超声引导下肝脏穿刺活组织检查对疑难肝脏疾病的诊断价值

发布时间：2018-02-16 01:06

  本文关键词： 经皮肝穿刺活检 疑难肝脏疾病 临床特征 组织病理学　出处：《滨州医学院》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景：近年来随着医疗技术的进步,影像技术的发展,肝脏疾病的无创检查方法随之增多,多数肝脏疾病可经无创检查方法诊断明确,但是仍有一部分肝病患者经无创检查方法诊断不明,需借助肝脏组织病理学以明确诊断,超声引导下肝穿刺活检定位准确,安全方便,创伤小,并发症少。目的：分析疑难肝脏疾病的临床与病理特点,评价肝穿刺活检对疑难肝病的诊断价值。方法：收集我院2010年1月-2014年2月采用常规无创检查不能确诊的疑难肝脏疾病患者,在彩色多普勒超声引导下应用ACECUT自动活检穿刺针行肝穿刺活检,活检组织常规HE染色镜检,必要时行免疫组织化学检查,分析其一般资料、临床表现、生化检验、影像检查及肝组织病理特点。结果：共有57例疑难肝病患者入选。其中男30例,女27例,男性与女性之比约为1. 1 1：1,平均年龄49.24岁。超声引导下肝穿刺取材全部成功,穿刺成功率100%。无明显疼痛、出血及血肿等严重并发症发生。1.患者疾病范围涉及肝脏占位性病变29例(经病理组织学证实为转移性肝癌[34.48%(10/29)],肝细胞癌[27.59%(8/29)],胆管细胞癌[6.90%(2/29)],肝脓肿[10.34%(3/29)],慢性肝炎重度[3.45%(1/29)],肝结核[3.45%(1/29)],肝海绵状血管瘤[3.45%(1/29)]),肝脏寄生虫病[3.45%(1/29)],另有2例患者未确诊)。2.慢性肝炎与肝硬化鉴别困难者15例(经病理组织学证实慢性肝炎轻度[20.00%(3/15)],慢性肝炎中度[33.33%(5/15)],慢性肝炎重度[6.67%(1/15)],早期肝纤维化[6.67%(1／15)],肝硬化[33.33%(5/15)])。3.隐源性肝炎7例(病理组织学显示急性淤胆型肝炎1例、慢性肝炎中度5例,脂肪性肝炎1例)。4.隐源性肝硬化3例(病理组织学为结节性肝硬化1例,特发性门静脉高压2例)。5.“慢性乙型病毒性肝炎”常规治疗效果欠佳者1例(病理组织学示急性淤胆型肝炎)。6.AFP明显升高肝细胞癌待排者1例(病理组织学为慢性肝炎中度伴结节性肝硬化)。7.自身免疫性肝病1例(病理组织学示：原发性胆汁性肝硬化)。病理组织学确诊55例,病理组织学确诊率96.49%。结论：1.疑难肝病中以肝脏占位性病变多见,其中以原发性肝癌与转移性肝癌最常见。2.对疑难肝病行肝病理组织学检查可明显提高确诊率。3.超声引导下应用自动活检穿刺针行肝活组织检查成功率高、安全,无严重并发症发生。
[Abstract]:Background: with the progress of medical technology and the development of imaging technology in recent years, the number of non-invasive examination methods for liver diseases has increased. Most liver diseases can be diagnosed by non-invasive methods. However, there are still some patients with liver disease whose diagnosis is unknown by non-invasive examination. It is necessary to make a definite diagnosis by means of liver histopathology. Ultrasound-guided liver biopsy is accurate, safe and convenient, and less traumatic. Objective: to analyze the clinical and pathological features of difficult liver diseases. To evaluate the diagnostic value of liver biopsy for difficult liver diseases. Methods: from January 2010 to February 2014, patients with difficult liver diseases who could not be diagnosed by routine noninvasive examination were collected. Under the guidance of color Doppler ultrasound (CDFI), the liver biopsy was performed with ACECUT automatic biopsy needle, the biopsy tissue was examined by HE staining, and the immunohistochemical examination was performed when necessary. The general data, clinical manifestation and biochemical examination were analyzed. Results: a total of 57 patients with difficult liver diseases were selected, including 30 males and 27 females. The ratio of male to female was about 1.11: 1, with an average age of 49.24 years. The success rate of puncture was 100%. There was no obvious pain. Occurrence of severe complications such as hemorrhage and hematoma. The range of diseases involved in the liver involved 29 cases of hepatic space-occupying lesions (histologically proved to be metastatic liver cancer [34.48% 10 / 29], hepatocellular carcinoma [27.59% 8 / 29], cholangiocarcinoma [6.90% 22 / 29], liver abscess [10.34 3 / 29], chronic hepatitis severe [3.45% 1.29], liver cancer. Tuberculosis [3.45 / 29], hepatic cavernous hemangioma [3.45 / 1 / 29], hepatic parasitosis [3.45 / 1 / 29], other 2 cases of undiagnosed chronic hepatitis and cirrhosis, 15 cases of chronic hepatitis and cirrhosis difficult to distinguish (pathologically confirmed mild chronic hepatitis [20.00% 15], chronic hepatitis moderate [33.33% 515], chronic hepatitis (33.33% 515)], chronic hepatitis (33.33% 515%), chronic hepatitis (33.33% 515), chronic hepatitis (33.33% 515). Severe [6.67 / 1 / 15], early hepatic fibrosis [6.67 / 1 / 15], liver cirrhosis [33.33 / 5 / 15] .Cryptogenic hepatitis in 7 cases (1 case of acute cholestatic hepatitis revealed by histopathology, 5 cases of chronic hepatitis, 1 case of fatty hepatitis, 3 cases of cryptogenic cirrhosis (histopathology, 1 case of nodular cirrhosis), 2 cases of idiopathic portal hypertension. 1 case of "chronic viral hepatitis B" was not well treated (histopathology showed that acute cholestatic hepatitis). 6. AFP significantly increased hepatocellular carcinoma (1 case was chronic liver histopathology). 1 case of autoimmune liver disease (histopathology: primary biliary cirrhosis, 55 cases confirmed by histopathology), The diagnosis rate of histopathology was 96.49.Conclusion 1. In the difficult liver diseases, the liver occupying lesions are more common. Among them, primary liver cancer and metastatic liver cancer are the most common .2.The rate of diagnosis can be significantly improved by histopathological examination of difficult liver diseases. 3. The success rate of liver biopsy with automatic biopsy needle under the guidance of ultrasound is high and safe. No serious complications occurred.
【学位授予单位】：滨州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575
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本文编号：1514304