本文關(guān)鍵詞： 經(jīng)皮肝穿刺活檢 疑難肝臟疾病 臨床特征 組織病理學(xué)　出處：《濱州醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景：近年來隨著醫(yī)療技術(shù)的進步,影像技術(shù)的發(fā)展,肝臟疾病的無創(chuàng)檢查方法隨之增多,多數(shù)肝臟疾病可經(jīng)無創(chuàng)檢查方法診斷明確,但是仍有一部分肝病患者經(jīng)無創(chuàng)檢查方法診斷不明,需借助肝臟組織病理學(xué)以明確診斷,超聲引導(dǎo)下肝穿刺活檢定位準確,安全方便,創(chuàng)傷小,并發(fā)癥少。目的：分析疑難肝臟疾病的臨床與病理特點,評價肝穿刺活檢對疑難肝病的診斷價值。方法：收集我院2010年1月-2014年2月采用常規(guī)無創(chuàng)檢查不能確診的疑難肝臟疾病患者,在彩色多普勒超聲引導(dǎo)下應(yīng)用ACECUT自動活檢穿刺針行肝穿刺活檢,活檢組織常規(guī)HE染色鏡檢,必要時行免疫組織化學(xué)檢查,分析其一般資料、臨床表現(xiàn)、生化檢驗、影像檢查及肝組織病理特點。結(jié)果：共有57例疑難肝病患者入選。其中男30例,女27例,男性與女性之比約為1. 1 1：1,平均年齡49.24歲。超聲引導(dǎo)下肝穿刺取材全部成功,穿刺成功率100%。無明顯疼痛、出血及血腫等嚴重并發(fā)癥發(fā)生。1.患者疾病范圍涉及肝臟占位性病變29例(經(jīng)病理組織學(xué)證實為轉(zhuǎn)移性肝癌[34.48%(10/29)],肝細胞癌[27.59%(8/29)],膽管細胞癌[6.90%(2/29)],肝膿腫[10.34%(3/29)],慢性肝炎重度[3.45%(1/29)],肝結(jié)核[3.45%(1/29)],肝海綿狀血管瘤[3.45%(1/29)]),肝臟寄生蟲病[3.45%(1/29)],另有2例患者未確診)。2.慢性肝炎與肝硬化鑒別困難者15例(經(jīng)病理組織學(xué)證實慢性肝炎輕度[20.00%(3/15)],慢性肝炎中度[33.33%(5/15)],慢性肝炎重度[6.67%(1/15)],早期肝纖維化[6.67%(1／15)],肝硬化[33.33%(5/15)])。3.隱源性肝炎7例(病理組織學(xué)顯示急性淤膽型肝炎1例、慢性肝炎中度5例,脂肪性肝炎1例)。4.隱源性肝硬化3例(病理組織學(xué)為結(jié)節(jié)性肝硬化1例,特發(fā)性門靜脈高壓2例)。5.“慢性乙型病毒性肝炎”常規(guī)治療效果欠佳者1例(病理組織學(xué)示急性淤膽型肝炎)。6.AFP明顯升高肝細胞癌待排者1例(病理組織學(xué)為慢性肝炎中度伴結(jié)節(jié)性肝硬化)。7.自身免疫性肝病1例(病理組織學(xué)示：原發(fā)性膽汁性肝硬化)。病理組織學(xué)確診55例,病理組織學(xué)確診率96.49%。結(jié)論：1.疑難肝病中以肝臟占位性病變多見,其中以原發(fā)性肝癌與轉(zhuǎn)移性肝癌最常見。2.對疑難肝病行肝病理組織學(xué)檢查可明顯提高確診率。3.超聲引導(dǎo)下應(yīng)用自動活檢穿刺針行肝活組織檢查成功率高、安全,無嚴重并發(fā)癥發(fā)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.
【學(xué)位授予單位】：濱州醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575
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本文編號：1514304