本文關(guān)鍵詞： 肝臟穿刺 病理學(xué) 肝病 兒童　出處：《重慶醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：對(duì)我院近年來超聲引導(dǎo)下經(jīng)皮肝組織活體穿刺術(shù)及組織病理學(xué)檢查在臨床中的應(yīng)用情況進(jìn)行回顧性分析，探討超聲引導(dǎo)下經(jīng)皮肝穿刺組織病理學(xué)檢查在兒童肝病診斷中的應(yīng)用價(jià)值。 方法：收集2011年9月～2013年10月重慶醫(yī)科大學(xué)附屬兒童醫(yī)院行超聲引導(dǎo)下經(jīng)皮肝組織活體穿刺術(shù)及組織病理學(xué)檢查的所有信息完善的病例,共46例。對(duì)其臨床資料、實(shí)驗(yàn)室檢查結(jié)果、病理學(xué)檢查進(jìn)行回顧性分析。 結(jié)果： 1．46例患兒超聲引導(dǎo)下經(jīng)皮肝組織活體穿刺術(shù)及組織病理學(xué)檢查均成功，成功率100%。無術(shù)后大出血、肝臟血腫、感染、膽漏及鄰近器官損傷等并發(fā)癥，3/46例術(shù)后訴穿刺部位輕微疼痛，2/46例嘔吐1次，1/46例低血糖。 2．行超聲引導(dǎo)下經(jīng)皮肝組織活體穿刺術(shù)及組織病理學(xué)檢查前僅有4/46例（8.7%）確診，通過綜合分析臨床資料、實(shí)驗(yàn)室檢查、病理檢查最終27/46例（58.7%）確診。 3．確診病例中3/46慢性乙型肝炎，3/46巨細(xì)胞病毒肝炎，12/46肝糖原累積癥，，2/46尼曼匹克病，2/46藥物性肝炎，1/46布加綜合征，1/46肝豆?fàn)詈俗冃裕?/46Alagille綜合征。感染性肝病6例（22.2%），非感染所致的肝病21例（77.8%）。 4．部分肝病在光鏡或電鏡下具有特征性病理改變，如慢性乙型肝炎的肝細(xì)胞腫脹，碎屑樣壞死，慢性炎癥細(xì)胞浸潤，匯管區(qū)纖維組織增生，免疫組化染色HBsAg陽性；Alagille綜合征可見肝竇受壓、狹窄，匯管區(qū)膽管數(shù)減少、體積變小，管腔消失，膽色素沉著；肝糖原沉積癥在肝細(xì)胞內(nèi)充滿糖原顆粒，PAS染色可見陽性著色的紅色糖原顆粒等。 結(jié)論： 1．小兒超聲引導(dǎo)下經(jīng)皮肝穿刺組織病理學(xué)檢查是一項(xiàng)成功率高、安全性好、方便快捷、副反應(yīng)極少的檢查方法。 2．對(duì)于病程較長、治療效果差及診斷困難的患兒應(yīng)盡早行超聲引導(dǎo)下經(jīng)皮肝穿刺組織病理學(xué)檢查，準(zhǔn)確診斷，以免錯(cuò)過最佳治療時(shí)機(jī)。 3．超聲引導(dǎo)下經(jīng)皮肝穿刺組織病理學(xué)檢查在兒童疑難肝病的臨床診斷中，既有其不可取代的優(yōu)越性，也有不可避免的局限性。臨床上還需將完整的病歷資料、實(shí)驗(yàn)室檢查結(jié)果以及病理學(xué)檢查結(jié)合起來并綜合分析，才能提高診斷的準(zhǔn)確性。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R725.7

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