术中快速病理诊断技术的优化

Optimization of intraoperative rapid pathological diagnosis

目的分析术中快速病理诊断技术的优化对提高编号效率与正确率、制片效率、制片质量与术中快速病理诊断及时率的影响。方法以2017~2021年优化前后的冷冻切片为研究对象,各选取2017年(优化前)与2021年(优化后)的100个冷冻标本,2017年为传统包埋盒生成方式,2021年为包埋盒打号机关联病理信息系统实现精准匹配打印。比较优化前后单个包埋盒病理号的平均生成时间及100个包埋盒的生成错误率。2017年为传统组织块速冻方法,2021年为将专利冰锤组件应用于病理冷冻切片制备的组织速冻环节,比较优化前后的速冻时间、冷冻切片组织完整性与细胞质挤压变形得分。随机取150个冷冻组织冻块,每块连续切取2片,1片手工染色,1片运用全自动染色机染色,比较优化前后的染色优良率及染色时间。比较优化前后两个年度的诊断报告及时率。结果优化后包埋盒病理号的平均生成时间(5.51±0.14)s/个显著短于优化前的(8.39±0.19)s/个,差异有统计学意义(P<0.05);优化后生成冷冻标本包埋盒病理号错误率为0,显著低于优化前的4.00%,差异有统计学意义(P<0.05)。优化后对组织的速冻时间(61.27±0.58)s明显短于优化前的(62.03±0.58)s,组织完整性得分(8.76±0.08)分及细胞质无挤压变形得分(9.16±0.06)分均显著高于优化前的(7.36±0.07)、(6.85±0.08)分,差异有统计学意义(P<0.05)。优化后的染色优良率97.33%高于优化前的89.33%,差异有统计学意义(P<0.05)。若两份冷冻标本同时送检或两份冷冻标本送检时间相距<3 min 150次,制成的冷冻切片需在同一时段染色,优化后染色完成时间(485.10±0.99)s短于优化前的(554.20±1.26)s,差异有统计学意义(P<0.05)。优化后术中病理诊断报告及时率显著高于优化前,差异有统计学意义(P<0.05)。结论优化术中快速病理诊断技术重要环节后缩短了术中冷冻切片的制备时间,提高了冷冻切片的制片与染色质量,可在规定时间内为病理医师提供优质的染色片,缩短术中冷冻标本的报告等待时间,提高手术进程。

Objective To analyze the effect of intraoperative rapid pathological diagnosis to improve the numbering efficiency and accuracy rate,production efficiency,production quality and the timeliness rate of intraoperative rapid pathological diagnosis.Methods Frozen sections before and after optimization from 2017 to 2021 were selected as the research objects,100 frozen specimens in 2017(before optimization)and 2021(after optimization)were selected respectively.In 2017,the traditional embedding box generation method was used,and in 2021,cassette numbering machine was associated with the pathological information system to achieve accurate matching printing,and the average generation time and error rate of the frozen specimen cassettes before and after the optimization were compared.In 2017,the traditional tissue block quick-freezing method was adopted,and in 2021,a patented ice hammer assembly has been applied to the tissue quick freezing process of pathological frozen section preparation.The quick-freezing time,tissue integrity score and the score of no extrusion deformation of cytoplasm were compared before and after optimization.150 frozen tissue blocks were randomly selected,and 2 pieces were continuously cut from each block,1 piece was dyed manually,and 1 piece was dyed by automatic dyeing machine.The excellent rate of dyeing and dyeing time before and after optimization were compared.The timeliness of diagnosis report in two years before and after the optimization was compared.Results After optimization,the average generation time of the embedded box of frozen samples was(5.51±0.14)s/piece,which was significantly shorter than that of(8.39±0.19)s/piece before optimization,and the difference was statistically significant(P<0.05).After optimization,the error rate of pathological number of the frozen specimen embedding box was 0,which was significantly lower than that of 4.00%before optimization,and the difference was statistically significant(P<0.05).After optimization,the quick-freezing time of tissue of(61.27±0.58)s was significantly shorter than that of(62.03±0.58)s before optimization;the tissue integrity score was(8.76±0.08)points and the score of no extrusion deformation of cytoplasm was(9.16±0.06)points,which were significantly higher than those of(7.36±0.07)and(6.85±0.08)points before optimization;the differences were statistically significant(P<0.05).After optimization,the excellent rate of staining was 97.33%,which was higher than that of 89.33%before optimization,and the difference was statistically significant(P<0.05).If two frozen specimens were submitted for inspection at the same time or time interval<3 min 150 times,the frozen sections made should be dyed at the same time.The dyeing completion time was(485.10±0.99)s,which was shorter than that of(554.20±1.26)s before optimization,and the difference was statistically significant(P<0.05).After optimization,the timeliness rate of intraoperative rapid pathological diagnosis report was significantly higher than that before optimization,and the difference was statistically significant(P<0.05).Conclusion After optimizing the important links of intraoperative rapid pathological diagnosis,the preparation time of intraoperative frozen sections is shortened,the production and dyeing quality of frozen sections are improved,high-quality staining tablets can be provided for pathologists within the specified time,the waiting time for intraoperative frozen specimen report is shortened,and the operation process is improved.