输精管绝育术后结节的病理研究

本研究通过对输精管绝育术后局部有疼痛症状结节35例与无症状结节25例的光镜、电镜、组化、免疫组化等比较研究,提出结节产生的主要病理基础是精子外漏至周围间质所引起的无菌性炎症的一系列反应。预防的关键是减少精子漏出。     

女性分化型甲状腺癌患者超声特点及危险因素分析

目的 对甲状腺结节病理特征及与超声特点进行相关性分析,探讨女性分化型甲状腺癌超声特点及相关危险因素。方法 回顾性选取北京大学国际医院2014 年12 月～2018 年4 月因甲状腺结节行病理检查的287 例患者资料,分析不同性质结节的临床、病理特征及超声特点。结果 287 例患者（男81 例,女206 例）中,病理诊断恶性病变者144 例（50.17%）,甲状腺乳头状癌132 例,滤泡状癌9 例,髓样癌3 例。超声影像特点：低回声结节比例,恶性（69.44% ）高于良性（22.38%）（P＜0.05）;实性结节比例,恶性（83.33%）高于良性（17.48%）（P＜0.05）;结节内血流丰富程度比例,恶性（73.61%）高于良性（42.66%）（P＜0.05）;结节形态不规则比例,恶性（68.75%）高于良性（19.58%）;结节纵横比＞1 的比例,恶性（77.08%）高于良性（9.09%）（P＜0.05）。甲状腺球蛋白抗体（Thyroglobulin antibody,TgAb）阳性率恶性结节中高于良性结节。Logistic 回归模型结果显示,女性发生恶性病变的风险是男性6 倍（OR：6.549,95%CI：1.313～32.658,P＜0.05）。结节低回声（OR：0.034,95%CI：1.148～32.607,P＜0.05）及TgAb 阳性（OR：4.062,95%CI：1.021～16.160,P＜0.05）为女性分化型甲状腺癌危险因素。而结节低回声（OR：0.119,95%CI：0.006～2.495,P＞0.05）及TgAb 阳性（OR：0.097,95%CI：0.004～2.206,P＞0.05）与男性分化型甲状腺癌的发生无明显相关。结论 女性甲状腺结节恶变风险较男性更高。重点监测低回声结节及TgAb 水平有助于女性分化型甲状腺癌的诊断及评估。     

良、恶性肺磨玻璃结节MSCT影像学特征及诊断价值

目的分析良、恶性肺磨玻璃结节MSCT影像学特征及诊断价值。方法回顾性分析,本院2017年2月至2019年8月在本院收治的100例肺部GGN患者,所有患者均进行MSCT检查。对患者所得图像进行分析,对患者临床资料进行收集分析,并以病理结果为基准比较MSCT检查对良、恶性肺磨玻璃结节诊断符合率。结果良恶性肺GGN患者在吸烟史、年龄、肿瘤直径,有MSCT征象(毛刺、空泡、分叶、胸膜凹陷、血管集束、支气管充气)、以及CT值比中差异有统计学意义(P<0.05)。多元Logistic回归分析:年龄偏大、CT值高、有毛刺、空泡、分叶、胸膜凹陷、支气管充气征为影响恶性肺GGN的危险因素(P<0.05)。与病理结果比较,MSCT对良性肺GGN诊断符合率不一致(P<0.05)。但对恶性肺GGN诊断符合率一致(P>0.05)。结论对存在危险因素的患者需怀疑是否为恶性肺GGN,对肺GGN性质诊断中需结合患者基本情况、临床表现、影像学检查进行诊断鉴别。     

多模态超声检查对甲状腺弥漫性病变合并结节的诊断分析

目的:探讨分析多模态超声检查对甲状腺弥漫性病变合并结节的诊断价值。方法:选取2017年5月-2019年5月我院收治的甲状腺弥漫性病变合并结节患者400例,所有患者均在我院接受超声检查。并且全部患者均通过穿刺活检或者手术病理检查确诊。观察比较与病理诊断结果相比超声检查的准确性;良性结节与恶性结节在不同超声特征方面的差异。结果:所有400例患者的病理诊断结果提示,共检查出甲状腺结节:418个,其中,良性结节:148个,恶性结节:270个;超声检查共检查出甲状腺结节408个,其中,良性结节:144个,恶性结节:264个,与病理诊断相比,超声检查在甲状腺结节方面的检出率并无显著差异(P>0.05)。恶性结节与良性结节在不同超声特征:形态、纵横比、边界、边缘、声晕、内部回声、钙化灶、后方回声、相对运动、血流分布、阻力指数、硬度等方面均存在显著差异(P<0.05)。结论:甲状腺弥漫性病变合并结节使用多模态超声检查诊断的准确率较高,且通过多模态超声检查也能够有效地区分良性结节与恶性结节,值得应用。     

支撑喉镜下喉显微手术治疗声带息肉、声带小结86例分析

目的：观察支撑喉镜下喉显微手术治疗声带息肉、声带小结的临床疗效。方法：回顾性分析86例采用支撑喉镜下喉显微手术治疗的声带息肉、声带小结患者的临床资料。结果：86例中，治愈84例，治愈率97．67％；好转2例，总有效率100％。结论：支撑喉镜下喉显微手术治疗声带息肉、声带小结是安全、彻底、疗效显著的治疗方法。     

CR钼靶与彩色多普勒超声对乳腺结节诊断的临床应用研究

目的:评价CR钼靶与彩色多普勒超声(color Doppler ultrasonography,CDUS)对乳腺结节诊断的临床应用价值。方法:对126例经CR钼靶、CDUS检查的乳腺结节资料进行分析比较,并与术后病理结果对照。结果:126例乳腺结节有76例良性病变,CR钼靶诊断正确66例,CDUS诊断正确68例(χ2=0.07,P>0.05),CR钼靶+CDUS诊断正确71例。有50例恶性病变,CR钼靶诊断正确46例,超声诊断正确36例(χ2=3.87,P<0.05),CR钼靶+CDUS诊断正确49例。结论:在乳腺结节良性病变诊断中,CR钼靶与CDUS无明显统计学差异,但对乳腺恶性肿块的检出,CR钼靶较CDUS有明显优势,二者联合诊断乳腺疾病的准确率高于两种方法单独使用,在乳腺疾病的检查中可以发挥优势互补的作用。     

Thyroid metastases from clear cell renal carcinoma 18 years after nephrectomy

Single or multiple thyroid metastases from extra-thyroid primary tumors are reported to be rare. Malignancies that metastasize to the thyroid include cancers originating from lung, breast and kidney. We report our experience with a case of thyroid metastases, which were detected 18 years after curative kidney surgery for renal cell carcinoma. After 18 years, the patients noted the sudden appearance of a lump in the neck. Ultrasonography showed the presence of a multinodular goiter, all nodules being “cold” at scintiscan. Total thyroidectomy was performed; histology of all nodules revealed a metastatic thyroid cancer from renal cell carcinoma. The patient was still alive and in good health 16 months after thyroidectomy. History of patients with thyroid nodules should include inquiring about extra-thyroid malignancies, especially renal cell carcinoma, that may have been diagnosed even many years earlier. As a corollary, follow-up of such patients should include periodic thyroid exploration or at least a physical examination.     

Minimally invasive thoracoscopic ultrasound for localization of pulmonary nodules in children

Purpose

Children with cancer may develop lesions in the lung that may represent metastatic disease. Thoracotomy is considered the standard approach for resection of pulmonary nodules. Recently, thoracoscopic techniques have been applied in these situations. However, nodules that are deep in the lung parenchyma may not be visible. A technique has been developed whereby minimally invasive thoracoscopic ultrasound (MITUS) may be used to guide resection of deep pulmonary nodules.

Methods

We conducted a retrospective review of children undergoing MITUS at our institution. Only patients with single isolated lesions were chosen to have this diagnostic procedure performed. Patients undergo single lung ventilation. Two 5-mm ports are inserted, one for the grasper and the other for the camera. One 12-mm port is inserted for the flexible 10-mm ultrasound probe and the endoscopic stapler. The patient has CO₂ insufflation to create a 5-mm Hg pneumothorax. Twenty mL/kg of normal saline is introduced into the chest cavity for acoustic coupling. The ultrasound probe is used to isolate the nodule(s), guide resection, and check margins. The specimen is removed and placed in a removable specimen bag to reduce the chance of port site recurrence. After the lung has been inspected, irrigation is removed, and a chest tube inserted.

Results

Eight procedures were performed on 7 patients (5 males, 2 females) with a median age of 15.2 years (range, 4-18 years). Patients had primary diagnoses of osteosarcoma (n = 4), Wilms' (n = 2), and lymphoma (n = 1). The median size of the lesions that were being isolated was 0.6 cm (range, 0.3-2.9 cm). None of the nodules removed were visible on the surface of the lung. Of the 8 procedures, 7 led to the removal of a pulmonary nodule. Of the 7 nodules isolated, 5 were removed thoracoscopically, with two requiring minithoracotomy because of anatomical limitations. The histologic evaluation on these specimens included osteosarcoma (n = 4), abscesses (n = 2), fibrosis (n = 1), and lymph node (n = 1). The median hospitalization was 2.5 days (range, 2-39 days). One patient had a prolonged hospitalization because of air leak and sepsis.

Conclusion

Minimally invasive thoracoscopic ultrasound is a real time imaging tool that helps isolate small pulmonary lesions that may otherwise be difficult to see intraoperatively. We would advocate this technique for those patients having video-assisted thoracoscopy to assist clarifying whether focal lesions are malignant, thereby guiding therapy.     

肺结节患者行多螺旋CT胸部低剂量扫描临床应用分析

目的:探讨多螺旋CT胸部低剂量扫描在肺结节患者临床诊断中的应用价值。方法:选取110例肺结节病患者作为研究对象,同期给予CT常规剂量和30～50mA低剂量多螺旋CT胸部扫描,比较两种检查方法的诊断结果。结果:①常规剂量检出肺结节165枚,低剂量检查肺结节163枚,两种剂量检查方法检出肺结节数量比较无明显差异(χ2=0.538,P>0.05);②不同剂量扫描肺结节不同形态特征包括钙化、空洞、毛刺征、分叶征、支气管征、胸膜粘连等数量均无明显差异(P>0.05)。结论:多螺旋CT胸部低剂量扫描与常规剂量扫描对肺结节患者的临床诊断价值相似,且前者可降低辐射危害及经济成本,是临床筛查肺结节的首选方法。