目的 探讨CT引导经皮穿刺肺活检(CT-GPLB)诊断肺感染性疾病病原体的临床意义.方法 回顾分析2018年3月-2022年8月109例临床怀疑肺感染性疾病患者CT-GPLB病原学诊断结果,并与痰、血、支气管镜常规病原学检查诊断结果比较.结果 109例肺感染性疾病患者中,47例(43.1％)明确病原体,其中真菌24例(其中1例与革兰阴性杆菌混合感染),细菌9例,结核分枝杆菌12例,病毒1例,快速生长型偶发分枝杆菌1例.CT-GPLB病原学诊断率42.2％,另1例痰涂片抗酸染色阳性但其他检查方法阴性.CT-GPLB组织培养阳性率21.1％,病理学阳性率28.4％,肺组织涂片阳性率7.3％.CT-GPLB肺组织病原体总诊断率42.2％(46/109)高于痰标本检查4.1％(3/73)、血标本检查3.1％(1/32)及支气管肺泡灌洗液检查9.8％(8/82).CT-GPLB组织培养阳性率21.1％(23/109)高于痰培养阳性诊断率2.7％(2/73)和支气管肺泡灌洗液培养阳性诊断率7.3％(6/82).结论 CT-GPLB组织检查对明确肺部感染性疾病的病原体具有较高的临床价值,诊断率高于常规病原学检查方法.

目的 总结成人巨大纵隔淋巴管瘤的临床表现、影像学特征,以及3D打印技术辅助手术治疗的效果.方法 回顾性分析1 例成人巨大纵隔淋巴管瘤患者的诊治过程,观察3D打印技术辅助手术治疗的效果.结果 患者主要表现为左侧胸壁隆起肿块,无压痛及其他特殊不适,3D打印技术结果提示肿瘤位置与纵隔内血管的相互关系极为复杂,肿瘤上部包裹升主动脉、主动脉弓、无名动脉、左颈总动脉、左锁骨下动脉、上腔静脉及左无名静脉,瘤体沿组织间隙向下生长,向左包裹部分心包并压迫左肺,向右贴着心包与胸膜间隙向下生长,压迫右肺与膈肌,与心包、胸膜、气管前壁等组织关系密切.采用3D打印技术辅助手术治疗,手术过程顺利,肿瘤可完整切除,术后病理检查证实为海绵状淋巴管瘤.结论 通过3D打印技术建立肿瘤实体模型,可多角度观察纵隔淋巴管瘤的结构、大小、数目、邻近关系等,提高手术的精准度,降低手术风险.

目的 探讨超声造影(CEUS)诊断喉癌及术前T分期的价值.方法 2017年4月至2020年5月广西壮族自治区人民医院病理确诊的喉癌患者43例,术前分别行常规超声、CEUS及增强CT(CECT)检查.观察记录喉癌的超声造影特征,对比评价CEUS、常规超声及CECT对喉癌术前T分期及喉软骨侵犯的判断准确性.结果 常规超声、CEUS与CECT对喉癌肿瘤检出率差异无统计学意义(P>0.05).喉癌的超声造影增强模式以高增强、分布不均匀、快速增强、快速消退为主要特点.常规超声、CEUS及CECT对喉癌术前T分期的准确度分别81.4％、88.4％及90.7％,差异无统计学意义(P>0.05).CEUS较常规超声可更清晰地显示喉软骨连续完整性,CEUS评价喉软骨侵犯的灵敏度、特异度及准确度高于常规超声.结论 超声造影可无创性准确评估喉癌术前T分期及喉软骨侵犯.

患者,男,32岁,反复淋巴结肿大、发热伴皮疹2年,广谱抗生素、抗结核治疗无效,肺部CT提示两肺内多发结节,血γ干扰素抗体阳性,皮肤活检组织、淋巴结组织、肺穿刺活检组织均培养出马尔尼菲篮状菌,予两性霉素B脂质体联合伏立康唑治疗效果佳.

Background Contrast-enhanced ultrasound (CEUS) is considered an attractive imaging technique to evaluate tumor microcirculation. However, the validity of CEUS for assessing laryngeal carcinoma is unclear. Purpose To compare the performance of CEUS with conventional US and contrast-enhanced computed tomography (CECT) in the diagnosis and preoperative T-staging of laryngeal carcinoma. Material and Methods Forty-one consecutive patients with laryngeal carcinoma underwent conventional high-frequency US, CEUS, and CECT before surgery. The CEUS characteristics of laryngeal carcinoma were recorded. The imaging findings of CEUS and conventional US were compared with CECT findings and the postoperative pathological examination. Results CEUS showed hyperenhancement in 38 cases and isoenhancement in three cases. Homogeneous distribution of contrast agent was found in 20 cases and heterogeneous distribution in 21 cases, of which 16 cases showed local perfusion defects. In the enhanced phase, rapid entry was observed in 37 cases, synchronous entry was observed in two cases, and slow entry was observed in two cases. Rapid exit was observed in 25 cases and slow exit was observed in 16 cases. The pretherapeutic T-staging accuracy was not significantly different between conventional US, CEUS, and CECT ( P ≥ 0.500). A high sensitivity and specificity were achieved by CEUS in the evaluation of involvement of thyroid cartilage. Conclusion Compared with conventional US and CECT, CEUS has a reliable initial T-staging accuracy and diagnostic properties for detecting laryngeal cartilage invasion.

目的 分析子宫内膜样腺癌(EA)患者的多功能蛋白聚糖(VCAN)和血清癌抗原125(CA125)表达情况及其与临床病理特征的关联性.方法 选择2016-01 ～ 2019-01在该院接受门诊宫腔内膜组织取检患者120例,其中EA患者60例(EA组),不典型子宫内膜增生患者40例(不典型子宫内膜增生组),正常子宫内膜者20例(正常子宫内膜组).比较三组患者的VCAN和血清CA125水平.分析EA患者的VCAN和血清CA125表达情况与临床病理特征的关联性.结果 EA组、不典型子宫内膜增生组和正常子宫内膜组在VCAN及血清CA125的阳性率方面比较差异有统计学意义(P＜0.05);且在三组中,EA组的VCAN及血清CA125的阳性率均为最高.VCAN阳性表达的EA患者手术分期为Ⅲ/Ⅳ期、浸润深度＞1/2、出现淋巴结转移的人数比例大于VCAN阴性表达者,差异有统计学意义(P＜0.05).血清CA125阳性表达的EA患者手术分期为Ⅲ/Ⅳ期及出现淋巴结转移的人数比例大于血清CA125阴性表达者,差异有统计学意义(P＜0.05).EA患者VCAN与血清CA125表达情况具有差异性(P =0.000).结论 VCAN和血清CA125对EA的发生与发展具有重要作用,其为EA的早期诊断及治疗方案的选择提供了参考.

目的 评估常规磁共振成像(M RI)、扩散加权成像(DWI)、动态对比增强磁共振成像(DCE-MRI)在颈部良恶性淋巴结鉴别诊断价值.方法 回顾性分析77例(300枚淋巴结)经病理确诊或临床治疗随访证实的颈部淋巴结病变患者的3.0T常规MRI、DWI和DCE-MRI等多模态影像资料,其中良性32例120枚,恶性45例180枚.评估影像资料中各项指标的诊断效能.其中两组间常规MRI评价指标、DCE-MRI中半定量参数比较采用x2检验,DWI和DCE-MRI中定量参数比较采用t检验,定量参数间的相关性采用直线回归分析并绘制受试者工作特征曲线(ROC).结果 良、恶性淋巴结长/短径＜1.5分别为20％(24/120)、71.7％ (125/180);边界不清楚分别为12.5％ (15/120)、53.3％ (96/180);T1WI高信号分别为15％ (18/120)、0(0/180);ADC图低信号分别为20％ (24/120)、88.3％ (159/180).两者在形态、边界、T1WI及ADC图信号差异上有统计学意义(x2=25.637、17.167、7.100、47.107,P＜0.05).在DCE-MRI的曲线类型中,良、恶性淋巴结TIC-B型分别占7.5％ (9/120)、53.3％ (96/180),两者差异有统计学意义(x2=22.596,P=0.000).良、恶性淋巴结的平均ADC值分别为1.324×10-3 mm2/s、0.783×10-3 mm2/s,两者差异有统计学意义(t=6.120,P=0.000);在DCE-MRI的定量参数中,良性淋巴结Kep值低,Ve值高;恶性淋巴结Kep值高,Ve值低,两者ADC、Kep、Ve差异有统计学意义(t=6.120、-3.048、7.025,P＜0.05);采用直线回归分析,ADC和KepVe值联合应用对颈部良恶性淋巴结影像学诊断有较强相关性(F =4.364、12.369、6.475,P＜0.05).结论 多模态的多项指标对颈部良恶性淋巴结的鉴别诊断具有很高的效能.

目的 探讨非哺乳期妇女乳腺炎性肿块的超声图像及超声造影特征.方法 收集该院2008-01～2016-12 52例非哺乳期乳腺炎性肿块患者的影像学资料进行超声图像和超声造影特征分析.结果 52例非哺乳期乳腺炎性肿块,其高频彩色超声图像表现为不规则实质低回声、混合型肿块、位置较表浅、与皮肤层分界不清、表面皮肤水肿增厚或层次模糊、肿块常有类似恶性肿瘤的表现.超声造影特征表现为非均质高增强强度,进入肿块的范围常较二维超声图像的范围明显增大,周围及内部有较粗大的条状血管增强;最具有特征性表现是丰富的造影剂进入后呈分隔状,内可见单个及多个无增强区,呈圆及椭圆状.彩色高频超声诊断符合率为57.69％(30/52),结合超声造影检查后诊断的符合率为82.69％(43/52),超声US-BI-RADS分级为Ⅲ～V级.结论 非哺乳期乳腺炎性肿块超声图像及超声造影可呈现一定的特征表现,两者结合检查有助于降低误诊及漏诊率,提高诊断符合率.

We investigated the value of combined acoustic radiation force impulse (ARFI) imaging and conventional ultrasound (US) in identifying renal histopathological fibrosis with immunoglobulin A nephropathy. A total of 146 patients with immunoglobulin A nephropathy, pathologically confirmed by renal biopsy were grouped according to Oxford classification and Katafuchi grading, were included in the test group, and 39 healthy volunteers were included in the control group. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic accuracy of ARFI, renal lengths, parenchymal thicknesses and interlobular arterial resistance index (RI) and their combinations in identifying Katafuchi grading at renal biopsy. Shear wave velocity (SWV), renal length, renal parenchyma thickness and the interlobular arterial RI were correlated with Katafuchi grading, mesangial hypercellularity (M) and tubular atrophy/interstitial fibrosis (T) (r = -0.504 to -0.407, p < 0.01) but were not correlated with endocapillary hypercellularity (E) or segmental glomerulosclerosis (S). The area under the curves of SWV value + conventional US index (renal length, renal parenchyma thickness and interlobular arterial RI) was higher than those of the SWV value or of the conventional US index alone. The combination of ARFI imaging and conventional US can improve the diagnostic performance in quantitative evaluation pathologic dam- age in patients with immunoglobulin A nephropathy. (C) 2019 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

目的 探讨高龄经产妇妊娠的临床特点及对其妊娠结局的影响,为临床诊治提供参考依据.方法 回顾性分析2014年1月-2016年12月广西壮族自治区脑科医院产科收治的160例高龄经产妇(年龄≥35岁)的临床资料,将其作为观察组,选择同期收治的200例非高龄经产妇(年龄＜35岁)作为对照组,收集两组产妇基本信息、既往分娩情况、妊娠合并症、妊娠并发症、分娩方式、是否难产及新生儿结局等资料,总结高龄经产妇妊娠基本特点及对其妊娠结局的影响.结果 ①观察组产妇年龄大于对照组,其距前次分娩时间长于对照组,差异有统计学意义(均P＜0.05).②观察组妊娠期高血压疾病、妊娠期糖尿病、胎膜早破发生率高于对照组,差异有统计学意义(均P＜0.05).③观察组慢性高血压、子宫肌瘤所占比例高于对照组,差异有统计学意义(均P＜0.05).④观察组阴道分娩所占比例低于对照组,差异有统计学意义(P＜0.05),其分娩孕周＜28周(流产)所占比例略高于对照组,分娩孕周为28 ～36+6周(早产)所占比例高于对照组,但差异无统计学意义(均P＞0.05).⑤观察组巨大儿、胎儿生长受限发生率高于对照组,差异有统计学意义(均P＜0.05).结论 高龄经产妇妊娠合并症、妊娠并发症发生率较非高龄经产妇高,且其围生儿不良结局发生率亦较高.

目的 探讨子宫内膜癌组织中多功能蛋白聚糖(Versican)的表达及与临床病理关系.方法 应用免疫组化Envision二步法检测50例子宫内膜癌、40例子宫内膜不典型增生、20例正常子宫内膜组织中Versican表达.结果 Versican在子宫内膜癌、子宫内膜不典型增生阳性率和正常子宫内膜组织阳性率分别为78.0％、57.5％和5.0％.Versican在子宫内膜癌和子宫内膜不典型增生组中的表达均高于正常子宫内膜组,差异有统计学意义(P＜0.05).子宫内膜癌中,Versican与肿瘤分期、肿瘤浸润肌层深度和淋巴结转移相关,差异有统计学意义(P＜0.05).结论 子宫内膜样腺癌中Versican的高表达可能与肿瘤发生、发展有关.

患者男,26岁.因出现肉眼血尿,于2016年9月24日到本院就诊.3年前因尿频、尿急、尿痛伴尿道口灼热痛,在基层医院按"尿路感染"予抗感染等处理,症状无明显好转.入院查体肛门指检触及前列腺Ⅳ度肿大,质韧,中间沟消失,表面尚光滑,无压痛,未触及明显结节.血清学检查:游离前列腺特异性抗原(PSA)、复合PSA、总 PSA均在正常范围.

Objectives: To assess the value of contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) imaging for the differential diagnosis of benign and malignant thyroid nodules. Methods: CEUS was performed in eighty-eight thyroid nodules. The patterns of CEUS were analyzed, and ARFI was then performed. The shear wave velocities (SWVs) of the nodules and the surrounding normal thyroid tissue were obtained. The areas under the curve (AUCs) and cut-off value were obtained by a receiver operating characteristic (ROC) curve analysis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic rate of each modality were assessed and compared using pathological diagnosis. Results: Among 88 nodules, 29 nodules were malignant and 59 were benign. The sensitivity, specificity, PPV, NPV, and diagnostic rate of CEUS were 79.3, 91.5, 82.1, 90, and 87.5%, respectively. Using a cut-off value of 2.565 m/s for SWV, the sensitivity, specificity, PPV, NPV and diagnostic rate for malignancy were 75.9, 94.9, 88.0, 88.9, and 88.6%, respectively. The AUC was 0.878. The sensitivity, specificity, PPV, NPV and diagnostic rate of CEUS in combination with ARFI were 93.1, 89.8, 81.8, 96.3, and 90.9%, respectively. Conclusion: Both CEUS and ARFI are valuable for the differential diagnosis of benign and malignant thyroid nodules. Combining these two methods can improve the diagnostic rate.

目的 探讨肾实质剪切波传播速度(SWV)评估IgA肾病牛津病理分型的价值.方法 143例经肾穿刺活检证实的IgA肾病患者根据牛津病理分型指标M、E、S、T进行分组,同时纳入33例健康志愿者作为对照组.应用声触诊组织量化(VTQ)技术定量分析肾实质SWV测值与MEST分型、尿素氮(BUN)、血肌酐(Scr)、肾小球滤过率(e-GFR)的相关性,构建ROC曲线确定VTQ技术评价IgA肾病病理分型的诊断效能.结果 IgA肾病SWV测值与M、T分型、BUN及Scr负相关(r=-0.179、-0.448、0.509、-0.578,P≤0.03),与e-GFR呈正相关(r=0.592,P＜0.001).IgA肾病组SWV测值较健康对照组降低(P=0.001);T2组SWV测值与T0、T1组比较,差异具有统计学意义(P≤0.001).以2.66、2.59 m/s和2.39m/s为诊断IgA肾病M1、T1及T2分型的最佳诊断界值,其对应的灵敏度分别为66.2％、65.6％和87.0％,特异度分别为59.0％、68.7％和83.0％,ROC曲线下面积分别为0.645、0.734和0.897.结论 VTQ技术可无创性评估IgA肾病牛津病理分型,具有推广应用价值.

Rationale: Malignant mixed Mullerian tumor (MMMT) of extragenital organs is rare, especially in male. To our knowledge, this is the first reported case of primary MMMT at the mediastinum in male. Patient concerns: A 5(-year-old male was admitted to the hospital due to repeated stimulating dry cough for 2 years. His systemic examination was unremarkable. Laboratory workup revealed that all blood indicators were within normal limits. But subsequent computerized tomography (CT) scans of chest showed an abnormal soft tissue density in the area of its left, measuring approximately (cm in anterior-posterior dimension and 7cm in maximum transverse dimension. Diagnoses and Interventions: The pathogenesis of these tumors remains controversial. The diagnosis is combined with biopsy and immunohistochemical staining. So, the patient underwent radical surgical resection and pathologic examination of the excised specimen was consistent with the diagnosis of MMMT. After surgery, he was treated by sequential chemoradiotherapy. Outcomes: The patient died from tumor recurrence 16 months later. Lessons: MMMT is a rare, highly aggressive tumor associated with interesting embryological origin, a definite diagnosis of which is only confirmed on pathological assessment. Due to its high degree of malignancy and high rate of recurrence, complete macroscopic excision of the tumor is recommended as soon as possible.

Objective:To investigate the expressions of Versican and VEGF,their correlation of endometrial carci-noma,atypical endometrial hyperplasia and normal endometrial tissue.Methods:Endometrial carcinomas were collect-ed,atypical endometrial hyperplasia and normal endometrial tissue.Immunohistochemistrical methods were used to de-tect their Versican and VEGF expressions.Results:The postive rate of Versican in the endometrial carcinomas,atypi-cal endometrial hyperplasia and normal endometrial tissue were 78.0%,57.5% and 5.0%,respctively,The postive rate of VEGF in the endometrial carcinomas,atypical endometrial hyperplasia and normal endometrial tissue were 86.0%,55.0% and 10.0%,respctively.The expression of Versican was significantly different in staging,invasion depth and lymph node metastasis respectively(P<0.05).The expression of VEGF was significantly different in his-topathologic types and invasion depth(P<0.05).There was positively correlation between the expressions of Versican protein and VEGF(P<0.05).Conclusion:Versican and VEGF enrichment of stroma may be associated with tumor occurrence,proliferation and invasion of endometrial carcinoma.

RATIONALE:Primary gastrointestinal mantle cell lymphoma is rare, and histopathological examination and specific immunohistochemical staining are still the gold standard for diagnosis. Therefore, it is necessary to find a new way to improve positive biopsy rates.PATIENT CONCERNS:A 58-year-old man was admitted to our hospital with epigastric pain, abdominal distension, nausea, and melena. Endoscopy identified submucosal neoplasms and diffuse gastrointestinal tract involvement including the esophagus.DIAGNOSES:A false-negative diagnosis was first determined by ordinary endoscopy. However, a large tissue biopsy was subsequently performed using endoscopic mucosal resection based on endoscopic ultrasonography (EUS). Pathological examination of the biopsy specimens taken from the lesions of the duodenum and rectum revealed diffuse lymphocytic proliferation and obscure nodular and small cleaved cells with irregularly shaped nuclei. Immunohistochemistry showed that the cells were positive for CyclinD1, BCL-2, CD20, CD21, and CD5; however, they were negative for CD3, CD6, CD10, and CD43.INTERVENTIONS:The patient refused to receive further treatment.OUTCOMES:Mantle cell lymphoma was conclusively diagnosed.CONCLUSIONS:EUS has an important role in the diagnosis and management of gastrointestinal submucosal tumors. Performing a pathological biopsy including EUS may be useful for identifying the unknown nature of tumors of the digestive tract.

OBJECTIVE:The purpose of the present study was to explore the correlation between the contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) characteristics of breast cancers and the expression of human epidermal growth factor receptor 2 (HER-2). METHODS:HER-2 expression levels in the tumor masses of 167 clearly diagnosed cases of breast cancer were measured and analyzed. The enhancement features and time intensity curve (TIC) of CEUS and virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ) technology of ARFI were employed to analyze the relationship between HER-2 expression and the CEUS and ARFI characteristics of breast cancer. RESULTS:(1) Statistically significant differences in the distribution of the contrast agent, perforator blood flow, the overranging phenomenon and perfusion defects between the study groups with different HER-2 expression levels (P < 0.05) were observed on CEUS. In addition, statistically significant differences in the TIC peak time (PT), slope of the ascending branch (K) and area under the curve (AUC) were found in the groups expressing different levels of HER-2 (P < 0.05). In contrast, the degree of contrast agent enhancement and TIC peak intensity (PI) were found to be independent of the expression status of HER-2, as they were not statistically significant (P > 0.05). (2) Statistically significant differences in the VTQ results between the groups with different HER-2 expression levels were found (P < 0.05). However, no statistically significant differences in VTI image characteristics were detected between the groups expressing different levels of HER-2 (P > 0.05). CONCLUSION:A correlation was found between the CEUS and ARFI characteristics of breast cancer and HER-2 expression levels. This correlation was principally reflected in perfusion defects, perforator blood flow, PI, PT, K and VTQ.

例1 患者男,28岁.全身丘疹、结节8个月余于2013年8月入院.入院前8个月患者背部被蚊子叮咬后出现丘疹,微痒,未予处理.随后皮疹逐渐增多,波及全身皮肤.夏天有痒感,冬天无自觉症状.体检:全身躯干、四肢及头面部散在淡黄色丘疹、结节,最大径0.2~1.5 cm,界清,部分有轻微囊性感.全身浅表淋巴结无肿大,肝脾肋下未触及.其他检查无殊.临床诊断:皮肤弹力纤维溶解症?取右前臂皮肤活检.

目的 本研究旨在探讨亚甲蓝示踪前哨淋巴结活检术(SLNB)在早期乳腺癌治疗的可行性及应用价值.方法 取2013年11月~2015年11月在我院就诊328例乳腺癌中体检腋窝淋巴结阴性的早期乳腺癌90例,所有患者亚甲蓝示踪行SLNB,同时行腋窝淋巴结清扫术(ALND),将前哨淋巴结与腋窝淋巴结送检.结果 通过亚甲蓝示踪,其中有4例患者未检出,前哨淋巴结检出率为95.6%(86/90),其中前哨淋巴结阳性36例,前哨淋巴结阴性50例,腋窝淋巴结阳性38例,前哨淋巴结假阴性2例,准确率97.6%(84/86),灵敏性94.7%(36/38),假阴性率5.26%(2/38),特异性为96%(48/50),假阳性率为0.所有患者未出现无皮肤蓝染坏死、过敏等不良反应.SLNB与ALND的准确率(P>0.05),差异无统计学意义,两者有显著的相关性.结论 亚甲蓝示踪前哨淋巴结活检经济安全、无环境污染以及并发症少,可准确预测早期乳腺癌腋窝淋巴结转移情况,可作为以后早期乳腺癌患者的一种手术方式.值得在各级医院推广.