The whole network released: 2013-01-11 14:28 Publisher: Nie Xiu (visit time: 2236) what is a pathological examination?A few years ago the hi
The whole network released: 2013-01-11 14:28 Publisher: Nie Xiu (visit time: 2236) what is a pathological examination?
A few years ago the hit TV series "judge of Song Dynasty" is about the ancient lawsuit story, the protagonist of the occupation called "Wuzuo", is now the equivalent of a branch of forensic medicine, the body belongs to the nature of the work, pathological anatomy and pathology. Here we talk about is the pathological examination of pathological examination of another branch of surgery, also known as external examination or biopsy, a pathologist using pathology theory and technology, combined with personal experience, observe the cell morphology and structure of lesions under the microscope, the reference patients clinical data, diagnosis of disease.
Under what circumstances need to do pathological examination?
Clinicians in clinical activities according to the specific condition of each patient, determine whether the patients need for pathological examination, and choose to obtain tissue samples by what means, such as surgery, needle puncture, curettage and clip etc.. The purpose of pathological examination is to determine the nature of the lesion, whether it is a tumor or a benign tumor or a malignant tumor. For patients who need to undergo a pathological examination, the pathology report is a medical judgment on the nature of the patient's disease".
What is the significance of pathological examination?
The results of pathological diagnosis are directly related to the choice of treatment and the prognosis of the patients. In the final discussion of the final will usually by the pathologist in consultation discussion in clinical pathology is composed of many disciplines, released the results of the pathological diagnosis, uncover the disease answers, thus, the medical profession that "the last word is to be made by pathologists, pathological diagnosis is also called" the final diagnosis, pathology the doctor was called "doctor doctor".
For example, patients with lymph node enlargement, lymph node resection for pathological examination. "If the pathological diagnosis of chronic lymphadenitis, clinicians can take medical treatment; if the pathological diagnosis of Hodgkin lymphoma, must immediately if chemotherapy; pathological diagnosis of the metastatic adenocarcinoma, need systemic examination, looking for the primary lesion resection, as far as possible.
Why can't the pathological examination "Lidengkequ"?
Paraffin embedded sections were used for routine pathological examination. The specimens were made into 3 to 5 micron thick slices and stained with hematoxylin and Yi Hong (HE). During after more than 40 technical steps, took ten hours, a part of any improper handling will affect the section definition, lead to pathological morphology of cells of the physician is not clear, affecting the accuracy of pathological diagnosis results. In addition to the time limitation of the production cycle, the pathological process of the pathologist depends entirely on the professional experience of the pathologist. Therefore, the pathological examination is different from the common blood test project, cannot achieve lidengkequ". The Ministry of health to make the relevant provisions of the pathology department is required to receive a sample in general 3 to 5 working days after the issue of the report, the case of appropriate delay.
In addition to the conventional paraffin sections, the pathological techniques include immunohistochemistry and in situ hybridization, which require 1 to 2 working days.
Why do some operations require intraoperative frozen section? Why do you want to do paraffin wax?
Intraoperative frozen section examination can be obtained within 20 to 40 minutes of pathological diagnosis. As the name suggests, "operation" refers to the operation; "frozen section" refers to the process of the examination to be removed into the organization of -20 degrees Celsius in the frozen section of the machine to make the tissue quickly frozen hard after slicing.
Intraoperative frozen section examination is mainly used for patients who can not be diagnosed before operation. This part of the surgery patients usually is "divided into two steps: the first step is the mass in accordance with the scope of operation of local resection of benign lesions; the second step is based on routine pathological report results to decide whether a patient needs second times to expand the scope of operation. Between the two steps need to wait for a few days, the patient not only suffer losses in the economy, but also in the spirit of a double blow. Intraoperative frozen section examination can determine the nature of benign and malignant lesions in the operation, which can provide guidance for the surgeon to determine the scope of surgery, thus the "two steps" has become a "step by step"".
However, intraoperative biopsy also caution and should not be applied. Compared with the conventional paraffin section, its tissue processing procedures are simplified, the cell morphology is not clear, may appear in the process of producing artifacts, generally only a preliminary judgment of the nature of the lesions, or sometimes even can make preliminary judgment. Therefore, after the rapid biopsy, we need to do the routine paraffin section examination of the remaining tissues. Of course, the consistency of the results of these two methods is more than 95%.
How to understand the pathological examination report?
Generally speaking, there are 4 basic types of pathological reports. The first type is the definite diagnosis: the diagnosis of the nature of the lesion is clear, and the pathological diagnosis is confirmed directly. Second is not entirely sure diagnosis: according to the intention of the different levels, the suspected lesions before the name preceded by words such as "consider" and "meet" and "tend to" and "tips", "may", "doubt", "cannot be ruled out (except)" such words. Referring to reservations on the pathological diagnosis of opinions. Third for the diagnosis of lesions based on inadequate: refers to the slices display lesions is not enough to make the 1 or 2 kinds of diagnosis, only describe the morphology of lesions in the main points of the report, namely descriptive report, no opinion. Fourth is unable to make a diagnosis: the pathological diagnosis and report the reasons were not diagnostic specimens, such as autolysis, dry, too small, severely affected by the extrusion deformation, burning or degeneration due to some reasons could not be made of slices.
Any type of pathological report can not be separated from the clinic, especially for the 2 and the 3 types of diagnostic reports, clinicians need to combine a wide range of data to select the appropriate treatment options. In addition, pathologists can only observe the specimen, when the pathological report results and clinical performance out of the larger, may be due to do not have the disease inspection organization representative, clinicians may consider repeated biopsy according to need.
Department of Pathology, Wuhan Union Hospital, Huazhong University of Science and Technology, Ke Niexiu
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