如何提高纤维支气管镜检查的病理诊断阳性率的探讨

纤维支气管镜（简称纤支镜）检查是属微创检查,以其创伤小、简单、易行、可重复检查的特点,成为诊断肺癌极为重要的手段,如何提高其病理诊断阳性率就显得至关重要,在检查中如何做才能减轻患者的痛苦、损伤小、成功率高,是每位医师须思考的问题,

体位训练和改进标本采集术在经支气管针吸活检术中的应用

目的探究体位训练和改进标本采集术在经支气管针吸活检术(EBUS-TBNA)中的应用效果。方法选取2014年6月—2016年8月在本院拟行EBUS-TBNA的102例患者作为研究对象,随机分为对照组和实验组,每组51例,分别采取常规护理方案和改进后的护理方案(进行体位训练)进行护理治疗。且对照组患者标本采集采用传统方法,实验组采用改进后的标本采集方法。观察2组患者护理成效状况、心理状态改善情况以及标本采集得到的病理阳性率。结果实验组患者的护理成效显著优于对照组,差异具有统计学意义(P<0.05);实验组患者的SAS评分、SDS评分优于对照组,差异均具有统计学意义(P<0.05);实验组得到的病理阳性率优于对照组(P<0.05)。结论体位训练和标本采集术在EBUS-TBNA的应用,提高了穿刺的准确率及病理诊断的阳性率,减少了患者痛苦,提高了患者满意度,值得在临床中推广应用。

251例意义不明确非典型鳞状上皮细胞(ASCUS)体检女性的临床分析

目的了解本院体检科常规体检人员宫颈液基细胞学检查(TCT)诊断为意义不明确非典型鳞状上皮细胞(ASCUS)的患者年龄分布特点、高危型人乳头瘤病毒(HR-HPV)感染及阴道镜检查活检组织病理情况,并探讨适合的临床处理方法。方法选取2018年7月至2019年12月于本院体检科行TCT检查诊断为ASCUS并进一步行高危型HPV检测、阴道镜检查及活检组织病理学检查的251例体检人员进行结果分析。结果251例ASCUS年龄分布与HR-HPV感染年龄分布一致,集中在35~54岁,特别是35~44岁;HR-HPV感染者67例,HR-HPV感染率为26.69%,阴道镜下活检病理组织阳性13例,低级别鳞状上皮内病变(LSIL,包括5例宫颈CIN1,7例阴道壁、穹窿部的VAIN1)12例,高级别鳞状上皮内病变(HSIL,CIN2-3)1例,未发现宫颈浸润癌患者;HR-HPV感染的ASCUS患者病理组织阳性率14.93%,HR-HPV感染阴性的ASCUS患者病理组织阳性率1.63%。结论定期规律体检人员宫颈细胞学为ASCUS的患者HR-HPV感染率及宫颈、阴道病理组织阳性率均较低,处理方式可首选观察随访。

Changes in the clinicopathological characteristics of gastric cancer in Hehuang Valley of China–2379 cases of gastric cancer in recent 10 years

Objective： The aim of our studywas to discuss changes in the clinicopathological characteristics of gastric cancer in Hehuang Valley of China in recent 10 years. Methods： A retrospective case-control study was performed on 2379 newly-diagnosed gastric cancer patients. All of them came from Hehuang Valley. The patients were divided into two groups [recent 5 years （R5Y） and late 5 years （L5Y）] from February 2003 to February 2013, and the clinicopathological data were surveyed retrospectively. Results： The constituent ratio of upper 1/3 gastric cancer in R5Y and L5Y was 33.5% and 20.7%, respectively, and it showed a significant difference between the two groups （X2 = 21.28, P = 0.00）, The constituent ratio of squamous carcinoma/adenosquamous carcinoma was 2.7% and 1.6%, respectively, and it also showed a significant differ- ence between two groups （X2 = 50.91, P = 0.00）. The constituent ratio of moderately-poorly differentiated/poorly differentiated gastric carcinoma was 84.2% and 50.2%, respectively, and it showed statistically significant difference （X2 = 30.28, P = 0.00）. The detection rate of early gastric cancer （EGC） was 1.47% （35/2379）. The constituent ratio of the types of Borrmann II and Borrmann IV of advanced gastric cancer （AGC） among 2379 cases was 47.6% and 40.8%, respectively, and that still showed statistically significant difference （X2 = 18,80, P = 0.00）. The constituent ratio of diffuse-type of gastric cancer in R5Y and L5Y was 36.2% and 30.8%, respectively, even there was a significant difference （X2 = 7.49, P = 0.01）. Furthermore, there were also significant differences in regional lymph nodes metastasis, perineural infiltration and vascular invasion （P 〈 0.05）. The positive detection rate of HER2, ER and PR was 14.88%, 17.23% and 15.93%, respectively. The constituent ratio of HP in two groups was 43.8% and 36.2% respectively, and it also showed a significant difference （~2 = 13.51, P = 0.00）. Conclusion： The pathogenic sites in gastric cancer change to the upper stomach in Hehuang Valley in recent 10 years, and the detection rate of squamous carcinoma/adenosquamous carcinoma reveals a sharp rise. Borrmann III is still one of the main types of advanced gastric cancer, but the detection rates of Borrmann II and IV are increasing. The main type of gastric cancer is the intestinal- type, but the ratio of diffuse-type is also increasing in recent 10 years. The HP detection rate is 40.65% （967/2379）, and it has a slight rise in recent 10 years. The detection rate of poorly differentiated adenocarcinoma is increasing despite the fact that the moderately/moderately-poorly differentiated adenocarcinoma is the main histologic types. High detection rates of lymph nodes metastasis, perineural infiltration and vascular invasion indicate poor prognosis in patients with gastric cancer. There is no change in HER2 positive rate, on the contrary, there are a little increase in ER and PR expression in Hehuang Valley.

甘露聚糖肽联合PC方案治疗肺腺癌恶性胸腔积液的疗效观察

目的探讨注射用甘露聚糖肽联合PC方案(注射用培美曲塞二钠、卡铂注射液)治疗肺腺癌恶性胸腔积液的临床疗效。方法选取2013年1月—2016年12月南京市胸科医院呼吸科收治的肺腺癌合并恶性胸腔积液患者80例为研究对象,所有患者以随机抽样法分为对照组和治疗组,每组各40例。对照组静脉滴注注射用培美曲塞二钠500 mg/m^2、卡铂注射液300 mg/m^2,1次/3周。治疗组在对照组基础上胸腔内注射注射用甘露聚糖肽,30 mg/次,2次/周。两组患者均治疗6周。观察两组的临床疗效,比较两组的胸腔积液病理阳性率。结果治疗后,对照组和治疗组的有效率分别为65.0%、85.0%,两组比较差异有统计学意义(P<0.05)。治疗2、4周后,对照组胸腔积液病理阳性率分别为67.5%、42.5%;治疗组胸腔积液病理阳性率分别为37.5%、17.5%,两组病理阳性率比较差异有统计学意义(P<0.05)。两组骨髓抑制、胃肠道反应、发热或胸痛症状比较差异均无统计学意义。结论注射用甘露聚糖肽联合PC方案治疗肺腺癌恶性胸腔积液具有较好的临床疗效,可降低胸腔积液病理阳性率,安全性较好,具有一定的临床推广应用价值。

消化内镜下活检止血新方法的临床应用

目的减少消化内镜下活检出血量,有效进行止血,使病变部位视野清晰,能够准确获取病理标本,提高消化内镜下活检阳性率。方法贮水瓶内注入止血药物,利用消化内镜注水按钮将止血药物通过注水孔道喷洒于钳取后的出血部位进行止血。结果经的临床工作实践和持续改进,此方法能够对活检部位迅速有效止血。结论经贮水瓶镜下喷洒止血药物进行活检止血的新方法,可有效减少出血,并使病变视野清晰,提高活检准确率和病理结果阳性率,对于疾病诊断和治疗起到重要意义。