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肾活检病理检查及肾脏病理基础知识课件

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活检 病理 检查 肾脏 基础知识 课件
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Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾脏病理基础知识及 肾活检病理检查 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾脏病理基础知识 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾脏的大体结构 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾单位 肾的基本结构和功能单位 肾小球 肾球囊 壁层上皮 内皮细胞 毛细血管丛 基底膜 肾单位 脏层上皮细胞 系膜 系膜细胞 系膜基质 肾小管 单层上皮细胞组成 肾脏的组织结构 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾小球结构模式图 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾小球结构模式图 横切 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾小球结构 LM Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 正常肾小球 小叶 系膜 毛细血管襻管腔 毛细血管襻管壁 内皮细胞 毛细血管基底膜 足细胞 包曼氏囊 Bowman囊 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 如何看肾活检病理报告 肾活检病理诊断是通过部分肾组织的病变 情况从而推断整个肾脏病变 其病理所见 的描述有时并不能独立作出疾病的最终诊 断 必须结合临床表现及检查结果进行系 统分析 才能作出正确的疾病诊断 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 病理术语 弥漫性 50 以上的肾小球有病变 切片 局灶性 不足50 的肾小球有病变 切片 球性 一个肾小球的病变部位超过50 节段性 一个肾小球的病变部位不足50 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 增生 肾小球固有细胞增多 内皮细胞增生 一个断面毛细血管腔内有2个及以上的 内皮细胞 系膜细胞增生 一个断面系膜区内有4个及以上的系 膜细胞 壁层上皮细胞增生 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 硬化 系膜基质高度结节状增生 毛细血管 襻塌陷 GBM增厚 皱缩 纤维化 间质中成纤维细胞增生 分泌胶原I 胶原III 玻璃样变 主要为血浆成分 HE染色均匀粉染 无细胞成分 MASSON染色呈红色 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一个完整的肾组织光镜检查病理报告 必 须综合HE PAS PASM Masson染色所 见 全面描述肾小球 肾小管和肾间质 小动脉的病变情况 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 穿刺组织中肾小球的数量 据统计 用包含5个肾小球的标本来 判断全部肾小球的病变状态 其准确率仅 为65 而用包含15个肾小球的标本来推 断全部肾小球的病变 其准确率可达95 因此光镜检查标本应超过10个肾小球为 好 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 球性硬化与缺血性球性硬化的数量 生理性硬化肾小球的数量所占穿刺标本肾小 球的百分比为 年龄 2 10 100 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾小球系膜细胞及基质的增生变化情况 系膜细胞和基质根据其增生程度 分为轻 中 重度增生 根据其增生的范围分为 弥漫性与局灶性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 新月体的形成 新月体主要由增生的壁层上皮细胞和渗出 的单核细胞构成 还可有嗜中性粒细胞和 淋巴细胞浸润 以上成分附着于球囊壁层 在毛细血管球外侧呈新月状或环状结构 分布 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 新月体的有无 根据新月体的大小 分为大新月体 新 月体的体积占肾小囊的50 以上 和小新 月体 新月体的体积占肾小囊的50 以下 一般所称的新月体指大新月体 根据新月体的组成成分 分为细胞性新 月体 细胞纤维性新月体和纤维性新月体 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 基底膜是否增厚 嗜复红蛋白的沉积部位 肾小管空泡变性及颗粒变性 肾间质纤维化 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾活检病理简介 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 急性肾炎 毛细血管内增生性GN 急进性肾炎 新月体性GN 隐匿性肾炎 系膜增生性GN 轻中重 原发 肾病综合征 膜增生性GN 和 慢性肾炎 肾小球微小病变 FSGS继发 急性肾衰 膜性GN 慢性肾衰 硬化性GN 急性肾小管坏死 间质性肾炎 急性 慢性 肾脏血管炎 肾活检病理检查的意义 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 我国肾活检病理检查的现状 各医院已经认识到了肾活检病理检查的重 要性 得以普遍开展 但在实际工作中 绝大多数医院病理科的 工作重心放在肿瘤的病理诊断上 对肾活检 病理重视不够 且由于人员编制限制 不可 能抽出专门人员专职做肾脏病理 发出的肾 活检病理报告不能满足临床需要 给患者和 送检医生带来了不必要的损失和麻烦 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾活检病理检查的特殊性 在方法上 需要光镜 免疫病理和电镜三者结合 缺 一 不可 在技术上 要求标本的处理不同于其它病理大标本 切片要薄 特殊染色技术要过硬 在诊断上 与临床结合紧密 需要病理医师具备一定 的临床知识 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 金域肾脏病理的优势 成立了专科病理室 肾脏病理室 聘请国内著名肾脏专家邹万忠教授为顾问 主诊医师具有多年的病理外检经验 且经 过系统的肾活检病理诊断专科培训 专门的技术人员 负责肾活检标本的处理 制片及染色 每一例肾穿标本均进行常规HE 特染 免 疫荧光 电镜观察 通过多种手段力争为临床提供更准确 更 专业的肾活检病理诊断 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾活检病理标本送检要求 肾活检常规病理诊断报告的签发周期为5个 工作日 透射电镜报告的签发周期为15个 工作日 疑难病例 节假日或机器故障适 当延期 周二 周四为标本接收时间 请尽量在此 时间内送标本以便及时集中处理 肾穿前请提前一天与我中心电话预约 以 便我们安排人员上门收取标本及做好标本 处理准备 送检标本时需注意 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 送检单内各项内容务请详细认真填 写 作为诊断时参考 送检单及标本容 器上均需写清病人的姓名 送检医院 床号等 以便查对 2 送检肾穿组织不宜过小 组织长度 应超过1 2cm 以皮质为主 最好能同 时穿刺两条组织送检 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾穿刺指导和切割 为保证标本中有足够的肾小球进行诊断 建 议常规穿刺两条标本 将其中一条标本自皮 质端 针尾端 至髓质端 针头端 依次分 割 皮质端1 2mm做电镜检查 放入戊二 醛中 相接2 3mm做荧光检查 放入 OCT保存液 其余部分做光镜检查 放入 10 福尔马林 将处理好的标本分别标记 后连同 肾脏病理专用申请单 一起保存 皮质端 髓质端 abc a 电镜 1 2mm b 荧光 2 4mm c 光镜 剩余部分 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 配送标本箱实验 6升标本箱温度测试 测试日期 6月20号到6月25号 测试时间 每天三次 8 00 12 00 16 00 连续6天128小时 测试数据 箱号1号箱2号箱3号箱 规格 mm 6升6升6升 制冷剂量 g 6 3007 300普通冷藏液 20日8 000h 13 2 16 3 1 3 12 004h 13 2 16 3 1 1 16 008h 13 1 16 30 8 21日8 0024h 13 16 31 5 12 0028h 11 3 15 92 3 16 0032h 9 15 74 7 22日8 0048h 5 8 10 76 1 12 0052h 1 7 9 28 9 16 0056h 0 5 5 79 5 23日8 0072h11 63 317 3 12 0076h15 2819 2 16 0080h17 49 820 5 注 内箱的预留空间可以满足肾穿标本存放 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾穿刺标本保存与配送 肾脏病理检测 光镜 荧光 电镜均有专用瓶子装有液体 光镜 6升箱 7个300g特殊制冷剂 于荧光空间分开 不 能小于2摄氏度 小于等于60H 从托运时算起 到达广州 实验室 荧光 6升箱 7个300g特殊制冷剂 小于等于60H 从 托运时算起 到达广州实验室 电镜 6升箱 7个300g特殊制冷剂 于荧光空间分开 不 能小于2摄氏度 要求小于等于60H 从托运时算起 到达 广州实验室 三者的共同点 荧光 部分和 光镜 电镜 空间分开 储存 配送可做到 荧光初始只要 20度或以下 全部 在2 8摄氏度 冷藏 条件下最长60H到达广州实验室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾穿刺我们可以提供的标本制备 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾组织的特点 髓质颜色暗红 皮质稍浅 镜下见髓质部隐约可见条状髓放线 皮质部 可见分布不规则 模糊的 红色小点即为肾 小球 比重较大 沉于固定液的底部 脂肪组织的特点 黄白色 镜下见一团晶莹 的脂肪细胞 比重较小 漂浮于固定液表面 结缔组织的特点 灰白色 质地柔软 不易 切割 肌肉组织的特点 颜色与肾组织相似 镜下 见不到肾组织的特点 比重也较大 沉于固 定液的底部 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾活检病理标本检测项目及收费标准 常规肾活检病理检查 HE染色 PAS染色 六胺银染色 Masson三色染色 免疫荧 光IgG IgA IgM C1q C3 透射电镜 检查 1202元 常规肾活检病理检查 857元 怀疑乙肝相关性肾炎需要加做免疫荧光 HBsAg HbcAg 怀疑淀粉样变 加做刚 果红特殊染色 费用另计 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 谢 谢
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