卵巢恶性肿瘤经阴道超声定量指标与病理微血管密度及临床分期相关研究

目的探讨卵巢恶性肿瘤血管病理学特征,评价经阴道超声定量指标与病理微血管密度的相关性及其与临床分期的关系。方法术前应用经阴道彩色多普勒超声(transvaginalcolor Dopplerultrasonography,TVCDU)与三维彩色血管能量成像(three-dimensional colorpower angiography,TR3D-CPA)检测38例卵巢恶性肿瘤患者,测定肿瘤血流阻力指数(RI)与血管指数(VI)。术后对组织切片进行免疫组化染色,计数微血管密度(microvesseldensity,MVD);确定卵巢恶性肿瘤临床分期;统计分析RI、VI与MVD的相关性及其与临床分期的关系。结果38例卵巢恶性肿瘤RI值0.44±0.13,VI值(0.08±0.052)条/cm3,MVD值(37.5±18.22)个/400倍视野。RI与MVD呈负相关(rs=-0.412,P<0.01)。VI与MVD呈正相关(rs=0.684,P<0.01)。RI随临床分期的升高而降低,VI随临床分期的升高而升高;临床、期VI、MVD明显高于、期,RI反之(P<0.05)。结论RI与VI可于术前评价卵巢恶性肿瘤血管生成,为术前诊断及预后评估提供有价值的信息。     

探讨血管指数在慢性肾脏病诊断中的意义

目的：探讨三维能量多普勒（3D-CPA）超声参数血管指数（VI）评估慢性肾脏病（CKD）患者肾损害的能力。方法：对60例临床诊断CKD的患者进行3D-CPA检查及肾脏组织病理活检,计算VI值及病理学积分,正常对照组30例。超声测量结果与肾穿刺活检病理结果、临床CKD分期对照分析。结果：不同病理类型的慢性肾脏疾病有不同的VI值;32例病变局限在肾小球（I组）,VI值37.64%±9.97%与对照组VI值33.44%±4.31%相接近（P≥0.05）,28例病变累及肾小管间质及血管（II组）,VI值23.34%±12.12%小于I组和对照组（P＜0.05）;同时VI与CKD临床分期呈正相关。结论：VI可以在一定程度上反映慢性肾脏病的病理类型;病例组在VI值正常时,其病变主要累及肾小球;在VI值降低时,其病变已累及肾小管间质或血管;VI值越小,CKD临床分期越高。     

三维多普勒能量成像检测卵巢肿瘤及其与病理MVD、VEGF表达的相关性研究

目的探讨三维彩色血管能量成像（3D-CPA）术前观察卵巢肿瘤的血流特点与术后病理微血管密度（MVD）及血管内皮生长因子（VEGF）的关系。方法术前应用3D-CPA观察76例卵巢肿瘤的血流信号,判断血管分级并计算肿瘤内血管指数（VI）,术后病理标本应用免疫组织化学染色技术检测肿瘤内的MVD及VEGF染色强度,进行相关性分析,评价三维能量多普勒成像的病理基础。结果卵巢癌的VEGF表达强度均显著高于良性上皮性卵巢肿瘤（P〈0.05）,Ⅲ级血管分型的VEGF染色强度高于Ⅰ、Ⅱ级;卵巢癌的血管分级及VI与MVD有相关性（r=0.84,P〈0.005）。结论血管分型、VI可用于术前间接评价肿瘤的血管生成,为卵巢肿瘤的诊断及鉴别诊断提供有价值的信息。     

卵巢肿瘤三维多普勒能量成像与病理MVD表达的相关性研究

目的探讨三维彩色血管能量成像（three-dimensional color power angiography,3D-CPA）术前观察卵巢肿瘤的血流特点与术后病理组织微血管密度（micro vessel density,MVD）之间的关系。 方法应用3D-CPA观察76个卵巢肿瘤的血管形态,判断血管分级并计算肿瘤内血管指数（vascular index VI）,采用免疫组织化学染色技术检测肿瘤内的MVD,并且进行相关性分析,评价三维能量多普勒成像与病理微血管密度的相关性。 结果三维多普勒能量成像所观测卵巢肿瘤的血管分级在良恶性肿瘤之间存在显著差异;级血管分型的血管分级与MVD相关;卵巢癌的血管指数与MVD有显著相关性（r=0.84,P〈0.005）。 结论应用3D-CPA对卵巢肿瘤的血供情况进行血管分型及VI的计算与免疫组化指标（MVD）有较好的相关性,综合分析可以从不同角度反应卵巢肿瘤的血管生成情况,为卵巢肿瘤的诊断及鉴别诊断提供有价值的信息。     

经阴道三维彩色血管能量成像对卵巢良恶性肿瘤的诊断价值

目的:探讨经阴道三维彩色血管能量成像(TV3D-CPA)对卵巢肿瘤的诊断价值及其与恶性肿瘤临床分期的关系。方法:术前应用TV3D-CPA技术检测65例卵巢肿瘤(47例恶性肿瘤,18例良性肿瘤),定量计算肿瘤内血管指数(VI),分析VI值在良、恶性肿瘤中的差异性及其与恶性肿瘤临床分期的关系。结果:卵巢恶性肿瘤VI值(0.080±0.052)条/cm³,明显高于良性组(0.043±0.031)条/cm³(P<0.05)。以VI≥0.035条/cm³诊断卵巢恶性肿瘤敏感性87.8%,特异性75%。Ⅲ、Ⅳ期卵巢恶性肿瘤VI值(0.089±0.037)条/cm³,明显高于Ⅰ、Ⅱ期(0.056±0.04)条/cm³(P<0.05)。结论:应用TV3D-CPA计测VI值是鉴别卵巢良、恶性肿瘤的有效方法。VI值随临床分期的增高而升高,是预后评价的重要指标。     

肝癌三维彩色血管能量成像与病理微血管密度研究

目的:探讨三维彩色血管能量成像(three-dimensional color power angiography,3D-CPA)检测肝癌血管的临床价值。方法:应用3D-CPA检测37例原发性肝癌(Primary Hepatocarcinomas,HCC)肿瘤血供及血管分布情况,计测肿瘤血管指数(Vascularity Index,VI),术后肿瘤组织切片行CD34单克隆抗体免疫组化染色,计数肿瘤微血管密度(Microvessel Density,MVD),对上述结果进行分析。结果:37个肝癌病灶VI为0.2647±0.1249条/cm3,免疫组化计测MVD为(63.31±29.93)/400倍视野,两者比较呈高度线性正相关(r=0.874,P<0.001)。结论:3D-CPA能客观评价肝癌血供,较准确地定量其血管,为临床定性诊断、估测预后及疗效判定提供依据。     

肾癌三维彩色血管定量与病理组织学分级及微血管密度的相关研究

目的探讨肾癌三维彩色血管定量指标血管指数(vascularityindex,VI)与术后病理组织学分级、微血管密度(microsvesseldensity,MVD)的相关性。方法应用三维彩色血管能量成像技术(three-dimensionalcolorpowerangiography,3D-CPA)术前检查50例肾癌患者,计测VI值;术后对肿瘤组织标本HE染色,进行病理组织学分级,用抗CD105单克隆抗体及抗CD34单克隆抗体行免疫组织化学染色,计测MVD值,对结果进行统计学分析。结果50例肾癌患者VI与MVD呈正相关(r=0.554,P<0.05),术后病理组织学分级~级,各病理组织学分级之间VI与MVD比较,差异有统计学意义(P<0.05),箱式图显示肾癌病理组织学分级与VI、MVD呈相关趋势,随病理组织学分级的增高,VI、MVD亦增高。结论肾癌3D-CPA定量指标VI与肿瘤病理MVD相关密切,VI能在术前客观显示肾癌不同病理组织学分级的血管分布情况,可作为判断肾癌预后的定量指标。     

卵巢肿瘤经阴道超声三维血管定量与病理微血管密度相关研究

目的探讨经阴道超声三维彩色能量血管成像（transvaginal three-dimensional color power angiography,TV3D-CPA）检测卵巢肿瘤的血管病理学基础,评价TV3D-CPA鉴别卵巢良、恶性肿瘤的临床应用价值及其与临床分期的关系.方法术前应用TV3D-CPA技术检测61例卵巢肿瘤患者（38例卵巢恶性肿瘤,5例卵巢交界性肿瘤,18例卵巢良性肿瘤）,观测肿瘤内血管分布类型,计算肿瘤内血管指数（vasculary index,Ⅵ）.术后应用抗CD34单克隆抗体对病理切片进行免疫组织化学染色,计数肿瘤微血管密度（microvessel density,MVD）,确定卵巢恶性肿瘤临床分期.分析Ⅵ与MVD的相关性及其与临床分期的关系.结果卵巢恶性肿瘤血管分布Ⅲ型30例（78.9%）,明显高于良性肿瘤（1例,5.6%）,以3D-CPAⅢ型诊断卵巢恶性肿瘤敏感性78.9%,特异性86.9%.卵巢恶性肿瘤Ⅵ与MVD均明显高于卵巢良性肿瘤（P＜0.05）,以Ⅵ≥0.035条/cm^3诊断卵巢恶性肿瘤敏感性84.2%,特异性70.0%.卵巢恶性肿瘤Ⅲ、Ⅳ期Ⅵ及MVD均明显高于Ⅰ、Ⅱ期（P＜0.05）.38例卵巢恶性肿瘤Ⅵ与MVD呈正相关（r=0.684,P ＜0.01）.结论TV3D-CPA可术前评价卵巢肿瘤血管的生成,为卵巢良恶性肿瘤的鉴别及肿瘤恶性程度的术前评估提供有价值的信息.     

肝细胞性肝癌超声造影定量参数与微血管密度的相关性研究

目的：探讨肝细胞性肝癌（HCC）超声造影血流灌注定量参数与肿瘤微血管密度（MVD）的相关性。方法：46例HCC患者术前行超声造影检查,利用时间-强度曲线（TIC）进行定量分析,得出肝癌及癌旁组织的达峰时间（TTP）、峰值强度（PI）,与术后病理免疫组织化学染色计数的MVD进行相关性分析。结果：46例HCC与癌旁组织的TTP平均值分别为（14.24±5.11）s及（25.34±9.11）s,PI平均值分别为（43.11±10.25）dB及（20.87±8.21）dB,MVD平均值分别为52.32±18.21及21.43±8.65。HCC术前TTP与术后MVD呈负相关（r=-0.75,P＜0.05）,PI与MVD呈正相关（r=0.73,P＜0.05）。结论：HCC超声造影定量灌注参数PI、TTP与MVD的表达有良好的相关性,可作为术前评估HCC血管生成状况的指标。     

肝癌的三维彩色血管能量成像与临床病理

目的探讨肝癌的三维彩色血管能量成像特征及其临床病理意义。方法采用ATL-HDI3000超声仪,C4-2超宽频探头,对58例肝癌进行三维彩色血管能量成像(3D-CPA)检查,并对其进行TNM分期,以评价3D-CPA在肝癌预后评估中的价值。其中30例进行3D-CPA检测与病理结果对比,病理观察指标包括癌瘤大小,肿瘤周边及内部血管形态、分布、排列、血管类型及肿瘤血管密度。结果肿瘤周边弧形包绕血流和瘤内树枝状血流为肝癌3D-CPA特异性表现。肿瘤周边血管较肿瘤内部血管丰富;肿瘤直径越大,血管越丰富;3D-CPA肿瘤血管分级与病理肿瘤血管密度相关(P>0.1),肝癌3D-CPA血管成像特征与病理检查结果相一致。TNM分期不同的肝癌1年生存率不同（P<0.05）。结论3D-CPA能反映肿瘤微血管水平的血流状况,在肝癌的血管显示、血管受累描述、TNM分期及病情判断、预后评价方面,3D-CPA能做出与临床病理学因素相关的影像学判断。     

Prevention and treatment of pathological scars

At times, the appearance of a pathological scar is a result of the scar process itself which can bring with it important physical and psychological complications for an affected person. The appearance of such a scar is more frequent in injuries which have followed a scar process caused as the consequence of a second operation and a disgraceful healing process. Preventive measures should be taken right at the start of treatment of the injury and continue during a set time after its initial closure. When, in spite of everything, a pathological scar appears, there are various materials and treatment techniques which provide different degrees of effectiveness.     

Oro-facial granulomatosis--a clinical and pathological analysis

A study of 60 patients with oro-facial granulomatosis has been conducted and the clinical presentation of this disorder defined. It encompasses the previously recognised clinical entities of Melkersson-Rosenthal syndrome and cheilitis granulomatosa. The pathological features of the disease are lymphoedema and the presence of multiple non-caseating giant cell granulomata. These granulomata are histologically indistinguishable from those found in both gastrointestinal Crohn's disease and systemic sarcoidosis. Within this series of patients, nine had evidence suggestive of gastrointestinal Crohn's disease, and in six this was confirmed. A diagnosis of sarcoidosis was made in a further two patients. The relationship of oro-facial granulomatosis to these systemic granulomatous diseases is not yet clear. Patients with oro-facial granulomatosis who have gastrointestinal symptoms should be investigated for the presence of gastrointestinal Crohn's disease. Those without symptoms should be investigated for evidence of malabsorption or serological evidence of Crohn's disease. Within the present study, the erythrocyte sedimentation rate, full blood count, corrected whole blood folate, serum albumin and calcium were the most sensitive markers of gastrointestinal involvement. Sarcoidosis should be considered in all patients with oro-facial granulomatosis. The absence of clinical signs suggestive of sarcoidosis, a normal chest radiograph and normal levels of serum angiotensin-converting enzyme makes sarcoidosis unlikely.     

骨性关节炎的生化及病理变化

骨性关节炎(Osteoarthritis,简称OA)时退行性软骨的生化及代谢发生了显著的变化.关节软骨表面的胶原纤维退化,软骨内化骨,出现骨刺,由此增生的骨刺压迫刺激周围神经、血管,引起肢体麻木疼痛,在空间失重环境中,重力负荷的消失,也可能形成软骨退行性改变,从而对航天员的生理健康造成严重威胁.对正常关节软骨的生化和代谢,以及发生骨关节炎后关节软骨的病理变化进行综述,包括其形态、胶原和蛋白及细胞水平上的一系列变化,简要阐述了骨性关节炎的可能的病因.     

额颞痴呆的临床与病理特征

额颞痴呆包含很多病,经典的是pick氏病。主要介绍额颞痴呆的临床表现、影像学改变、近年来这个领域神经生化方面的重大进步、与阿尔茨海默病的鉴别诊断。     

脑胶质瘤病临床及病理分析

目的 观察脑胶质瘤病的临床、病理、磁共振成像(MRI)特征，寻找本病患者生前确诊的方法。方法 对高度怀疑脑胶质瘤病患者3例进行脑组织活检，将临床症状、影像学特点及病理结果进行对照研究。结果 3例患者有进行性加重的头痛、呕吐等颅内压力增高表现，并伴有智能与精神障碍、癫痫、偏瘫等症状。影像学显示双侧大脑半球对称性弥漫性病灶，并灰白质均受累，占位效应不明显，没有显著强化。肿瘤细胞在大脑半球灰白质中广泛增殖，主要在血管、神经元周围呈浸润性生长，不形成团块。结论 脑胶质瘤病的临床表现与影像学结合可帮助诊断，最终诊断仍需依靠病理学检查。     

Gallbladder cancer: Clinical and pathological approach

Gallbladder cancer (GBC) shows a marked geographical variation in its incidence. Middle-aged and elderly women are more commonly affected. Risk factors for its development include the presence of gallstones, chronic infection and pancreaticobiliary maljunction. Controversy remains in regard to the theory of carcinogenesis from adenomyomatosis, porcelain gallbladder and adenoma of the gallbladder. The surgical strategy and prognosis after surgery for GBC differ strikingly according to T-stage. Discrimination of favorable cases, particularly T2 or T3 lesions, is useful for the selection of surgical strategies for individual patients. Although many candidate factors predicting disease progression, such as depth of subserosal invasion, horizontal tumor spread, tumor budding, dedifferentiation, Ki-67 labeling index, p53 nuclear expression, CD8+ tumor-infiltrating lymphocytes, mitotic counts, Laminin-5-gamma-2 chain, hypoxia-inducible factor-1a, cyclooxygenase-2 and the Hedgehog signaling pathway have been investigated, useful prognostic makers or factors have not been established. As GBC is often discovered incidentally after routine cholecystectomy and accurate preoperative diagnosis is difficult, close mutual cooperation between surgeons and pathologists is essential for developing a rational surgical strategy for GBC.