消化系统疾病诊治与组织病理诊断密切相关,高效、规范获取组织样本是关键,对此2021年欧洲胃肠内镜学会制定了消化道及肝胰腺胆道的内镜下组织活检的指南,分为上消化道（含肝、胰腺、胆道）和下消化道两部分,提供了规范活检的指导及建议。笔者对指南就上消化道内镜下组织活检的部分内容进行解读,解读内容为个人观点。

The diagnosis and treatment of digestive system diseases are closely related to histopathological diagnosis．Efficient and standardized acquisition of tissue samples plays a key role．In 2021,European Society of Gastrointestinal Endoscopy（ESGE）had developed guidelines for endoscopic tissue biopsy of the digestive tract and hepatopancreatic biliary tract,which divided into upper gastrointestinal tract（including liver,pancreas,biliary tract）and lower gastrointestinal tract．This guideline provided guidance and recommendations for standardizing biopsies．We interprets some of the contents of the guideline on tissue biopsy under endoscopy of the upper gastrointestinal tract,which are personal opinions．

目的 分析超声引导下经皮肾穿刺活检术对弥漫性肾病进行病理诊断的临床应用价值。方法 回顾性分析我院275例弥漫性肾病患者经超声引导下行经皮肾穿刺活检术进行诊断的情况,针对上述患者的穿刺活检情况、穿刺满意度、取材成功率、并发症发生状况、弥漫性肾病病理分型结果以及术后诊断更正的情况进行分析。结果 275例患者穿刺满意度、取材成功率、并发症总发生率分别为94.91%,100%、10.91%。275例患者术后并发症的发生与年龄、穿刺次数、肾实质厚度、术前血肌酐水平有关。275例患者以膜性肾病、IgA肾病居多,分别占比23.27%、18.55%。275例患者术后诊断更正率为19.79%。结论 超声引导下经皮肾穿刺活检术是一种安全有效的弥漫性肾病诊断方法,其术后并发症发生率较低且较轻。在弥漫性肾病病理分型诊断中以膜性肾病、IgA肾病的发病率较高。超声引导下经皮肾穿刺活检术可早期诊断弥漫性肾病的病理类型,为确定治疗方案提供可靠依据,改善肾脏疾病的预后。

Objective To analyze the clinical value of ultrasound-guided percutaneous renal biopsy for pathological diagnosis of diffuse renal disease. Methods Retrospective analysis of 275 patients with diffuse renal disease in our hospital underwent ultrasound-guided percutaneous renal biopsy for diagnosis. According to the above-mentioned patients' biopsy status,puncture satisfaction,success rate of material extraction,complications,and diffuse results of pathological typing of nephropathy and correction of postoperative diagnosis were analyzed. Results The satisfaction rate of puncture,the success rate of material extraction and the total incidence of complications were 94%,100%,and 10.91%,respectively. The incidence of postoperative complications in 275 patients was related to age,number of punctures,thickness of renal parenchyma,and preoperative serum creatinine levels. Membrane nephropathy and IgA nephropathy were the most common in 275 patients,accounting for 23.27% and 18.55% respectively. The correction rate of postoperative diagnosis in 275 patients was 19.79%. Conclusion Ultrasound-guided percutaneous renal biopsy is a safe and effective method for diagnosing diffuse nephropathy,and the incidence of postoperative complications is low and mild. Membrane nephropathy and IgA nephropathy have a higher incidence in the diagnosis of diffuse nephropathy. Ultrasound-guided percutaneous renal biopsy may early diagnose the pathological type of diffuse renal disease,provide a reliable basis for determining the treatment plan,and improve the prognosis of renal disease.

目的 探讨内镜活检Crohn病（CD）的临床病理特征,为临床提供更可靠的诊断。方法 回顾性分析内镜活检12例CD的临床表现、内窥镜特征,采用HE染色及免疫组化EnVision二步法。结果 显微镜下CD的组织学形态主要特征是非干酪样坏死性肉芽肿、裂隙状溃疡、黏膜及黏膜下层不均匀分布的重度炎症,淋巴管扩张和纤维组织增生,免疫组化染色CD68、D2-40、S-100均表达。结论 CD是一肿少见的炎症性肠病,回盲部及末段回肠是最好发部位,主要表现反复腹泻、血便等症状,内镜下见多灶溃疡,不连续性病变等特征,组织学见裂隙性溃疡,黏膜及黏膜下层的重度炎症且不均匀分布,位于生发中心的非干酪结节病样肉芽肿、淋巴管扩张和纤维组织增生等非特异性特征,可靠的病理诊断要结合临床、内镜、影像等检查及多部位多次活检。

Objective To investigate the clinical and pathological features of endoscopic biopsy tissue of Crohn disease （CD） and further to provide more reliable evidence for clinic. Methods A retrospective analysis of 12 cases of endoscopic biopsy tissue about CD’s clinical manifestations and endoscopic features,by HE staining and immunohistochemistry EnVision two-step method. Results The morphology of CD specimen is characterized by non-caseous necrotizing granuloma,ulceration,mucosal and submucosal uneven distribution of severe inflammation,dilated lymph vessels and fibrous hyperplasia. Immunohistochemical staining , all of cases express CD68,D2-40 and S-100. Conclusion CD is a rare inflammatory bowel disease. The majority of CD arises in ileocecal and terminal ileum. The main symptoms show repeated diarrhea,bloody stool and others. Endoscopic examination revealed multifocal ulcers,discontinuous lesions and other characteristics. Histological examination showed that there were nonspecific features such as fissure ulcer,severe inflammation in mucosa and submucosa with uneven distribution,non-caseous sarcoid-like granuloma in the germinal center,lymphangiectasis and fibrous tissue hyperplasia. An reliable pathological diagnosis is made that depends on many examinations including clinical,endoscope,radiology and multiple biopsy.

目的 研究对比胃癌患者术前胃镜活检病理与外科术后病理的异同并进行观察。方法 选取我院消化科于2016年7月—2017年12月收治的64例胃癌患者作为此次研究对象,术前均展开胃镜活检,术后展开外科病理检查,判断两种诊断方法的异同。结果 胃癌确诊率对比,术前胃镜活检后确诊胃癌患者占比85.9%(55/64),疑似胃癌患者占比10.9%(7/64),排除胃癌患者占比3.1%(2/64),术前胃镜活检确诊率85.9%,低于术后病理诊断95.3%,组间比较差异无统计学意义(P>0.05);胃镜活检病理结果对比,术前胃镜检查黏液腺癌占比35.9%,乳头状腺癌占比51.6%,均高于术后病理检查的25.0%、28.1%,组间比较差异具有统计学意义(P＜0.05);胃镜活检分化程度结果对比,胃镜病理与术后病理检查结果对比有明显差异,具有统计学意义(P＜0.05)。结论 对胃癌进行诊断时,尽管术前胃镜活检病理检查与外科术后病理检查结果存在差异,但术前胃镜活检对胃癌确诊率较为理想,可作为术前诊断参考,外科术后病理检查对全面评估胃癌病情具有较高应用价值,值得在临床中应用。

目的 分析针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的临床效果。方法 选择我院收治的乳腺肿物患者200例进行观察（2012年1月—2017年12月）,针对200例乳腺肿物患者存在的305个乳腺不可触及肿物进行活检检查,采用随机分组的方式将其分成两组后针对常规组100例乳腺肿物患者实施传统手术治疗,针对治疗组100例乳腺肿物患者实施超声引导下微创旋切活检术治疗,对比两组的治疗效果。结果 两组乳腺肿物患者之间对比的术中出血量、术后愈合时间、术后并发症发生率、治疗显效率存在差异（P<0.05）,统计学有意义;且超声引导下微创旋切活检术对于乳腺癌的诊断检出率较高。结论 针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的疗效显著,促进患者预后。

Objective To analysis of the clinical effect of ultrasound guided minimally invasive rotary biopsy for untouchable breast masses. Methods A total of 200 patients with breast masses were selected for observation （January 2012 to December 2017）, and 305 untouchable breast masses in 200 patients were examined by biopsy. It was divided into two groups randomly and then treated with traditional surgical treatment for 100 patients with breast masses in the routine group and 100 patients with breast masses in the treatment group with minimally invasive biopsy under the guidance of ultrasound. The therapeutic effects of the two groups were compared. Results There were differences between the two groups in the amount of intraoperative bleeding, postoperative healing time, the incidence of postoperative complications and the effective rate of treatment （P < 0.05）, and the differences were statistically significant （P < 0.05）. The diagnostic rate of breast cancer was higher with minimally invasive rotary biopsy guided by ultrasound. Conclusion The effect of ultrasound-guided minimally invasive rotary biopsy on untouchable breast masses is significant and promotes the prognosis of the patients.

目的 分析16G活检针应用于肾活检的安全性。方法 选取2014年3月—2016年7月收治的142例肾脏疾病患者临床资料,将其分为对照组(71例)、观察组(71例),对照组以18G针,观察组以16G针穿刺活检,观察比较两组穿刺取材情况以及取样后并发症情况。结果 观察组穿刺次数(1.95±0.52)次较对照组(2.83±0.65)次少,样本肾小球数(23.09±6.24)个较对照组(17.26±7.13)个多(P＜0.05);观察组穿刺成功率97.23%较对照组81.69%高(P＜0.05),并发症发生率18.06%较对照组23.95%略低(P＞0.05)。结论 采用16G活检针进行肾活检效果优于18G针,其取样成功率高,并发症少,具较高安全性。

目的 探讨超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中的应用价值。方法 我院52例经皮肺穿刺活检的病例,术前均采用高效抗逆转录病毒治疗,依据CD4⁺T淋巴细胞确定是否手术,术中规范手术方式,做好防护措施,27例行超声引导穿刺,25例行CT引导穿刺,术后应用抗生素预防机会性感染等。结果 所有患者穿刺成功率100%,超声组肺结核13例,真菌感染67例,细菌感染4例,肺腺样囊性癌2例、卡波西肉瘤1例。CT组肺结核11例,真菌感染7例,细菌感染5例,肺腺样囊性癌1例。术后并发症:超声组5例病灶少量气胸,2例周围少量出血,咯血4例;CT组8例病灶少量气胸,4例周围少量出血,咯血7例。结论 经过术前控制患者计数及预防感染治疗,超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中应用更为安全、有效、可行的,值得临床应用及推广。

Objective Objective to investigate the value of ultrasound-guided percutaneous lung biopsy in the diagnosis of peripheral lung lesions in AIDS patients. Methods 52 cases in our hospital of percutaneous pulmonary biopsy cases, preoperative highly active antiretroviral therapy was used, basis of CD4⁺T lymphocytes count determined whether the operation were performed, standard operation mode in the operation. It must to take good protective measures. 27 cases underwent ultrasound guided puncture, 25 cases underwent CT guided puncture and had postoperative application of antibiotics to prevent opportunistic infections. Results The successful rate of puncture was 100% in all patients. Tuberculosis in the ultrasound group was 13 cases, fungal infection was 67 cases, bacterial infection was 4 cases, pulmonary adenoid cystic carcinoma was 2 cases, and Posey's sarcoma was 1 cases. There were 11 cases of pulmonary tuberculosis in CT group, 7 cases in fungal infection, 5 cases in bacterial infection, and 1 cases in adenoid cystic carcinoma of the lung. Postoperative complications included: 5 cases of small pneumothorax in the ultrasound group, a small amount of bleeding around the surrounding, hemoptysis in 4 cases, CT group of patients with 8 cases of a small amount of pneumothorax in the lesions, 4 cases of a small amount of bleeding around the case, 7 cases of hemoptysis. Conclusion After preoperative control count and prevention of infection in patients with treatment, ultrasound guided percutaneous lung biopsy in peripheral pulmonary lesions of AIDS is more safe and effective, worthy of clinical application and promotion.

目的 探讨彩色多普勒超声在无精子症患者睾丸穿刺活检中的应用价值。方法 回顾性分析2012年11月—2015年2月在我科诊断为无精子症的53例患者的病例资料。所有患者进行常规阴囊超声检查,采用频谱多普勒检测睾丸动脉(TA)、睾丸内动脉(ITA)的收缩期最大速度(PSV)、舒张末期速度(EDV)和阻力指数(RI)。采用彩色多普勒超声观察睾丸内的血管分布及其数目,并进行半定量评分。所有患者进行睾丸穿刺活检并进行Johnsen评分。结果 47例患者诊断为梗阻性无精子症(OA),6例患者诊断为非梗阻性无精子症(NOA)。0A组睾丸的平均体积(15.3±3.6) mL,NOA组睾丸的平均体积(7.1±2.8) mL,差异有统计学意义(P＜0.01);OA组与NOA组患者睾丸的血流参数(PSV、EDV、RI) 结果有统计学意义(P＜0.05);OA组与NOA组睾丸内血管半定量分级有的差异,其差异有统计学意义(P＜0.01)。结论 彩色多普勒超声检查对睾丸生精功能有很好的预测作用,可作为鉴别OA患者和NOA患者的指标。

Objective To explore the application value of color Doppler ultrasound in patients with azoospermia who underwent testicular needle biopsy. Methods Retrospective analysed the clinical data of 53 cases patients with azoospermia from 2012 November to 2015 February in our department.All patients underwent routine scrotal ultrasonography, to detecte the peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI) of testicular artery (TA)and intratesticular artery (ITA)with spectral Doppler ultrasound. Color Doppler ultrasound was used to observe the distribution and the number of blood vessels in the testicle, and semi quantitative score. All patients underwent testicular biopsy and Johnsen score. Results 47 patients were diagnosed as obstructive azoospermia(OA), 6 patients were diagnosed as non obstructive azoospermia(NOA). The average volume of testis was (15.3±3.6)mL in 0A group. The average volume of testis was (7.1±2.8) mL in N0A group.There was significant difference (P<0.01). The blood flow parameters(PSV, EDV, RI) results between OA group and NOA group have obvious difference,the difference was statistically significant (P<0.05). The semi quantitative classification of testicular vessels between OA group and NOA group have obvious difference,the difference was statistically significant (P< 0.01). Conclusion Color Doppler ultrasound is a good predictor of testicular spermatogenic function, can be used as the identification index of patients with OA and patients with NOA.

目的 分析经直肠彩超引导下不同前列腺穿刺方式的阳性率及其相关因素,探讨安全的穿刺方案。方法 回顾性分析接受经直肠彩超引导下前列腺穿刺的701例患者临床资料,所有患者均接受系统性13点穿刺活检,并假设13点穿刺中减少前列腺中线3个穿刺点为10点穿刺术式,加之标准的6点穿刺术式。比较上述穿刺术式的阳性率,分析T-PSA、前列腺体积、PSA体积密度(PSAD)、有无前列腺结节对穿刺阳性率的影响。结果 随前列腺穿刺针数的增加,活检阳性率增高。同一穿刺方式,不同T-PSA组间、不同前列腺体积组、不同PSAD组阳性率有差异。T-PSA>100 ng/mL时,三种穿刺方式的阳性率无差异;T-PSA<100 ng/mL时,6点穿刺法阳性率较低,而10点穿刺、13点穿刺阳性率无差异。前列腺体积>80 mL时,不同穿刺法阳性率有差异。PSAD<0.5 ng/mL²时,10点、13点穿刺阳性率无差异。结论 前列腺穿刺活检阳性率随穿刺针数增多而增加,可根据PSA水平、前列腺体积、PSAD选择个体化穿刺方案。

      目的   探讨分析超声引导下胸膜活检（USPB）联合胸腔积液检验对于临床确诊结核性胸膜炎的应用价值。方法   选取2021年6月—2023年6月广州市胸科医院收治的96例临床诊断为结核性胸膜炎（渗出性胸膜炎）的患者为研究对象，分别使用胸腔积液检验（包含胸腔积液腺苷脱氨酶及细菌培养）、USPB、两者联合三种方法诊断，计算其准确率、特异度及灵敏度并进行分析。结果   胸腔积液诊断准确率73.96%、灵敏度72.84%，USPB诊断准确率为85.42%、灵敏度82.71%，两者联合诊断准确率为88.54%，灵敏度90.12%，较胸腔积液检验单独诊断准确率及灵敏度明显升高（P＜0.05），胸腔积液、USPB、两者联合诊断特异度差异（P＞0.05）无统计学意义。结论  USPB联合胸腔积液检验对结核性胸膜炎的确诊具有较高临床价值。

       Objective  To investigate the value of ultrasound-guided pleural biopsy（USPB）combined with  pleural effusion test in the diagnosis of tuberculous pleurisy．Methods  A total of 96 patients with tuberculous pleurisy（exudative pleurisy）admitted to the Guangzhou Chest Hospital from June 2021 to June 2023 were selected．The accuracy，specificity，and sensitivity of pleural effusion test（including adenosine deaminase and bacterial culture），USPB，and their combination were calculated and analyzed．Results  The diagnostic accuracy of pleural effusion was 73.96% and the sensitivity was 72.84%．The diagnostic accuracy of USPB was 85.42% and the sensitivity was 82.71%．The diagnostic accuracy 88.54% and sensitivity 90.12% of USPB combined with pleural effusion test were significantly higher than that of pleural effusion alone（P＜0.05），but there was no significant difference in the diagnostic specificity of pleural effusion，USPB and combination of them（P＞0.05）．Conclusions  USPB combined with pleural effusion test has high clinical value in the diagnosis of tuberculous pleurisy．