Pathological diagnosis of malignant tumors is considered the gold standard for diagnosis, therefore, must follow the "no pathological diagnosis, no cancer diagnosis and treatment" principle.
Pathological diagnosis of a tumor. Cytology
Cytology has been widely applied in clinical practice for: exfoliated cells in body fluids naturally, take the pleural effusion, ascites, urine sediment, sputum, vaginal secretion smears. mucosa, esophageal netting, eluent gastric, cervical smear and endoscopic brush off the surface of tumor cells. puncture cytology, neither natural exfoliated cells, but also the endoscope can not reach the organs, by fine-needle aspiration or ultrasound, CT directed biopsy to obtain cells in cytology material. Advantage of simple, mainly derived cells is the lack of a small number of cells shed naturally easy to degeneration, in particular, higher differentiation of individual cells or tumor is often the diagnosis difficult.
Pathological diagnosis of tumors 2. Immunohistochemical analysis
Immunization is a basic principle of enzyme labeled antibodies and specific antigen binding reaction, the role of vinegar and substrate color reaction. Immunohistochemical differential diagnosis of the tumor tissue contribute to the origin, functional classification, etiology and pathogenesis of research to guide clinical treatment.
1914 Kappis first reported celiac plexus block (CPN) technology, there was no theory of human anatomy, the only understanding of the solar plexus is located in front of the spine. Therefore, as the basis for anesthesia professional lumbar puncture, a number of years most of the anesthesiologist to CPN. After percutaneous route, needle length 15 – 20cm, in a near both sides of the lumbar vertebral body into the needle, the puncture needle in front of the spine just in front. Has undertaken a variety of ways back CPN, including breast feet, legs and chest by the front foot by abdominal aorta puncture CPN technology. Typically, the needle is in place, bilateral injection of the celiac trunk line. The main disadvantage of the path after the neurological complications, dural puncture to the spinal artery or aortic branch, can cause direct damage or tissue ischemia. With the B-, CT and EUS in clinical application, and finally formed by B-ultrasound and CT guided percutaneous CPN technology before the path, the path before the operation speed, the risk of neurologic complications can be avoided. Before EUS-CPN particular path, only separated by a thin stomach wall puncture of the solar plexus, to improve efficacy and reduce the inevitable complications is important.
CPN patients, the use of local injection of nerve solvent line, resulting in permanent neurological damage, the main agents for the hope of benzene and alcohol injection. Local anesthetics, such as bupivacaine, before the first injection of alcohol to avoid alcohol on the pain caused by nerve stimulation increased. CPN prior to the injection of alcohol in fact, it was commonly used anesthetic injection to test the effectiveness of treatment, if effective, then injected with alcohol. For classification purposes, the use of ethanol injection cause permanent nerve damage are known as celiac plexus block CCPN, a brief injection of hormones known as nerve block nerve block CCPB. Benign pain, often without alcohol and other corrosive chemicals, for fear of long-term structural changes and the complications of surgery. CPB is mainly used in benign lesions, local anesthetic commonly used drugs and hormones.
A variety of ways CPN percutaneous techniques, treatment of cancer pain effect almost. Drugs can be asked along the arteries around the gap slowly spread. Even if the line side of the foot after the injection path is also the case. Of course, the drugs will be free of tumor growth and spread of chronic pancreatitis and fibrosis or radiation treatment resulted in changes of anatomical structures. Although theoretically equivalent efficacy of various therapeutic approaches, but the location of the puncture needle after the curative effect is not so. A study was carried out before the path of CPN treatment of cancer pain, by observing the injection of contrast agents and drugs in the celiac four weeks, and postoperative pain score changes in dispersion compared celiac and superior mesenteric artery or between the tip toward the head to the side effects of injection . Whether to tip toward the celiac trunk or lateral head position, all quadrants have higher rates of drug dispersion, 30 days after surgery significantly reduced pain scores. But the study did not include mutation celiac anatomical situation, and then peritoneal malignant celiac variable. Of experience, after celiac invasion, EUS image shows the difficulties of blood vessels greatly increased the accuracy of injection will be significantly affected.
Pathological diagnosis of cancer, pancreatic cancer and chronic pancreatitis pain usually located on the abdomen, often radiating to the lower back, the nature of sustainability. 29% of pancreatic cancer cases, there is moderate to severe degree of pain, 34% mild pain, only 37% had no pain. 80% -85%, the performance of advanced pancreatic cancer pain. Pancreatic cancer pain transmission, mainly through the solar plexus, celiac plexus block has been used for the treatment of advanced cancer pain. All along, this treatment mainly by surgery or percutaneous plexus ways. Celiac artery is the positioning of the landmark structure, EUS easy to identify. Wiersema compared to other methods through the CPN, recognized the advantages of EUS check the celiac artery, first launched in 1995 by the stomach, EUS-guided celiac plexus block, the success rate of percutaneous and surgical approaches and methods similar to the CPN.
Nerve endings in the pancreas by the pain stimulation, pain signals will be transmitted to the solar plexus. Plexus contains sympathetic elements the main, most of the abdominal organs and the introduction of smart information came from the celiac plexus of information transmission. Visceral nerve plexus of sympathetic synapses, through the legs reach the spinal muscular chest, the pain transmission neurons in the hypothalamus and cerebral cortex reaches, where the information came to be felt as pain. Ascending branch of the descending pain information may be subject to the regulation of inhibitory mechanisms.
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