胸腹水细胞蜡块制作的常见问题分析

Analysis of common problems in making cell wax blocks of hydrothorax and ascites

目的针对胸腹水在细胞蜡块制作过程中几种常见问题探索合适的方法,提高蜡块的质量。方法分别收集2021年1月至2022年8月福建省肿瘤医院病理科在制作蜡块方面有困难的3种类型胸腹水标本,第1种为血性胸腹水标本,第2种为离心后细胞量较多细胞的标本,第3种为性状透明清亮或者胶冻状标本、离心后仅有微量可见的细胞标本,3种标本类型分为第1组、第2组、第3组,每组40例。每组均分为A、B两管,A管采用常规方法制作蜡块,B管分别采用不同的改良方法制作蜡块,最终比较三组A、B两管蜡块的质量。结果第1组B管解决了血性胸腹水镜下红细胞较多、有用细胞较少的问题;B管蜡块质量优于A管,差异有统计学意义(χ_(2)=72.381,P<0.001)。第2组B管解决了样本较多时制作出的蜡块较为松散,固定不佳,有用细胞流失的问题;B管蜡块制作难易度优于A管,差异有统计学意义(χ^(2)=45.113,P<0.001)。第3组B管解决了样本少、标本性状不佳无法包埋、脱水容易丢失、蜡块制作困难等难题;B管蜡块制作难易度优于A管,差异有统计学意义(χ^(2)=57.945,P<0.001)。结论通过蜡块制作中常见的几种问题,阐明了制作蜡块过程中,可以有针对性地对血性胸腹水使用新柏氏红细胞清洗液,标本量多的标本多1 h 95%酒精固定,量少的标本使用微量细胞蜡块包埋机制作,最大程度解决问题,制作出优质的细胞蜡块。

Objective In order to improve the quality of wax block,a suitable method was discovered for several common problems of hydrothorax and ascites in the process of making cell wax blocks.Methods Collection of Department of Pathology,Fujian Cancer Hospital from January 2021 to August 2022 with difficulty in making wax blocks of three types of hydrothorax and ascites specimens,the first type was bloody hydrothorax and ascites specimens,the second type was specimens with high cell count after centrifugation,and the third type was traits clear or jelly specimens after centrifugal only trace visible cell specimens,and the three specimen types were divided into the first group,the second group and the third group,with each group of 40 cases.Each group was divided into two tubes:A and B.Tube A made wax blocks by conventional method,and tube B used different modified methods to make wax blocks.Finally,the quality of the tube A and B of three groups was finally compared.Results The first group of tube B solved the problem of more red blood cells and fewer useful cells in hemorrhagic hydrothorax and ascites under the mirror.The wax block quality of tube B was better than that of tube A,and the difference was statistically significant(χ^(2)=72.381,P<0.001).The second group of tube B solved the problems of loose wax blocks,poor fixation and loss of useful cells when the samples were large.The difficulty in making wax blocks tube B was better than that in tube A,and the difference was statistically significant(χ^(2)=45.113,P<0.001).The third group of tube B solved the problems of small samples,poor specimen characteristics and inability to embed,easy loss due to dehydration,and difficulty in making wax blocks.The difficulty in making wax blocks of tube B was better than that of tube A,and the difference was statistically significant(χ^(2)=57.945,P<0.001).Conclusion Through several common problems in the preparation of wax blocks,it is explained that we can use new Bergscher red blood cell cleaning solution for blood thoracoabdominal fluid,fix the specimens with more than 1 hour of 95%alcohol,and use the embedding mechanism of tracing cell wax blocks for less specimens to solve the problem to the maximum extent and make high-quality cell wax blocks.