目的 分析肺动脉栓塞超声心动图表现,探讨超声心动图估测肺动脉高压对肺动脉栓塞的诊断意义。方法 回顾性分析确诊肺动脉栓塞患者的超声心动图影像表现,就超声诊断征象进行对比分析。结果 累及肺动脉主干、两侧肺动脉近端的肺动脉栓塞检出率92.31%。肺动脉栓塞患者肺动脉高压检出率达78.38%。结论 经胸超声心动图估测肺动脉收缩压具有重要的诊断提示意义。

Objective To analyze the doppler echocardiography in the cases of pulmonary embolism and evaluate the relationship between pulmonary hypertension and pulmonary embolism. Methods To retrospectively analyze the echocardiography findings of the pulmonary hypertension. The causes of disease were classification analyzed. Results The detection rate of the embolus in the main pulmonary trunk and proximal pulmonary arteries is 92.31%. The detection rate of the pulmonary hypertension is 78.38%. Conclusion The estimation of pulmonary artery pressure in the echocardiography is helpful to diagnosis.

目的 研究乳管镜在乳头溢液的诊断中的应用价值。方法 回顾性分析2010年2月－2014年3月采用乳管镜检查的123例乳头溢液患者的临床资料。结果 乳管镜检查发现乳腺导管癌8例,导管内乳头状瘤33例,乳头状瘤病32例,导管扩张及炎症35例。术后病理检查证实乳腺导管癌5例,导管内乳头状瘤35例,乳头状瘤病30例,导管扩张及炎症33例。结论 乳管镜可作为诊治乳头溢液的首选措施,其所起到的作用是超声、钼靶及乳管造影所不及的。

Objective To study the clinical application value of the fiberoptic ductoscopy(FDS) on the diagnosis of nipple discharge. Methods A retrospective analysis of 123 patients with nipple discharge undergoing FDS from February 2010 to March 2014. Results After fiberoptic ductoscopy examination,it was found there were 8 cases of breast cancer,33 cases of intra-duct papilloma,35 cases of papillomatosis,35 cases of dilatation and inflammation. However there were 5 cases of breast cancer,35 cases of intra-duct papilloma,30 cases of papillomatosis, and 33 cases of dilatation and inflammation were comfirmed through postoperative pathological examination. Conclusion Fiberoptic ductoscopy is more effective than B-ultrasonography and Mo-traget mammography, so it can be the preferred method of diagnosis and treatment for nipple discharge.

目的 探讨OAB与CP/CPPS的症状及诊断的重叠情况,为临床诊疗提供参考。方法 151例中青年男性患者入选为研究对象,按OAB及CP/CPPS的定义及诊断标准将其分为OAB组、CP/CPPS组及OAB+CP/CPPS组,并对OAB+CP/CPPS组进行诊断性治疗对研究对象进行明确诊断;根据年龄分为:18~25岁组、26~35岁组和36~49岁组,比较各年龄组患者OAB及CP/CPPS的重叠情况;对各组患者的临床症状进行分析比较,了解其重叠情况。结果 在151例研究对象中,可诊断为OAB、CP/CPPS、OAB+CP/CPPS的分别有62例(41.06%)、32例(21.19%)、57例(37.75%),因此OAB与CP/CPPS的诊断重叠率为37.75%,明显大于CP/CPPS患者的诊断率;各年龄组间诊断重叠率无差异(P>0.05);症状的重叠方面,OAB+CP/CPPS组有尿急、尿频、夜尿症、急迫性尿失禁、尿不尽感、排尿困难、泌尿生殖系疼痛和或不适症状的分别为57例(100.00%)、50例(87.72%)、21例(36.84%)、2例(3.51%)、12例(21.05%)、2例(3.51%)、57例(100.00%),其中,尿急、尿频及泌尿生殖系疼痛或不适症状的重叠率最高;OAB+CP/CPPS组经诊断性治疗后诊断为OAB患者约61.40%,而CP/CPPS患者为38.60%。结论 OAB与CP/CPPS两者间有相当高的重叠率且远高于CP/CPPS的诊断率,在OAB与CP/CPPS两者诊断重叠的患者中为OAB的可能性更大。

Objective To explore symptoms and diagnosis of overlap between OAB and CP/CPPS, providing reference for clinical treatment. Methods 151 cases of young men were enrolled in the study. According to the definition and diagnostic criteria of OAB and CP/CPPS, we divided the study subjects into OAB group, CP/CPPS group and OAB+CP/CPPS group. And OAB+CP/CPPS group would get a two-week diagnostic treatment to study a clear diagnosis. We also divided the subjects into 18-25 age group, 26-35 year-old age group and 36-49 group according to the age, comparing the overlap of OAB and CP/CPPS in different age groups. The symptoms of the subjects in each group were analyzed to compare and study the overlap. Results Among these 151 cases, 62 cases (41.06%) can be diagnosed as OAB, 32 cases (21.19%) as CP/CPPS, 57 cases (37.75%) as OAB+CP/CPPS. Therefore, OAB and CP/CPPS diagnostic overlap was 37.75%, significantly higher than the diagnosis of CP/CPPS patients; no significant difference (P>0.05) among all age groups diagnostic overlap rate; overlapping terms of symptoms, OAB + CP/CPPS group urgency, urinary frequency, nocturia, urgency incontinence, urine not the flu, difficulty urinating, or genitourinary pain and discomfort were 57 cases (100.00%), 50 cases (87.72%), 21 cases (36.84%), 2 cases (3.51%), 12 cases (21.05%), 2 cases (3.51%), 57 patients (100.00%), which overlap ratio urgency, frequency, and genitourinary pain or discomfort was high; OAB+CP/CPPS group after diagnosis diagnostic treatment of OAB patients was about 61.40%, while CP/CPPS patients was 38.60%. Conclusion There is high overlap rate between OAB and CP/CPPS, which is much higher than the diagnostic rate of CP/CPPS. It is likely to have an OAB when a patient is diagnosed as OAB or CP/CPPS at the same time.

目的 探讨子宫内膜微腺体癌的临床病理特征、诊断及鉴别诊断。方法 对1例首诊误诊为子宫颈微腺体增生的子宫内膜微腺体癌病例进行临床、病理组织学及免疫组织化学特征的观察及总结,同时进行相关文献复习。结果 本例患者年龄61岁,因绝经后阴道不规则流血1年就诊,B超提示子宫内膜不规则增厚,并行分段诊刮术,先后两次诊刮标本光镜下均见黏液性柱状上皮呈乳头状及网格状结构,细胞轻度异型,核分裂罕见,间质内大量中性粒细胞浸润伴腺上皮内“微脓肿”形成;免疫组化示:上皮成分P16弥漫强(+),CEA小灶(+),Vimentin弥漫(+),ER约90%(+,中-强),PR约90%(+,弱),Ki-67约3%(+),间质细胞CD10(+)、CD34(-)。结论 子宫内膜微腺体癌是一种极为罕见的子宫内膜黏液腺癌,其组织学形态与子宫颈良性病变微腺体增生十分相似,易于混淆,但通过免疫组化检查及详细地临床病史资料收集、分析,可以与其鉴别,从而做出正确地诊断。

Objective To investigate clinical and histopathological features, dignosis and differential diagnosis of the endometrial microglandular adenocarinoma (MGA). Methods The clinical and pathological features of microglandular adenocarinoma in a patient were observed. Immunohistochemical staining and literature review were also used. Results In the case, the age of patient was 61 years. Clinical manifestation was vaginal irregular bleeding for 1 year. Type-B ultrasound suggested endometrium was irregular thickening. Histologically, it was mainly composed of irregular shape, closely spaced small glands, and glandular cells was mild atypical. Mitosis was rarely observed. The endometrial stromata between gland were rare, but neutrophil were much observed with the formation of neutrophil microabscess in the glandular epithelium. Immunohistochemical study showed neoplastic cells were diffuse and strongly positivity for P16, diffuse positivity for vimentin, focally positive for CEA. ER and PR expression was found in approximately 90% tumor cells. The index of Ki-67 was about 3%. Interstitial cells were positivity for CD10, negativity for CD34. Conclusion The microglandular adenocarcinoma is a rare endometrial adenocarcinoma. It can be differentiated from cervical microglandular hyperplasia(MGH) and cervical mucinous adenocarcinoma by immunohistochemistry and morphological characteristics.

       目的   探讨CT、MRI影像学表现对原发性肝细胞癌（HCC）微血管侵犯（MVI）的诊断价值。方法   选取2018年1月—2024年7月江门市第二人民医院（江门市中心医院蓬江分院）和江门市中心医院120例（共158个病灶）HCC患者，均行上腹部CT、MRI平扫+增强及弥散加权成像（DWI）检查；以术后病理结果为金标准。比较CT、MRI平扫+增强及DWI对HCC MVI诊断效能；分析HCC MVI诊断中CT、MRI平扫+增强及DWI检查与术后病理确诊结果之间的一致性；比较HCC MVI与无HCC MVI患者影像学表现及表观扩散系数（ADC）值。结果    DWI检查对HCC MVI的诊断效能（灵敏度、特异度、准确度、阳性预测值、阴性预测值）均显著性高于CT、MRI平扫+增强（P＜0.05）；CT、MRI、DWI对原发性肝细胞癌患者微血管侵犯的诊断效能比较，差异均无统计学意义（P＞0.05）。在HCC MVI诊断效能中，CT、MRI影像学表现与术后病理确诊结果之间为中度一致性；DWI与术后病理确诊结果之间为高度一致性。HCC MVI患者的强化方式在非边缘动脉期强化、强化包膜、晕状强化、结中结、门脉分支癌栓占比均显著性高于无HCC MVI患者（P＜0.05）。在不同b值（400、800、1 000、1 500 s/mm² ）下，HCC MVI患者的ADC值均显著性高于无HCC MVI患者（P＜0.05）。结论    CT、MRI平扫+增强及DWI对HCC MVI均具有较好的诊断效能，而MRI诊断结果与病理诊断一致性更佳，尤其DWI图中ADC值可更加精准地判断HCC的患者是否发生微血管侵犯，有助于指导临床医生建立“个体化”精准诊疗策略。

       Objective  To explore the diagnostic value of CT and MRI imaging manifestations for microvascular invasion（MVI）in primary hepatocellular carcinoma（HCC）．Methods  A total of 120 patients（158 lesions in total）with HCC in the Second People’s Hospital of Jiangmen（Pengjiang Branch of Jiangmen Central Hospital）and Jiangmen Central Hospital were selected from January 2018 to July 2024，all underwent CT and MRI plain + enhanced and diffusion-weighted imaging（DWI）of the upper abdomen；postoperative pathology results was used as the diagnostic gold standard．The diagnostic efficacy of CT，MRI plain + enhanced and DWI for HCC MVI was compared．The concordance among CT，MRI plain + enhanced and DWI examinations with postoperative pathological diagnostic findings in the diagnosis of HCC MVI．Imaging manifestations and apparent diffusion coefficient（ADC）values in patients with and without HCC MVI were compared．Results  Diagnostic effectiveness of DWI examination for HCC MVI（sensitivity，specificity，accuracy，positive predictive value，negative predictive value）were all significantly higher than those of CT and MRI plain + enhanced（P＜0.05）；none of the differences were statistically significant（P＞0.05）in the comparison of diagnostic effectiveness of CT，MRI，and DWI for the diagnosis of MVI in patients with primary HCC．In HCC MVI diagnostic effectiveness，moderate concordance was found among CT，MRI imaging phenotypes and postoperative pathology results；high concordance was found between DWI and postoperative pathology results．In HCC MVI patients，the proportion of non-marginal arterial reinforcement，enhanced envelope，halo reinforcement，nodal in nodal and portal branch cancer thrombi was significantly higher than that in patients without HCC MVI（P＜0.05）．At different b-values（400，800，1 000，1 500 s/mm² ），ADC values were all significantly higher in patients with HCC MVI than in patients without HCC MVI（P＜0.05）．Conclusions  CT，MRI plain + enhanced and DWI have good diagnostic effectiveness for HCC MVI，while MRI diagnostic results are in better concordance with pathologic diagnosis．In particular，ADC values in DWI maps can more accurately determine whether MVI occurs in patients with HCC，which helps to guide clinicians to establish“individualized”and precise diagnosis and treatment strategies．

       人工智能（AI）这一新兴技术的出现和应用给炎症性肠病（IBD）的诊断带来了巨大的变革。越来越多的研究着手于开发基于机器学习（ML）和深度学习（DL）的诊断模型，并获得了良好的诊断性能，尤其是在IBD的图像诊断，卷积神经网络（CNN）等模型由于其出色的图像分析能力，在内镜检查和组织病理检查等方面具有十分可观的发展前景。近年来AI诊断模型的应用越发广泛，但与此同时，关于算法、数据库及其应用方面仍存在一些难以忽视的局限性。本文将主要就图像识别方面对AI在IBD诊断中的应用进行综述，以期为IBD精准图像诊断领域下步研究提供参考。

        As an emerging technology，artificial intelligence（AI）has brought great changes to the precise diagnosis of inflammatory bowel disease（IBD）．More and more  researches have developed diagnostic models which are based on machine learning（ML）and deep learning（DL）and obtained satisfactory diagnostic performance．Especially in the image  diagnosis of IBD，convolutional neural network（CNN）and  other models  have  considerable  development  prospects in  endoscopy  and histopathology due to their excellent image analysis capabilities．In recent years，the application of AI diagnostic models has become more and more widespread，but at the same time，there are still some limitations about algorithms，databases and their applications that cannot be ignored．This review mainly focused on the application of AI in IBD diagnosis from the aspect of image recognition，to provide a reference for IBD diagnosis towards precision medicine．

       目的     探讨CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。方法    对2021年5月—2024年5月商丘市第一人民医院收治的82例非小细胞肺癌手术治疗患者进行回顾性分析，将其分为观察组，另选取82例肺部良性肿瘤患者作为对照组，收集其术前CT增强延迟扫描结果，以术后病理诊断结果为金标准，分析CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。并对比不同临床病理特征非小细胞肺癌患者CT增强延迟扫描的CT增强值，采用Spearman相关性分析法分析CT增强值与非小细胞肺癌病理特征的关系。结果  CT增强延迟扫描显示观察组患者分叶征（12.50% vs 53.57%）、内部空泡征数量（6.25% vs 39.29%）低于对照组（χ ² =26.560、24.680，P＜0.05），观察组患者边缘毛刺（56.25% vs 17.86%）、胸部凹陷征（59.38% vs 14.29%）、高于对照组（χ ² =43.330、64.600，P＜0.05）；82例非小细胞肺癌通过CT增强延迟扫描共确诊79例，CT增强延迟扫描诊断对非小细胞肺癌的准确率为96.34%（79/82），与病理诊断结果100.00%对比差异无统计学意义（χ ² =3.060，P=0.080）；82例非小细胞肺癌平均CT增强值为（39.14±7.31），不同性别、年龄、肿瘤最大直径、淋巴结浸润情况患者CT增强值对比差异无统计学意义（P＞0.05），不同病理类型［腺癌（43.75±7.15）vs 鳞癌（34.74±6.12）］、细胞分化程度［中、低分化（45.71±7.21）vs 高分化（32.81±5.11）］、临床分期［Ⅰ期（31.03±2.12）vs Ⅱ期（36.61±3.13）vs Ⅲa期（46.32±6.83）］患者、淋巴结转移［是（42.75±4.21）vs 否（35.77±8.13）］CT增强值对比差异有统计学意义（t/F=5.243、8.804、84.828、4.378，P＜0.05）；Spearman相关分析结果显示：病理类型、细胞分化程度、临床分期、淋巴结转移与非小细胞肺癌患者CT增强值呈正相关（r=0.431，P=0.021；r=0.511，P=0.009；r=0.586，P=0.005；r=0.579，P=0.008，P＜0.05）。结论  CT增强延迟扫描技术对非小细胞肺癌术前确诊具有重要价值，其诊断准确率与病理诊断并无显著差异，且可通过CT增强延迟扫描技术确定患者CT增强值，从而为非小细胞肺癌患者术后病理特征判断提供参考。

      Objective  To explore the application value of CT enhanced  delayed  scanning in  preoperative  diagnosis of non-small cell lung cancer（NSCLC）．Methods  A retrospective analysis was conducted on 82 patients with NSCLCwho underwent surgical treatment in a hospital from May 2021 to May 2024．They were included into  an  observation  group and another 82 patients with benign lung tumors were included in the control group．The  preoperative CT enhanced  delayed scanning results were collected，and the postoperative pathological diagnosis was used as the “gold standard” to analyze the application value of CT enhanced delayed scanning in the preoperative diagnosis of NSCLC．And the CT enhancement values of delayed CT scans in NSCLC patients with different clinical and pathological features were compared，and Spearman correlation analysis was used to analyze the relationship between CT enhancement values and pathological features of NSCLC．Results  CT enhanced delayed scanning showed that the number of lobular（12.50% vs 53.57%）and internal vacuolar signs（6.25% vs39.29%）in the observation group was significantly lower than that in the control group（χ ² =26.560，24.680，P＜0.05），while the edge spicules（56.25% vs 17.86%）and chest depression signs（59.38% vs 14.29%）in the observation group were significantly higher than that in the control group（χ ² =43.330，64.600，P＜0.05）．A total of 79 cases of 82 NSCLC were diagnosed by CT-enhanced delayed scan，and the accuracy of CT-enhanced delayed scan diagnosis for NSCLC was 96.34%（79/82），with no significant difference from the pathological diagnosis result of 100.00%（χ ² =3.060，P=0.080）．The average CT enhancement value of 82 NSCLC cases was（39.14±7.31）．There was no significant difference in CT enhancement values among patients of different genders，ages，maximum tumor diameter，and lymph node infiltration（P＞0.05）．Patients with different pathological types ［adenocarcinoma（43.75±7.15）vs squamous cell carcinoma（34.74±6.12）］，degree of cell differentiation ［moderate，and low differentiation（45.7±7.21）vs high differentiation（32.81±5.11）］，clinical stage ［I（31.03±2.12）vs II（36.61±3.13）vs IIIa（46.32±6.83）］ and lymph node metastasis ［yes（42.75±4.21），vs no（35.77±8.13）］ CT enhancement had significant difference（t/F=5.243，8.804，84.828，4.378，P＜0.05）．The Spearman correlation analysis results showed that pathological type，degree of cell differentiation，clinical stage，lymph node metastasis were positively correlated with CT enhancement values in NSCLC patients（r=0.431，P=0.021；r=0.511，P=0.009；r=0.586，P=0.005；r=0.579，P=0.008）．Conclusions  CT enhanced delayed scanning has important value in preoperative diagnosis of NSCLC．Its diagnostic accuracy is not significantly different from pathological diagnosis，and the CT enhanced value of patients can be determined through CT enhanced delayed scanning，providing reference for postoperative pathological feature judgment of NSCLC patients．

      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．

       目的   探析子宫输卵管超声造影（D-HyCoSy）配合宫腔水造影对不孕症患者宫腔粘连（IUA）诊断灵敏度、特异度情况。方法   选取2021年1月—2023年2月南华大学附属长沙中心医院的110例不孕症者为研究对象，均予以宫腔水造影、D-HyCoSy，以宫腔镜病理结果为金标准，分析不同诊断方法应用的效果。结果   在110例不孕症患者中，经宫腔镜病理检查发现，宫腔粘连患者占比47.27%（52/110）。D-HyCoSy的诊断准确率为76.36%、宫腔水造影的为79.09%，均低于联合诊断的93.63%（P＜0.05）。D-HyCoSy的诊断灵敏度为73.08%，宫腔水造影的为80.77%，均低于联合诊断的94.23%，差异具有统计学意义（P＜0.05）。D-HyCoSy的诊断特异度为79.31%，宫腔水造影的为77.59%，与联合诊断的93.10%相比，差异无统计学意义（P＞0.05）。结论   对于不孕症患者，予以宫腔水造影联合D-HyCoSy诊断，其诊断效能高于单一诊断检查率，能更准确地判定宫腔粘连，效能高。

       胰源性门静脉高压（PSPH）是由脾静脉（SV）流通受阻引起的一种临床综合征，在临床较为罕见且对患者造成生命威胁，但却为门静脉高压唯一可治愈的类型。其主要发病诱因是胰腺原发疾病，通常为胰腺急（慢）性炎症、胰腺占位性病变和胰腺手术操作导致。1型孤立性食管胃底静脉曲张、脾大、脾功能亢进是PSPH的主要临床表现特征，其中食管胃底曲张静脉破裂出血是PSPH最为严重的并发症；患者若表现为肝功能正常但出现原因不明脾肿大并伴有消化道出血症状，应考虑可能出现了PSPH。PSPH的治疗可分为胰腺原发病、门静脉高压及并发症的综合性诊治。本文旨在回顾PSPH的相关文献，对其有关临床诊断与治疗现状进行综述，以期指导医务工作者在临床中尽早发现PSPH并对患者及时有效治疗。

       Pancreatic segmental portal hypertension（PSPH）is a clinical syndrome caused by spleen vein（SV）occlusion or stenosis．It is a rare and life-threatening hemorrhagic disease of the upper digestive tract，but it is the only curable type of portal hypertension．The main cause is primary pancreatic disease，which is usually due to acute or chronic pancreatic inflammation，pancreatic space-occupying lesions and pancreatic surgery．Type 1 isolated esophagogastric varices，splenomegaly and hypersplenism are the main clinical features of PSPH，and esophagogastric variceal bleeding is the most serious complication of PSPH．PSPH  should  be  considered in  patients with  normal liver function  but  unexplained  splenomegaly  accompanied  by gastrointestinal bleeding．The treatment of PSPH can be divided into a comprehensive diagnosis and treatment of primary pancreatic disease，portal hypertension and complications．Therefore，the purpose of this paper is to review relevant literature of PSPH，the relevant clinical diagnosis and treatment status quo were summerized，in order to guide the medical workers in clinical PSPH，early detection and timely and effective treatment for patients．