高强度聚焦超声技术治疗甲状腺结节的临床观察

目的探讨高强度聚焦超声(HIFU)治疗甲状腺结节的方法、安全性及近期疗效。方法治疗组20例单发甲状腺良性实性结节行高强度聚焦超声(HIFU)治疗,治疗后采用常规超声随访(1月、3月、6月、12月)观察结节大小、血供,并观察并发症的发生情况及监测甲状腺功能。对照组20例单发甲状腺良性实性结节未经任何治疗,随访方法及时间与治疗组相同。结果治疗组20例患者均成功进行了高强度聚焦超声(HIFU)治疗,术后超声随访结节的体积较术前逐渐缩小(P<0.05),血流信号消失。治疗前、后检测甲状腺功能(FT_3、FT_4及TSH)无明显变化(P>0.05)。对照组随访12个月结节体积及甲功均无明显变化(P>0.05)。结论高强度聚焦超声(HIFU)是治疗甲状腺良性结节安全性高、创伤小、可控性强、疗效确切、具有临床应用潜质。     

术前CT引导穿刺定位并亚甲蓝染色在胸腔镜治疗肺部小结节中的应用

目的探讨CT引导下肺小结节穿刺并亚甲蓝染色定位在胸腔镜切除中的临床价值。方法我院58例患者,行CT引导Hookwire系统与亚甲蓝染色联合定位,后行胸腔镜下肺楔形切除术,若术中快速病理为肺癌则行完全胸腔镜肺叶切除术。统计穿刺定位时间、并发症,肺楔形切除术时间等。结果穿刺定位时间20.18±5.39 min,少量气(9/58),胸膜反应(2/58),血胸或血气胸(2/58);肺楔形切除时间15.71±4.25 min。结论术前CT引导穿刺并亚甲蓝染色定位肺小结节方法准确率高,并发症少,提高成功率,对肺小结节诊断及治疗具有很好的临床价值。     

Outcomes in patients with indeterminate pulmonary nodules undergoing resection for colorectal liver metastases

Objectives

This study aimed to assess outcomes in patients who underwent hepatic resection for colorectal liver metastases (CRLM) with subcentimetre indeterminate pulmonary nodules (IPN) and to devise a management pathway for these patients.

Methods

Patients undergoing CRLM resection from January 2006 to December 2010 were included. Survival differences following liver resection in patients with and without IPN were determined.

Results

A total of 184 patients were included, 30 of whom had IPN. There were no significant differences between the IPN and non-IPN groups in terms of demographics, surgery and pathological factors. There were no significant differences between patients with and without IPN with respect to disease-free (P = 0.190) and overall (P = 0.710) survival. Fifteen patients with IPN progressed to metastatic lung disease over a median period of 10 months (range: 3–18 months); six of these patients underwent lung resection. Of the remaining 15 patients with IPN, eight showed no IPN progression and subsequent CT scans did not identify IPN in the remaining seven.

Conclusions

Colorectal liver metastases patients with IPN who have resectable disease should be treated with liver resection and should be subject to intensive surveillance post-resection. Although 50% of these patients will progress to develop lung metastases, this does not appear to influence survival following liver resection.     

术前CT引导下亚甲蓝与Hookwire联合定位肺小结节临床应用价值

目的 探讨CT引导下亚甲蓝与Hookwire联合定位在胸腔镜下孤立性肺小结节(SPN)切除术中的临床应用价值.方法 对56例患者的60枚SPN术前行CT引导下亚甲蓝与Hookwire联合定位后行胸腔镜(VATS)肺楔形切除术.全组患者男19例,女37例;年龄35～81岁,平均(61.1±8.9)岁.结果 56例60枚SPN直径为(6.80±4.12) mm,距壁层胸膜(15.38±4.63) mm.CT引导下定位成功率100％,定位时间(10.76±8.17) min.定位后5例(8.9％)发生局部少量气胸,4例(7.1％)发生肺出血,均无需治疗.60枚肺小结节病灶均准确定位,VATS楔形切除术成功率100％.术后病理显示,肺泡细胞癌(BAC)33枚(55.0％),肺泡细胞癌伴腺癌(BAC+ AC) 11枚(18.3％),肺泡细胞不典型增生(AAH)7枚(ll.8％),炎性肉芽肿4枚(6.7％),错构瘤3枚(5.0％),结核性肉芽肿2枚(3.3％).结论 胸腔镜术前CT引导下亚甲蓝与Hookwire联合定位准确率高,对胸腔镜手术(VATS)楔形切除病灶有极大的帮助作用,具有良好的临床应用价值.     

超声弹性成像在甲状腺结节鉴别诊断中的价值

目的评价超声弹性成像指标在鉴别甲状腺良、恶性结节中的价值。方法对116个甲状腺结节行灰阶超声和超声弹性成像检查,计算病灶在弹性图/灰阶图的直径变化率和面积比值,与病理结果对照分析甲状腺良、恶性结节的超声弹性指标。结果超声弹性分级4级及以上者在恶性甲状腺结节中所占比例显著高于良性结节(P<0.05);甲状腺恶性结节弹性图/灰阶图直径变化率和面积比值均显著高于良性结节(P<0.05);分析ROC曲线,甲状腺结节灰阶图和弹性图面积比值较直径变化率诊断价值高,诊断准确性亦高(P<0.05)。结论超声弹性成像灰阶图和弹性图直径变化率和面积比值作为甲状腺弹性成像检查的诊断指标,明显提高了甲状腺结节鉴别的诊断价值和诊断准确性。     

C型臂CT在肺结节活检术中的应用价值

目的探讨C型臂CT在肺结节活检术中的应用价值。方法根据活检方法将57次肺活检术（56例患者）分为传统方法组和改进方法组,比较2组阳性率、并发症发生率及辐射剂量,分析肺活检术阳性率和并发症的影响因素。结果传统方法组及改进方法组肺活检阳性率分别为69.44%（25/36）和95.24%（20/21）,差异有统计学意义（P=0.049）。改进方法组的辐射累积剂量及有效剂量均高于传统方法组,差异有统计学意义（P均〈0.05）。活检方法是活检阳性率的独立影响因素。结论 C型臂CT可明显提高肺结节穿刺准确率,有重要临床应用价值。     

经支气管超声诊断肺结节性病变

目的 探讨经支气管超声(EBUS)诊断肺部结节性病变的价值。方法 对CT扫描提示肺部占位的52例肺部结节性病变患者行EBUS检查, 观察病灶内部回声、边界、后壁回声及后方回声等超声表现。结果 52例肺部结节性病变患者中, 良性病变18例, 恶性病变34例。边界清晰和后壁呈线状均匀增强是肺部恶性病变的重要声像图特征, 边界不清和后壁带状不均匀增厚是肺部良性病变的声像图特征;在肺部结节性病变中, "彗星尾征"提示肺鳞癌病变。声像图表现中内部回声、后方回声变对肺部结节性病变的诊断价值不大。EBUS检查未发生并发症。结论 EBUS是肺部结节性病变超声诊断的新方法, 且安全有效。     

Immunohistochemical expression of HBME-1 and galectin-3 in the differential diagnosis of follicular-derived thyroid nodules

BackgroundThyroid nodules are common among adults with only a small percentage being malignant and histologically mimic benign nodules. Accurate diagnosis of these thyroid nodules is critical for the proper clinical management. The determination of malignancy in follicular patterned thyroid lesions is based on postoperative histological findings. Therefore, affected patients are referred for surgery, although only 10% will have a final diagnosis of malignancy. The aim of this study was to investigate the ability of two immunohistochemical (IHC) markers; galectin-3 and Hector Battifora mesothelial-1 (HBME-1) individually or in combination, to distinguish between benign (non-neoplastic and neoplastic) and malignant (follicular and papillary carcinomas) thyroid lesions removed by surgical resection.MethodsWe investigated the immunoexpression of galectin-3 and HBME-1 in 50 cases of benign and malignant thyroid nodules. The benign group included 13 cases of thyroid nodular goiter (NG) and 9 cases of follicular adenoma (FA). The malignant group included 5 cases of follicular thyroid carcinomas (FC), 18 cases of classic papillary thyroid carcinoma and 5 cases of follicular variant papillary carcinoma (FVPC).ResultsThe staining results showed that malignant tumors expressed galectin-3 and HBME-1 significantly more than benign nodules. The sensitivity of these markers for the distinction between benign and malignant lesions ranged from 89.3% to 92.9%. Co-expression of galectin-3 and HBME-1 was seen in 82.1% of carcinomas, but in none of the benign nodules. Immunoexpression was usually diffuse in malignant tumors, and focal in the benign lesions.ConclusionOur findings indicate that these immunohistochemical markers are significantly more expressed in malignant tumors compared to benign lesions and may be of additional diagnostic value when combined with routine histology. Galectin-3 has higher sensitivity and specificity of immunoexpression in thyroid malignancy than HBME-1, and the combined use of galectin-3 and HBME-1 can increase the specificity of immunoexpression in malignant tumors.     

甲状腺恶性结节的彩色多普勒超声的特征研究

目的：分析甲状腺恶性结节彩色多普勒超声特征,探讨彩色多普勒超声对甲状腺恶性结节的诊断价值。方法：收集近期在笔者所在医院选择手术治疗的甲状腺恶性结节患者79例,对其临床资料进行统计分析,回顾性分析甲状腺恶性结节彩色多普勒超声特征,探讨彩色多普勒超声对甲状腺恶性结节的诊断价值。结果：超声对甲状腺恶性结节的诊断率为72.2%,误诊率为27.8%;其中误诊为结节性甲状腺肿17例（77.3%）,甲状腺腺瘤3例（13.6%）,其他2例（9.1%）。甲状腺恶性结节超声检查主要依赖于对结节形态特征的评价,主要包括：边界、回声、内部回声结构、钙化特点以及结节内部血流情况等,恶性结节的主要特点为边界不清、低回声、内部为实性结构、无钙化或微钙化、结节内部血流丰富。结论：彩色多普勒超声对于甲状腺恶性肿瘤的诊断具有一定的价值,根据各项超声检查特征进行综合分析可以提高诊断率。     

CT引导下肺部结节、条块病灶经皮穿刺活检的临床应用

目的:探讨肺部结节病灶、条块病灶CT引导下经皮穿刺活检的诊断价值及检验方法选择.方法:对比分析某医院66例肺部结节病灶、35条块病灶行CT引导下经皮穿刺活检的临床资料、病理及手术、随访资料.结果:66例肺部结节病灶穿刺取材成功65例,2例是凝血块,其中腺癌25例,鳞癌19例,小细胞癌4例,转移癌6例,结核球3例,异常细胞2例,腺瘤2例,硬化性血管瘤1例,支气管囊肿1例;35例肺部条块病灶穿刺成功35例,取材成功28例.诊断炎性病变9例,肺结核6例,鳞癌5例,脓疡4例,腺癌2例,炎性肉芽肿2例.结论:肺部病变CT引导下穿刺活检具有较高的诊断准确率,结节病灶准确率为95%,条块病变准确率为78%,条块病变需要多种方法取材并与病菌检查相结合,以提高穿刺活检断准确率.