰肿瘤外科2015年7月至2016年1月行腹腔镜超声引导下肝脏Ⅶ、Ⅷ段肿瘤RFA患者的临床资料。 结果5例患者均成功地应用仰角穿刺法完成RFA,未出现严重并发症。平均射频消融引导时间(4.4 ± 5.7)min,肿瘤完全坏死率为100%。平均随访时间4.8个月,未发现肿瘤复发。 结论在腹腔镜超声引导下肝脏Ⅶ、Ⅷ段肿瘤RFA中通过"仰角"穿刺法计算穿刺路径的方法是安全可行的。     

超声造影引导浅表肿物穿刺活检术的应用

目的:探讨超声造影引导浅表肿物穿刺活检的价值.方法:将106例浅表肿物患者分为造影组及常规组,造影组47例接受超声造影引导下穿刺活检术,常规组59例接受常规超声引导下穿刺活检术,以术后病理为参照,比较两组穿刺活检的阳性率差异.结果:造影组及常规组穿刺活检术的阳性率分别为95.74%、83.05%,差异有统计学意义(P=0.04).结论:超声造影引导下浅表肿物穿刺活检术具有较高临床应用价值.     

经直肠超声引导下9+X点法前列腺穿刺活检术的临床经验

正经直肠超声引导下前列腺穿刺活检术(Transrectal ultrasound-guided protste biopsy)是诊断前列腺癌的最可靠的检查[1],但回顾性分析大量临床资料后发现,常规的前列腺穿刺活检术因外周区穿刺取材太少,并易漏诊外周带的肿瘤病灶而存在缺陷,此外,前列腺穿刺的阳性检出率还随着前列腺体积的增大而下降,而穿刺针数的增多必然增加了患者痛苦     

经直肠超声造影靶向前列腺穿刺活检在PSA水平为4~20 ng/ml患者中的作用

目的：探讨前列腺超声造影在经直肠前列腺靶向穿刺活检中的临床应用价值.方法选择96例血清PSA在4~20 ng/ml行前列腺穿刺活检的患者,其中50例行经直肠超声前列腺13针系统性穿刺活检;46例先行经直肠前列腺超声造影,后对超声造影异常增强区靶向穿刺加6点常规穿刺,超声造影无异常者同系统性穿刺.比较两组穿刺活检的效率.结果系统性穿刺组前列腺癌的阳性率为22.0％,造影穿刺组为41.3％,两组间对单纯移行区肿瘤的检出率有统计学差异(P＜0.05).系统穿刺组人均穿刺13.0针,单针阳性率为11％;造影穿刺组人均穿刺10.9针,单针阳性率为20％;两组单针阳性率、人均穿刺针数差异均有统计学意义(P＜0.05).超声造影异常的患者单针阳性率明显高于普通超声检查的患者(31.5％ v s 11.3％),同时人均穿刺针数低于超声引导下系统性穿刺(9.7 vs 13.0针),差异具有统计学意义(P＜0.05).系统性穿刺组前列腺癌患者总 Gleason评分为74分,人均6.7分,超声造影穿刺组则分别为133、7.0分,两组比较有统计学差异.两组无严重并发症.结论对于PSA＜20 ng/ml 的患者,超声造影对引导经直肠前列腺靶向穿刺活检具有更高的效率,可减轻患者的痛苦.     

腹腔镜超声在胰腺壶腹部肿瘤分期诊断和治疗中的价值

目的 评价腹腔镜超声技术(LapUS)在胰腺和壶腹部癌肿分期诊断和治疗中的临床应用价值。方法 自1996年12月～1999年12月连续对46例怀疑胰腺和壶腹部肿瘤病人进行腹腔镜和腹腔镜超声分期诊断。并与术前影像学检查、手术中发现及术后标本病理学检查进行前瞻对比研究。着重检查肿瘤范围、周围血管侵犯、周围淋巴结转移、浆膜浸润和肝、邻近脏器转移;对可疑病变和肿大的淋巴结进行腹腔镜超声引导下穿刺活检。判断肿瘤切除性。结果 46例病人中。LapUS发现肿块性病灶44例,2例阻塞性黄疸确诊为壶腹部结石嵌顿排除肿瘤。44例肿块性病变中41例为恶性肿瘤,3例为炎性病变,肿瘤诊断正确率为93．2％。本组未发生腹腔镜和腹腔镜超声检查有关并发症。结论腹腔镜和腹腔镜超声检查应列为重要的分期诊断工具,剖腹探查前常规应用可明显提高诊断正确率、完善肿瘤分期诊断和可切除性判断。可避免不必要的剖腹探查术。在微创外科诊治中具有重要的临床应用价值。     

CT多平面重建图像引导肝脏顶部病变经皮穿刺活检术

目的探讨CTMPR图像引导肝脏顶部病变经皮穿刺活检术的应用价值。方法收集CT检查发现右膈下肝顶部局限性病灶的49例患者,于螺旋CTMPR技术引导下行右膈下肝脏穿刺活检,统计取材成功率及并发症。结果49例穿刺活检均获得成功;取材组织均呈圆柱状,全部获得病变组织,能够用于病理诊断。并发症包括少量气胸2例,右肺小片状出血5例,肝包膜下少量出血1例;无肝内血肿及穿刺相关死亡病例。结论CTMPR技术引导肝顶部病灶经皮穿刺活检术安全、可行,值得推广。     

超声引导下麦默通旋切系统与BARD活检针在乳腺触诊阴性病灶诊断中的价值

目的比较超声引导下麦默通旋切系统与BARD活检针在乳腺触诊阴性病灶诊断中的价值。方法选择本院经乳腺钼靶X线检查、乳腺超声检查发现而临床触诊结果为阴性的90例乳腺肿瘤患者(2017年1月至2019年1月)进行回顾性研究,所有患者均接受BARD活检针穿刺活检、超声引导下麦默通旋切活检,以手术病理诊断结果为参照,计算和比较BARD活检针穿刺活检、超声引导下麦默通旋切活检对乳腺癌的诊断灵敏度、特异度、准确率,分析其与手术病理诊断结果之间的一致性,并比较两种活检方法下患者的并发症发生率。结果①90例乳腺肿瘤患者中,有30例患者经手术病理诊断证实为乳腺癌,其余60例乳腺肿瘤为良性病变。以手术病理诊断结果为参照,超声引导下麦默通旋切活检对乳腺癌的诊断灵敏度、特异度、准确率均较BARD活检针穿刺活检更高(P0.05);超声引导下麦默通旋切活检与手术病理诊断结果之间的一致性良好,而BARD活检针穿刺活检与手术病理诊断结果间的一致性中等。②超声引导下麦默通旋切活检的并发症总发生率较BARD活检针穿刺活检更低(P0.05)。结论超声引导下麦默通旋切系统活检可提高触诊阴性乳腺病灶的定性诊断准确性,还可提高其穿刺活检的安全性。     

超声造影引导浅表肿物穿刺活检术的应用

目的探讨超声造影引导浅表肿物穿刺活检的价值。方法将106例浅表肿物患者分为造影组及常规组,造影组47例接受超声造影引导下穿刺活检术,常规组59例接受常规超声引导下穿刺活检术,以术后病理为参照,比较两组穿刺活检的阳性率差异。结果造影组及常规组穿刺活检术的阳性率分别为95.74%、83.05%,差异有统计学意义（P=0.04）。结论超声造影引导下浅表肿物穿刺活检术具有较高临床应用价值。     

Laparoscopic ultrasonography and biopsy of hepatic tumors in 310 patients

BACKGROUND: Laparoscopic ultrasonography is increasingly being recognized as an important tool in the evaluation of patients with possible hepatic tumors. The aim of this paper is to describe the technical aspects of imaging and biopsy based on our experience in 310 patients with 1,080 primary and metastatic liver tumors within a 6.5-year period. METHODS: A 10-mm rigid or flexible, 7.5 MHz linear, side-viewing laparoscopic ultrasonography probe was used for imaging, and an 18G spring-loaded core biopsy gun was used for tissue diagnosis. RESULTS: There were no complications. The entire liver was imaged using a right subcostal port. Using a free-hand technique, the needle was best targeted into the lesion when inserted parallel to the plane of the transducer. The rigid transducer was found to be more convenient to guide needle placement. CONCLUSIONS: The use of this minimally invasive technique avoids laparotomy in many patients undergoing staging of malignancy and also offers increased sensitivity for tumor detection compared with conventional imaging modalities.     

Ultrasonographic laparoscopy of the liver

SITUATION: In spite of recent progress in medical imagery, the findings of preoperative investigations of the liver are not always accurate and precise. Since the development of surgical laparoscopy, advantages of the laparoscopic examination are associated with advantages of laparoscopic ultrasonography. OBJECTIVE: The purpose of this work is to report the technique of staging laparoscopy with laparoscopic contact ultrasonography in the intraoperative assessment of patients with liver tumors, and to analyse its impact on the selection of patients for hepatic resection with curative intent. METHODS: The basic exploration follows at first portal branches and then hepatic veins. During the course of vascular exploration, the corresponding liver parenchyma is examined. A mobilization of the probe with clockwise or anticlockwise rotation movements allows full exploration of the liver. RESULTS: The association of laparoscopic examination and laparoscopic ultrasonography allows to localize with accuracy malignant and benign lesions and to perform ultrasound guided biopsy. Liver tumors not visible on preoperative imagery may be identified, relationships with adjacent vessels and presence of tumoral thrombi in major vascular structures may be assessed. Resectability of the liver tumors is at the best specified. CONCLUSION: Staging laparoscopy with laparoscopic ultrasonography improves selection of patients for liver resection and facilitates choice and performance of the most appropriate resection.     

Easy and accurate targeting of deep-seated hepatic tumors under laparoscopy with a forward-viewing convex-array transducer

Background: It is technically difficult to puncture deep-seated hepatic tumors by conventional laparoscopic ultrasonography with a linear-array probe. We have developed a laparoscopic ultrasonography system with a convex-array probe. Methods: The laparoscopic system used had a fixed forward-viewing convex-array transducer, and a guide groove for puncture was added to the back of the unit. These characteristics enabled us to continuously monitor the position of the needle tip on the ultrasonographic image immediately after puncturing on the liver surface. We attempted tumor puncture in 11 patients with hepatocellular carcinoma under a new probe guidance. Results: The mean puncturing distance up to the tumors was 38.7 mm. All punctures were successful on the first pass and the tumors were treated with radiofrequency ablation. Conclusion: Using this new equipment, puncturing hepatic tumors for treatment is relatively easy, irrespective of the position of the tumor.     

Laser therapy for small breast cancers

BACKGROUND: Widespread mammography has resulted in the increased detection of breast cancer <1.5 cm. It may be possible to treat these small tumors with in-situ laser ablation. Prior to ablation tumor size is determined by ultrasound and mammogram. Histologic diagnosis and determination of prognostic factors are obtained from image-guided needle core samples. Invasive and in-situ tumors may be percutaneously ablated by a stereotactically guided laser needle and subsequently evaluated by imaging methods and needle biopsy. METHODS: Fifty-four patients (50 invasive, 4 in-situ); 51 mass, 3 microcalcification; mean diameter 12 (5 to 23) mm were treated by a stereotactically guided 805 nm laser beam via a fiber in a 16G needle delivered to the cancer. One to 8 weeks later the coagulated lesions were surgically removed for pathologic evaluation. In 2 additional patients, the laser-treated tumors were not removed but were monitored by mammography, ultrasonography, and needle core biopsy. RESULTS: None of the patients sustained any adverse effect. The average treatment time was 30 minutes. Pathology analysis revealed a 2.5 to 3.5 hemorrhagic ring surrounding the necrotic tumor. Under steady conditions, in two groups of 14 patients, 93% and 100% of the tumors showed complete destruction, with no residual cancer report. In the 2 unresected cases kept under surveillance for 6 to 24 months, the laser-treated tumors first showed shrinkage, followed by a 2 to 3 cm oil cyst. Fibrosis was demonstrated on needle core biopsies. CONCLUSIONS: Laser energy delivered through a stereotactically guided needle appears to ablate mammographically detected breast cancer. A multicenter clinical trail is planned.     

荧光导航系统联合术中超声在精准腹腔镜肝肿瘤切除术中的应用

目的 探讨荧光导航系统联合术中超声在精准腹腔镜肝肿瘤切除术中的应用价值。方法 回顾性分析2019 年3 月至2019 年5 月期间浙江省人民医院应用荧光导航系统联合术中超声实施腹腔镜肝肿瘤切除术12 例患者的临床资料,其中男5 例,女7 例;原发性肝癌9 例,转移性肝肿瘤3 例。术中荧光导航系统联合腹腔镜超声进行肿瘤定位及精准切除,对术中切除肿瘤数量、肿瘤的荧光显影情况、肿瘤切缘、病理类型数据进行分析。结果 术中共发现病灶20个,术后病检提示恶性肿瘤15个、肝硬化结节5个。术中直接于荧光导航系统下显影病灶13 个,腹腔镜超声下发现病灶14 个,腹腔镜超声引导下定位切开部分肝脏后荧光显影病灶6 个。1 例患者的病灶术中荧光导航未直接显影,且超声未发现,结合术前检查切开部分肝脏组织后于荧光下显影后予以切除。其中荧光导航系统下显影切除病灶中5 个术后病理提示为肝硬化结节,术后所有肿瘤切缘均为阴性。结论 荧光导航联合术中超声技术的应用对于腹腔镜肝肿瘤切除术中的肿瘤定位、精准切除有重要临床价值。     

Results of computerized tomography guided percutaneous ablation of renal masses with nondiagnostic pre-ablation pathological findings

PURPOSE: Ablative therapy for renal masses has been criticized because the entire tumor cannot be evaluated pathologically after the procedure. Diagnosis depends on imaging findings and the results of percutaneous needle biopsies, which may be nondiagnostic in up to 21% of cases. We determined outcomes in patients undergoing ablation who had nondiagnostic biopsies at the time of the procedure. MATERIALS AND METHODS: A total of 79 patients (88 renal masses) underwent percutaneous computerized tomography guided biopsy and ablation of a renal mass under conscious sedation. Patients with nondiagnostic biopsies were identified and the medical records were reviewed retrospectively. All patients had an enhancing renal mass on preoperative computerized tomography or magnetic resonance imaging and all underwent postoperative contrast imaging to evaluate persistent viable tumor. RESULTS: A total of 19 patients (20 tumors) with nondiagnostic percutaneous biopsy (22.7% or 20 of 88) were included in the study. No serious complications occurred. Tumors were treated with frequency ablation (12) or cryoablation (7). In 17 patients (89.5%) post-procedure imaging confirmed the absence of contrast enhancement at a median followup of 27.3 months (range 3 weeks to 56 months). In 2 cases (10.5%) post-procedure imaging showed a residual renal mass or recurrence with enhancement, suggesting that the original percutaneous biopsy result was false negative. In 1 patient residual tumor was identified on initial post-ablation imaging and the patient underwent laparoscopic partial nephrectomy. In another patient recurrence was diagnosed 30 months after ablation and the patient underwent laparoscopic radical nephrectomy. Although there was a nondiagnostic percutaneous biopsy in each case, pathological findings in the subsequent surgical specimen confirmed renal cell carcinoma. CONCLUSIONS: Nondiagnostic percutaneous biopsy at renal tumor ablation does not obviate the need for standard post-procedure imaging followup. Of patients with nondiagnostic biopsies in this series 10.5% still harbored viable renal cell carcinoma after percutaneous ablation.     

Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound.

OBJECTIVE. The authors describe the technique of staging laparoscopy with laparoscopic contact ultrasonography in the preoperative assessment of patients with liver tumors, and assess its impact on the selection of patients for hepatic resection with curative intent. SUMMARY BACKGROUND DATA. Laparoscopy may be useful in the selection of patients with a variety of intra-abdominal malignancies for operative intervention. Laparoscopic ultrasonography is a new technique that combines the principles of high resolution intraoperative contact ultrasound with those of the laparoscopic examination, and thus, allows the laparoscopist to perform detailed assessment of the liver. METHODS. This study analyzes a cohort of 50 consecutive patients who were diagnosed as having potentially resectable liver tumors, and in whom staging laparoscopy was successfully undertaken. Laparoscopic ultrasonography was performed in 43 patients, and the impact of the ensuing findings on the decision to proceed to operative assessment of resectability is examined. The resectability rate in those patients assessed laparoscopically and subsequently submitted to laparotomy is compared with a preceding group of patients in whom no laparoscopic assessment was performed. RESULTS. Laparoscopy demonstrated factors precluding curative resection in 23 patients (46%). Laparoscopic ultrasonography identified liver tumors not visible during laparoscopy in 14 patients (33%), and provided staging information in addition to that derived from laparoscopy alone in 18/43 patients (42%). The resectability rate was significantly higher among those patients undergoing laparoscopic staging (93%) compared with those in whom operative assessment was undertaken without laparoscopy (58%). CONCLUSIONS. Staging laparoscopy with laparoscopic ultrasonography optimizes patient selection for liver resection with curative intent.     

Percutaneous ultrasonography-guided cutting biopsy from liver metastases of endocrine gastrointestinal tumors.

Ultrasonography-guided cutting needle biopsy of the liver was performed in 186 instances on 95 different patients with carcinoid and endocrine pancreatic tumors. In 171 cases, biopsy specimens were taken from liver metastases found on ultrasonography, and in 93% of these the obtained material was adequate for a correct diagnosis. In the 7% for which an incorrect diagnosis was made, all but one biopsy specimen contained normal liver tissue, indicating that the needle-guiding technique, and not the sampling technique, is the most critical part of the biopsy procedure. Tumor specimens were examined with silver stains and immunocytochemistry after application of monoclonal serotonin antibodies. The argyrophil silver stain of Grimelius could be applied on all specimens and had positive results in all but one case, demonstrating the neurohormonal endocrine origin of the metastases. The argentaffin reaction and/or serotonin immunoreactivity could be applied in 152 cases and had positive results in 115 of 122 (94%) of the mid-gut carcinoid tumors and negative results in 27 of 28 (96.4%) of the non-mid-gut carcinoid tumors and endocrine pancreatic tumors. Major complications occurred in 1.5%; none was lethal or required surgery. The results show that the technique used for tumor biopsy is very accurate and provides material sufficient for multiple histopathologic and immunocytochemical analyses without exposing the patients to high complication risks. It is further concluded that the staining techniques and immunocytochemical analyses applied on the biopsy specimens are valid for the prediction of the location of the primary endocrine tumor.     

腹腔镜联合经皮超声射频消融治疗肝细胞肝癌的疗效探讨

目的:探讨腹腔镜联合经皮超声射频消融术治疗肝癌的临床应用价值。方法:2011年5月至2015年10月为56例肝癌患者行腹腔镜下联合经皮超声射频消融术,记录术后肝功能、甲胎蛋白、生命体征及1个月后影像学检查结果。结果:56例患者、108个病灶均完成射频消融治疗,术后无针道出血、肝功能衰竭及邻近脏器损伤等严重并发症发生,102个病灶消融满意,6个病灶周围有残存,2个病灶在超声造影指引下予以再次消融,4个病灶在CT引导下再次消融,再次消融效果满意。结论:腹腔镜联合经皮超声射频消融治疗特殊部位的肝癌具有消融完全,避免针道出血、周围脏器损伤等特点,具有良好的临床应用价值。