摘要
目的探讨针式内镜切除甲状腺病变冷冻切片的取材方法、诊断要点，提高病理诊断准确率，为临床选择此术式提供病理依据。方法选择102例针式内镜（内镜组）切除的甲状腺病变组织冷冻切片及冰残组织常规石蜡切片病理诊断符合率。另随机选择102例传统外科常规手术（对照组）切除的甲状腺病变组织冷冻切片及冰残组织常规石蜡切片病理诊断符合率作为对照。部分病例作免疫组化辅助诊断及鉴别诊断。统计两组手术方法冷冻切片病理诊断准确率以及石蜡常规病理诊断准确率作为对比。结果针式内镜组冷冻切片病理诊断准确率为97.06％（99／102），未能明确（延迟）诊断的仅占2.94％（3／102），对照组冷冻切片病理诊断准确率为96.08％（98／102），未能明确（延迟）诊断占3．92％（4／102）。内镜组及对照组石蜡常规切片准确率均为100％（102／102）。结论采用多包埋或全部包埋方法，内镜组切除的甲状腺病变冷冻切片检查可以基本明确甲状腺病变的性质，与对照组相比，诊断准确率及延迟诊断率无明显差异（P〉0．05），临床术式的选择不影响病理诊断的准确性，针式内镜切除甲状腺病变冷冻切片病理诊断仍然是诊断的金标准。
Objective To discuss into materials and diagnosis essentials for freezing slices of pathological changes in thyroidectomy with acus laparoscope and to improve the accurate rate of diagnosis. Methods Select freezing tissue slices of pathological changes from 102 cases undertaken hyroidectomy with acus micro laparoscope, and normal olefin slices from the remained icy tissues for pathological diagnosis to achieve diagnostic accordance rate. Then randomly choose freezing tissue slices of pathological changes from 102 cases undertaken hyroidectomy by traditional open surgical operation, and normal olefin slices from the remained icy tissues for pathological diagnosis to achieve diagnostic accordance rate as the contrast group. Some cases were undertaken immunity CK dyeing accessorial diagnosis and discriminating diagnosis. Statistics was made to the pathological diagnosis accuracy of the freezing slices from the two groups by different surgery methods, and made contrast to the pathological diagnosis accuracy of the normal olefin slices. Results The accurate rate of pathological diagnosis for freezing slices of pathological changes in group of thyroidectomy with acus laparoscope was 97.06% （99/102 cases） , the unclear （delay） diagnosis was only 2.94% （3/102 cases）. The accurate rate of pathological diagnosis for freezing slices of pathological changes in the contrast group was 96.08% （98/102 cases）, the unclear （delay） diagnosis was only 3.92% （4/102 cases）. The accurate rate of pathological diagnosis for the thyroidectomy group and the contrast group was 100% （102/102）. Conclusions With the method of wrapping most or all the tissues of pathological changes, the freezing slice examination in hyroidectomy with acus laparoscope can help to define the nature and character of numerous pathological changes of hypothyroid. Compared to the contrast group, there was no distinct difference between the diagnosis accurate rate and delay diagnosis accuracy.As a result, pathological diagnosis of freezing
基金
广西钦州市科学研究与技术开发计划课题（钦科发No：20073702）
关键词
针式内镜
甲状腺病变
冷冻切片
病理诊断
Acus laparoscope Thydroid pathological changes Freezing slices Pathological diagnosis
