CAJ | 학술논문

目的评价眼内活检手术在非典型性眼内病变诊断中的应用价值.方法回顾分析经临床特征及多种非侵人性检查难以确定眼内病变性质而行前房穿刺抽吸、玻璃体穿刺抽吸、玻璃体内切除小块病变活检手术的31例患者31只眼的临床资料.对所有抽取液体或病变组织立即行细胞学检查,统计分析活检取材次数、组织细胞检出率和病理独立诊断率.观察活检手术中和手术后并发症发生情况.对活检诊断送检材料为恶性并随后摘除眼球者再给予组织病理检查,分析眼内活检手术在恶性肿瘤诊断中的敏感性和特异性、阳性及阴性预测价值.结果 31只眼共取材活检35次,其中29只眼经31次取材活检检出病变组织,检出率为88.6%.31只眼中,恶性眼内病变12只眼,占38.7%;良性眼内病变15只眼,占48.3%%;先诊断为良性眼内病变,经再次活检诊断为恶性眼内病变2只眼,占6.5%;无法定性诊断2只眼,占6.5%.经31次取材活检检出病变组织的29只眼中,病理独立诊断23只眼,取材活检25次;病理结合临床再诊断6只眼,取材活检6次;病理独立诊断率为71.4%.眼内活检手术中眼内出血5只眼;手术后视网膜脱离3只眼;炎症加重1只眼.眼内活检手术对恶性肿瘤诊断的敏感性为85.7%,特异性为100.0%,阳性预测价值为100.0%,阴性预测价值为86.7%.结论眼内活检手术在非典型性眼内病变诊断中有重要的应用价值.
목적 평개안내활검수술재비전형성안내병변진단중적응용개치.방법 회고분석경림상특정급다충비침인성검사난이학정안내병변성질이행전방천자추흡、파리체천자추흡、파리체내절제소괴병변활검수술적31례환자31지안적림상자료.대소유추취액체혹병변조직립즉행세포학검사,통계분석활검취재차수、조직세포검출솔화병리독립진단솔.관찰활검수술중화수술후병발증발생정황.대활검진단송검재료위악성병수후적제안구자재급여조직병리검사,분석안내활검수술재악성종류진단중적민감성화특이성、양성급음성예측개치.결과 31지안공취재활검35차,기중29지안경31차취재활검검출병변조직,검출솔위88.6%.31지안중,악성안내병변12지안,점38.7%;량성안내병변15지안,점48.3%%;선진단위량성안내병변,경재차활검진단위악성안내병변2지안,점6.5%;무법정성진단2지안,점6.5%.경31차취재활검검출병변조직적29지안중,병리독립진단23지안,취재활검25차;병리결합림상재진단6지안,취재활검6차;병리독립진단솔위71.4%.안내활검수술중안내출혈5지안;수술후시망막탈리3지안;염증가중1지안.안내활검수술대악성종류진단적민감성위85.7%,특이성위100.0%,양성예측개치위100.0%,음성예측개치위86.7%.결론 안내활검수술재비전형성안내병변진단중유중요적응용개치.
Objective To evaluate the application value of intraocular biopsy in the diagnosis of atypical intraocular lesions. Methods The clinical data of 31 patients (31 eyes) with atypical intraocular lesions were retrospectively analyzed. All patients received intraocular biopsy including anterior chamber puncture, vitreous puncture and vitreous biopsy followed by pathological cell examination. Cytological examination was immediately performed for all biopsy fluids or tissues;biopsy times, the positive detecting rate and independent pathological diagnosis rate were analyzed. Intraoperative and postoperative complications were observed. Eyeballs with biopsy-suggested malignancy lesions were enucleated and underwent histopathological analysis. The biopsy results and histopathological results were compared and analyzed. Result Thirty-one eyes received 35 times of biopsy operation in total. The available samples harvested from 29 patients through 31 operations were valid for pathological cell examination, the positive detecting rate was 88.6%. Among the 31 eyes, 12 eyes had malignant lesions;15 eyes had benign lesions;two eyes were diagnosed with benign lesions initially, but corrected to malignant through the second biopsy;the lesions in two eyes were not determined by biopsy. Among the 29 eyes with valid biopsy, 23 eyes were diagnosed independently by pathological examination;the diagnosis of the other six eyes was made based on pathological examination and clinical features. The independent pathological diagnosis rate was 71.4%. The complications included intraocular bleeding in five eyes, retinal detachment in three eyes and more serous inflammation in one eye. The sensitivity for diagnosis of malignant lesions was 85.7% and the specificity was 100.0%. The predictive value of positive test was 100.0% and the negative one was 86.7%.Conclusion Intraocular biopsy has important values in the diagnosis of atypical intraocular lesions.