小儿超声引导下经皮肝穿刺组织病理检查的临床应用价值

发布时间：2018-02-02 12:06

本文关键词： 肝脏穿刺病理学肝病儿童　出处：《重庆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：对我院近年来超声引导下经皮肝组织活体穿刺术及组织病理学检查在临床中的应用情况进行回顾性分析，探讨超声引导下经皮肝穿刺组织病理学检查在儿童肝病诊断中的应用价值。方法：收集2011年9月～2013年10月重庆医科大学附属儿童医院行超声引导下经皮肝组织活体穿刺术及组织病理学检查的所有信息完善的病例,共46例。对其临床资料、实验室检查结果、病理学检查进行回顾性分析。结果： 1．46例患儿超声引导下经皮肝组织活体穿刺术及组织病理学检查均成功，成功率100%。无术后大出血、肝脏血肿、感染、胆漏及邻近器官损伤等并发症，3/46例术后诉穿刺部位轻微疼痛，2/46例呕吐1次，1/46例低血糖。 2．行超声引导下经皮肝组织活体穿刺术及组织病理学检查前仅有4/46例（8.7%）确诊，通过综合分析临床资料、实验室检查、病理检查最终27/46例（58.7%）确诊。 3．确诊病例中3/46慢性乙型肝炎，3/46巨细胞病毒肝炎，12/46肝糖原累积症，，2/46尼曼匹克病，2/46药物性肝炎，1/46布加综合征，1/46肝豆状核变性，3/46Alagille综合征。感染性肝病6例（22.2%），非感染所致的肝病21例（77.8%）。 4．部分肝病在光镜或电镜下具有特征性病理改变，如慢性乙型肝炎的肝细胞肿胀，碎屑样坏死，慢性炎症细胞浸润，汇管区纤维组织增生，免疫组化染色HBsAg阳性；Alagille综合征可见肝窦受压、狭窄，汇管区胆管数减少、体积变小，管腔消失，胆色素沉着；肝糖原沉积症在肝细胞内充满糖原颗粒，PAS染色可见阳性着色的红色糖原颗粒等。结论： 1．小儿超声引导下经皮肝穿刺组织病理学检查是一项成功率高、安全性好、方便快捷、副反应极少的检查方法。 2．对于病程较长、治疗效果差及诊断困难的患儿应尽早行超声引导下经皮肝穿刺组织病理学检查，准确诊断，以免错过最佳治疗时机。 3．超声引导下经皮肝穿刺组织病理学检查在儿童疑难肝病的临床诊断中，既有其不可取代的优越性，也有不可避免的局限性。临床上还需将完整的病历资料、实验室检查结果以及病理学检查结合起来并综合分析，才能提高诊断的准确性。
[Abstract]:Objective: to review the clinical application of ultrasound guided percutaneous liver biopsy and histopathology in our hospital in recent years. To evaluate the value of ultrasound-guided percutaneous liver biopsy in the diagnosis of children with liver disease. Methods: from September 2011 to October 2013, all the cases with complete information of percutaneous biopsy and histopathology were collected from the Children's Hospital affiliated to Chongqing Medical University. The clinical data, laboratory results and pathological findings of 46 cases were analyzed retrospectively. Results: 1. Ultrasound guided percutaneous liver biopsy and histopathological examination were successful in 46 children. The success rate was 100%. No postoperative massive hemorrhage, hepatic hematoma and infection were found. Complications such as bile leakage and injury of adjacent organs 3 / 46 cases complained of minor pain at puncture site 2 / 46 cases of vomiting 1 / 1 / 46 cases of hypoglycemia. 2. Only 4/46 cases were diagnosed by ultrasound guided percutaneous biopsy and histopathological examination. Pathological examination was confirmed in 27/46 cases (58.7%). 3. Of the 3/46 confirmed cases of chronic hepatitis B, 3 / 46 / 46 of cytomegalovirus hepatitis, 12 / 46 / 46 of hepatic glycogen accumulation, 2 / 46 / 46 Neimanpik disease / 2 / 46 drug-induced hepatitis. 1/46 Budd-Chiari syndrome 1 / 46 hepatolenticular degeneration 3 / 46 Alagille syndrome. Infectious liver disease in 6 cases. There were 21 cases of liver disease caused by non-infection. 4. Some liver diseases have characteristic pathological changes under light or electron microscope, such as liver cell swelling, clastic necrosis, chronic inflammatory cell infiltration and fibrous hyperplasia in the catchment area of chronic hepatitis B. Immunohistochemical staining was positive for HBsAg; In Alagille's syndrome, the hepatic sinusoids were compressed, narrow, the number of bile duct decreased, the volume of bile duct became smaller, the lumen disappeared, and the bile pigmentation was found. Liver glycogen deposition in liver cells filled with glycogen granules pas staining can be seen positive staining of red glycogen granules and so on. Conclusion: 1. The histopathological examination of percutaneous liver puncture guided by ultrasound in children is a high success rate, safe, convenient and rapid, with few side effects. 2. For the children with long course of disease, poor therapeutic effect and difficult diagnosis, ultrasound guided percutaneous liver biopsy should be performed as soon as possible to make accurate diagnosis so as not to miss the best time of treatment. 3. Ultrasound-guided percutaneous liver biopsy has irreplaceable advantages in the clinical diagnosis of difficult liver diseases in children. In order to improve the accuracy of diagnosis, it is necessary to combine and analyze the complete medical records, laboratory results and pathological findings.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R725.7

【参考文献】