超声介入微创组织病理活检在甲状腺结节诊断中的临床意义
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张广 E-mail:zhangguang_74@163.com

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Value of ultrasound-guided minimally invasive biopsy in diagnosis of thyroid nodules
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    目的:探讨超声介入微创组织病理活检技术在甲状腺结节诊断中的临床意义。 方法:回顾性分析2008年10月—2010年4月在彩色多普勒超声引导下用美国巴德穿刺活检系统完成甲状腺结节患者微创组织病理活检528例(共591个结节)临床资料, 结节直径0.4~1.5 cm, 平均0.76 cm。 结果:528例患者活检取材, 穿刺成功率为99.4%(525/528)。活检诊断为甲状腺癌的161例, 良性病变367例。活检后行手术治疗226例, 病理符合率98.7%。假阴性(甲状腺癌误诊为良性疾病)3例, 假阴性率1.3%(3/226), 无假阳性。同时行颈部肿大淋巴结病理活检27例, 活检病理与术后石蜡病理结果一致。活检后患者均未出现明显不适, 发生腺体表面及肌间血肿22例, 无特殊处置平均1个月后自行缓解。 结论:超声介入微创组织活检技术对甲状腺结节和转移性颈淋巴结诊断的临床符合率高, 特别是对于微小结节的术前诊断具有较高的价值, 既可避免不必要的过度治疗, 又可减少甲状腺癌的漏诊。

    Abstract:

    Objective:To evaluate the value of ultrasound-guided minimally invasive biopsy in diagnosis of thyroid nodules. Methods:The records of 528 patients with thyroid nodules (a total of 591 nodules, diameters ranged from 0.4 to 1.5 cm with the average diameter of 0.76 cm) undergoing ultrasound-guided minimally invasive biopsy (Bard Access Systems), from Oct. 2008 to Apr. 2010, were retrospectively analyzed. Results:Of the 528 patients, the biopsy specimens were succeesfully obtained from 525 patients, and the success rate was 99.4% (525/528). There were 161 cases of thyroid carcinoma and 367 cases of benign lesion diagnosed by biopsy. A total of 226 cases underwent surgical treatment after biopsy and the postoperative pathological consistency rate was 98.7%, in which false negative rate was 1.3% (3/226), and no false positive cases were found. In 27 cases, preoperative cervical lymph node minimally invasive biopsy was performed at the same time, and their biopsy pathologies were completely consistent with the results of postoperative pathological examination. All patients had no apparent discomfort after biopsy except for hematoma occurring intramuscularly or on the surface of the gland in 22 cases, which spontaneously resolved after about 1 month without special treatment. Conclusions:Preoperative diagnosis of thyroid nodules and cervical lymph node using ultrasound-guided minimally invasive biopsy has high clinical consistency, especially for small nodules, which not only avoids unnecessary over-treatment but also reduces the misdiagnosis of thyroid cancer.

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边学海, 张广, 张纯海, 赵涛, 张大奇, 周乐, 孙辉.超声介入微创组织病理活检在甲状腺结节诊断中的临床意义[J].中国普通外科杂志,2011,20(5):450-452.
DOI:10.7659/j. issn.1005-6947.2011.05.005

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  • 收稿日期:2010-11-15
  • 最后修改日期:2011-04-18
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  • 在线发布日期: 2011-05-15