The 55-year-old sister Li was found to have thickened gallbladder wall, enlarged retroperitoneal lymph nodes, and significantly elevated tumor marker CA199 due to repeated abdominal distension for more than 10 days, which was considered to be lymph node metastasis of gallbladder cancer.
Because there is no surgical indication, and the pathology can not be obtained by routine puncture, the follow-up ** is quite tricky, in order to further receive diagnosis and treatment, I came to the interventional department of Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine).
After admission, the interventional team discussed that the pathology must first be obtained and the gallbladder cancer can be diagnosed before further progress, but the gallbladder mass only shows the thickening of the gallbladder wall, and has not yet formed a soft tissue mass, and the gallbladder is a hollow organ, and conventional puncture is used, which can easily cause gallbladder perforation, biliary fistula, and peritonitis.
After examining the patient, Deputy Chief Physician Li Wenquan, Director of the Interventional Department of Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine), proposed that in such a situation, surgery or laparoscopic surgery is mostly used to take pathology, but it is traumatic and risky.
Combined with the characteristics of the patient's lesions, the fRNA method of thyroid nodules can be used as a reference, and non-cutting fine needle puncture can be used to perform liquid-based cytological pathological examination, and the risk of injury and biliary fistula is very small.
The puncture process was smooth, and the postoperative pathological diagnosis was clear, which was gallbladder adenocarcinoma, followed by anti-tumor**.
The following ** are the puncture process and postoperative pathological results
What is a fine-needle aspiration biopsy (FNA)?
Fine-needle aspiration and needle biopsy (FNA) is the use of a special fine needle with an inner core of more than 23g, a specific length and hardness, and a special fine needle with an inner core, which uses its siphon effect to puncture into the lesion, and after 9-10 repeated insertions, the tissue and liquid enter the puncture needle, and the aspirated specimen is smeared or liquid-based cytopathological examination is performed.
Because the lesion is extremely small, generally within a few millimeters, and adjacent to blood vessels, intestinal tract and other hollow organs, the technical accuracy requirements are relatively high, and rich experience accumulation is required.
This method is suitable for small organs, complex parts, small lesions, and lesions that are not easy to undergo coarse needle histological biopsy, such as thyroid nodules, intraductal masses, intraorbital tumors, deep lymph nodes, retroperitoneal masses, hollow organ lesions, etc. Fine-needle aspiration biopsy has the advantages of less trauma, fewer complications, low cost, and simple and fast operation.
In recent years, under the leadership of Director Li Wenquan, the interventional department of Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine) has achieved rapid development on the basis of stable radiological intervention, and the annual volume of interventional surgeries in the department is nearly 1,500. The department is characterized by minimally invasive intervention combined with traditional Chinese medicine**, and the scope of diagnosis and treatment includes:
1. Needle biopsy and arteriovenous angiography of solid tumors in all parts of the body.
2. Intervention of malignant tumors**
1) Arterial perfusion chemoembolization (TACE, TAE, HAIC, CC-TACE, D-TACE, B-TACE): such as liver cancer, lung cancer, esophageal cancer, gastric cancer, pancreatic cancer, colorectal cancer, cervical cancer and metastases of various organs;
2) Ablation**: radiofrequency, microwave, cryotherapy (argon-helium knife, Combo knife);
3) Opening of various orifice obstructions**: esophageal, airway, biliary tract, intestinal stent implantation, decompression of upper and lower gastrointestinal obstructions**;
4) Infusion port, arterial medicine box, PICC placement;
5) Intractable Pain Nerve Block**; Radioactive seed implantation**.
3. Benign tumors: hepatic hemangioma, limb hemangioma embolization and sclerosis**; Embolism of uterine fibroids, adenomyosis**.
4. Intervention of other benign diseases**: hypersplenism, prostatic hyperplasia embolism**; tubal recanalization, embolization; drainage of thoraco-abdominal, pelvic, pericardial effusion, and empyema; cirrhosis of liver and kidney cysts; Drainage of acute cholecystitis, cholangitis**. Intervention of varicocele, pelvic vein stasis syndrome**.
5. Intervention of portal hypertension**: portosystemic shunt tips; gastric coronary vein embolization; brto；Portal vein stenting.
6. Emergency intervention for bleeding disorders**: massive hemoptysis, gastrointestinal bleeding, urinary bleeding, biliary bleeding, **bleeding, iatrogenic bleeding, traumatic bleeding.
7. Intervention of peripheral blood vessels and large vessels**: venous thrombosis of lower limbs; inferior vena cava filter placement; pulmonary embolism; varicose veins of the lower extremities, iliac vein stenosis; arterial thrombosis of the lower extremities; arteriosclerosis occlusive disease of the lower extremities; iliac artery stenosis; renal artery stenosis; arteriovenous fistula, etc.; inferior vena cava filter placement; Aortic dissection, abdominal aortic aneurysm, etc.
Li Wenquan, deputy chief physician of the interventional department of Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine), introduced that intervention does not require surgery, and has the advantages of small trauma, fast recovery, short hospital stay, and low anesthesia risk.
Hunan Medical Chat Special Author: Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine) Interventional Department Xia Wenhui Follow @Hunan Medical Chat to get more health science information!
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