立体定向活检术在AIDS伴发颅内病变诊断中的应用  

Application of Stereotactic Biopsy for the Diagnosis of the Intracranial Lesions in Patients with AIDS

作　　者：张继波[1] 刘学猛 付锴[1] 宫睿[1] 陈礼道 徐成仕[1] 熊勇[2] 杨桂芳[3] 张捷[1] ZHANG Jibo LIU Xuemeng FU Kai GONG Rui CHEN Lidao XU Chengshi XIONG Yong YANG Guifang ZHANG Jie(Dept. of Neurosurgery Dept. of Infectious Diseases Dept. of Pathology, Zhongnan Hospital of Wuhan University, Wuhan 430071 , China)

机构地区：[1]武汉大学中南医院神经外科,湖北武汉430071 [2]武汉大学中南医院感染科,湖北武汉430071 [3]武汉大学中南医院病理科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2017年第1期61-64,共4页Medical Journal of Wuhan University

摘　　要：目的:总结立体定向活检术在诊断艾滋病(AIDS)伴发颅内病变诊断中的经验,探讨手术方法及技术要点、如何降低手术并发症以及提高阳性诊断率。方法:回顾性分析7例行脑立体定向活检术AIDS伴发颅内病变患者(男4例,女3例;年龄15-49岁),病史1月-1年。均行核磁共振定位立体定向脑活检术,活检标本术后行常规HE染色及免疫组化病理学检查。结果:7例患者手术顺利,病理结果示:脑弓形虫病2例,隐球菌脑炎2例,巨细胞脑炎2例,结核性脓肿1例,星形细胞瘤1例,其中1例为脑弓形虫病和隐球菌脑炎共同感染。诊断成功率100%,术后并发症率14.3%(1/7),无死亡。术后随访6月-6年,1例完全康复,4例症状明显好转,2例死亡。结论:立体定向活检术是诊断AIDS伴发颅内病变安全、有效的方法,有助于协助诊断、制定治疗方案和改善预后。Objective：To summary our experiences of stereotactic biopsy for the diagnosis of the intracranial lesions in patients with AIDS,discuss surgery strategy and technical key points,so as to increase positive diagnostic rate and reduce complications.Methods：Seven AIDS patients with an intracranial lesion,15 to 49years old and disease history ranged from 1month to 1year,who underwent stereotactic biopsy guided by magnetic resonance were included in this retrospective study（4males and 3females）.Biopsy samples were then examined by haematoxylin-eosin（HE）staining and immunohistochemical examination.Results：All patients were successfully sampled,and the histological results showed toxoplasma encephalitis（TE）in 2cases,cryptococcus encephalitis in 2cases,cytomegalovirus（CMV）encephalitis in 2case,tubercular abscess in 1case,astrocytoma in 1case,and co-infection of TE with cryptococcus infection in 1patient.The diagnostic yield was 100%,and the morbidity of post-operation complications was 14.3%（1/7）.There was no operation-related mortality.Patients were followed up for 6months to 6years andthe results showed that 1case fully recovered,4cases significantly improved in symptoms,and 2died.Conclusion：Stereotactic biopsy may be a safe and effective way for the diagnosis of intracranial lesions in AIDS and helpful for differential diagnosis,developing treatment planning,and improving the prognosis.

关 键 词：立体定向活检术 艾滋病 颅内病变 

分 类 号：R651.1[医药卫生—外科学]