https://www.chamfondbiotech.com/4-types-of-pob txha-marrow-biopsy-needles/

I. Thawj Yam Ua Ntej: Dab Tsi Yog Pob Txha?

1.1 Pob txha pob txha - Lub cev "Central Blood Factory"

Xav txog koj lub cev raws li lub nroog loj heev. Ntshav yog lub nroog tsis nres "kev thauj mus los" - cov qe ntshav liab xa cov pa oxygen, cov qe ntshav dawb ua "cov neeg saib xyuas kev nyab xeeb" yos hav zoov cov kab mob thiab cov kab mob, thiab cov platelets ua haujlwm ua "cov neeg kho txoj kev" ntsaws qhov txhab.Cov pob txhayog covloj tshaj plaws ntau lawm Hoobkashauv lub nroog no.

Lub Hoobkas no tsis nyob ntawm lub cev qhov chaw - nws tau muab zais rau hauv cov kab noj hniav ntawm koj cov pob txha. Kov koj lub hauv siab (sternum), koj cov pob txha hauv lub duav (cov pob txha iliac), lossis saum koj cov pob txha ncej puab - tag nrho cov no muaj cov pob txha hauv. Tus neeg laus tag nrho cov pob txha ntim hnyav txog3kg ua​ - tsis loj, tab sis nws ua hauj lwm ib ncig ntawm lub moos, ua roughly200 billion cov qe ntshav tshiab txhua hnubkom koj lub cev ua haujlwm zoo.

1.2 Cov "Cov Neeg Ua Haujlwm" thiab "Kev Ua Haujlwm Ib Cheeb Tsam" Hauv Marrow

Nyob rau hauv lub tshuab marrow, muaj ob yam khoom:

Cov "Cov Neeg Ua Haujlwm" - cov hlwb hematopoietic: Pib los ntawm qhov tseem ceeb tshaj plaws "tag nrho- cov neeg ua haujlwm lub hom phiaj" (hematopoietic stem cells), lawv maj mam sib txawv rau hauv "semi-tiav" thiab "tiav" versions ntawm cov qe ntshav liab, cov qe ntshav dawb, thiab platelets.

Lub "Rov Ib puag ncig" - Microenvironment: Muaj xws li ib tug reticular scaffold, cov hlab ntsha network (hu ua "sinusoids"), rog hlwb, thiab ntau yam "kev tswj teeb liab molecules." Qhov chaw no txiav txim siab seb "cov neeg ua haujlwm" puas tuaj yeem ua lawv txoj haujlwm zoo thiab qhov kev coj ua uas lawv sib txawv.

1.3 Vim li cas Tus Kws Kho Mob Yuav Tsum "Tshuaj Xyuas Lub Hoobkas"?

Thaum koj lub cev xa cov cim ceeb toom, cov kws kho mob xav tias qee yam yuav tsis raug rau hauv "lub Hoobkas":

Unexplained anemia (tsis muaj cov qe ntshav liab txaus)

Cov qe ntshav dawb siab dhau lossis qis dhau (ib qho teeb meem nrog "team kev ruaj ntseg")

Cov platelets tsawg ua rau qhov nqaij tawv yooj yim lossis los ntshav (cov "neeg ua haujlwm kho" luv luv -cov neeg ua haujlwm)

Cov qog nqaij hlav o los yog tus po loj (qhov "lub Hoobkas" yuav raug coj los ntawm cov neeg sab nrauv)

Thaum lub sijhawm ntawd, tus kws kho mob yuav tsum tau "saib lub Hoobkas" kom pom tias muaj dab tsi tshwm sim hauv. Tab sis muaj ob txoj hauv kev ua qhov no - thiab qhov no yog qhov peb tab tom piav qhia hnub no:pob txha pob txha aspirationthiabpob txha hlwb biopsy.

1.4 Ib qho yooj yim Analogy

Txhawm rau pab koj nkag siab qhov txawv ntawm ib nrais muag, ntawm no yog qhov piv txwv:

Xav txog cov pob txha pob txha yog aJell-O ncuav mog qab zib​ - nws muaj cov txiv hmab txiv ntoo (hlwb) tshem tawm hauv nws, nrog rau lub ncuav mog qab zib thiab qab zib (lub scaffold thiab microenvironment).

Pob txha mob aspiration​=ntxig ib lub straw thiabnqus ib lub qhov ncauj ntawm Jell-O kuatxhawm rau xyuas seb cov txiv hmab txiv ntoo zoo li cas los yog puas muaj kab mob.

Bone marrow biopsy​=siv lub khob noom cookie me me rautxiav tawm tag nrho me ntsis cylindrical daim ncuav mog qab ziblos xyuas seb tag nrho cov ncuav mog qab zib cov qauv zoo li cas thiab seb cov txiv hmab txiv ntoo puas sib npaug los yog clumped ua ke.

Ib tug saib ntawm "qhov"; lwm tus saib ntawm "tag nrho cov qauv." Qhov ntawd yog qhov txawv txav.

II. Cov cuab yeej sib txawv: A "Straw" vs A "Hollow Laum"

2.1 Lub Koob Aspiration - Zoo li "Specialized Straw"

Cov koob siv rau pob txha pob txha aspiration tuaj yeem xav tias yog ib qhontxiv -ntev, me ntsis thickened hollow koob, tab sis thicker dua li niaj zaus txhaj koob. Nws cov yam ntxwv tsim tseem ceeb yog:

Ib qho khoom siv sab hauv pas nrig (stylet): Ua ntej nkag mus rau hauv cov pob txha, tus pas nrig no thaiv cov koob taub kom tiv thaiv cov pob txha tawg los ntawm kev txhaws ntawm rab koob.

Ib lub hub uas txuas rau lub koob txhaj tshuaj: Thaum lub taub nkag mus rau hauv cov kab mob hauv cov quav, cov pas nrig raug tshem tawm thiab ib lub koob txhaj tshuaj txuas rau "suck."

Lub koob lub cheeb yog roughly piv rau ib tug tuab noodle (1.6-2.1 mm). Nrog rau kev siv tshuaj loog hauv zos, cov neeg feem coob xav tias qee yam zoo li lub siab ruaj khov - zoo ib yam li qhov mob ntawm kev txhaj tshuaj loog.

2.2 Cov koob Biopsy - Zoo li "Miniature Hollow Laum"

Cov koob tshuaj biopsy yog ntau "heftier" - nws txoj kab uas hla yog roughly sib npaug rau ob noodles ib sab (2.4–3.0 mm). Nws tus qauv tsim ntau dua li ibme hollow xyaum:

Ib lub raj txiav sab nraud: Rotates zoo li lub laum me ntsis los txiav tawm ib qho tseem ceeb ntawm cov ntaub so ntswg.

Ib qho khoom siv sab hauv: Ntxig ua ntej rau qhov chaw, tom qab ntawd tshem tawm kom lub raj sab nraud tuaj yeem tig thiab txiav.

Vim tias nws tuab dua, thaum lub sij hawm biopsy koj yuav hnov ​​​​qhov kev paub ntau duasiab thiab puv​ - tab sis nws tsis yog qhov ntse, stabbing mob, vim hais tias cov tshuaj loog ua haujlwm. Nws zoo li ib tug neeg nias thiab twisting nrees tiv thaiv koj cov pob txha. Me ntsis mob, me ntsis mob, tab sis tag nrho zam.

2.3 Cov koob Thickness puas cuam tshuam rau kev nyab xeeb?

Ntau tus neeg txhawj xeeb: "Yog tias rab koob tuab heev, nws puas yuav ua rau kuv cov pob txha puas tsuaj?"

Cov lus teb yog:Tsis muaj.​ Cov pob txha cortical ntawm lub nraub qaum qaum qaum (qhov feem ntau puncture/biopsy site) feem ntau yog 3-5 hli tuab, thiab rab koob tsuas yog nkag mus rau 1.5-2 cm - zoo li drilling qhov me me hauv phab ntsa tuab. Lub phab ntsa ntawm cov qauv kev ncaj ncees yog kiag li tsis muaj kev cuam tshuam. Cov pob txha pob txha yuav zoo tom qab, ib yam li daim tawv nqaij qhov txhab.

III. Sib txawv Kev Xeem tsom xam: "Cell Appearance" vs. "Tissue Layout"

3.1 Pob Txha Aspiration - Tshwj xeeb hauv "Cell Appearance"

3.1.1 Tus Qauv Zoo Li Cas?

Cov kua dej tau los ntawm kev xav zoo lintshav liab, tab sis me ntsis thicker dua li niaj hnub venous ntshav. Tus kws kho mob tsuas yog kosob peb tee rau ib lub raj me me​ (0.2–0.5 ml - hais txog qhov ntim ntawm ib lossis ob lub kua muag) los ua txhua yam kev ntsuam xyuas tsim nyog.

3.1.2 Tus kws kho mob nrhiav dab tsi hauv qab lub tshuab tsom?

Cov "pob txha te" no kis tau rau ntawm cov iav slides, stained, thiab magnified 1000 × nyob rau hauv ib lub microscope. Tus kws kho mob feem ntau saib peb yam:

Ua ntej: Cov hlwb puas zoo li qub?

Ib yam li saib cov duab ntawm tib neeg - qee qhov yuav tsum yog puag ncig- ntsej muag (liab hlwb), qee qhov ntau -angled (granulocytes), qee qhov loj thiab loj (megakaryocytes). Yog hais tias "round faces" ua "distorted faces" - piv txwv li, nuclei ua tsis xwm yeem los yog npaj txhij txog granules tshwm nyob rau hauv cytoplasm - ib yam dab tsi tsis ncaj ncees lawm.

Qhov thib ob: Puas yog qhov kev faib ua feem ntawm txhua hom cell muaj tseeb?

Hauv cov kab mob ib txwm muaj, cov kab mob liab "cov neeg ua haujlwm" ua rau ib nrab, cov kab mob dawb ntawm ib nrab, thiab cov kab mob platelet ib feem me me. Yog hais tias ib tug kab mob dheev tawg (piv txwv li, blasts tshaj 20%), uas yuav qhia tau tias mob leukemia.

Peb: Puas muaj "cov cim tshwj xeeb"?

Piv txwv li, Auer rods ( pas nrig- cov qauv zoo li tshwm sim hauv qee cov qog ntshav qog ntshav) ua zoo li "tus ntiv tes" ntawm qhov chaw ua txhaum cai - ib zaug pom, lawv tuaj yeem txheeb xyuas hom kab mob.

3.1.3 Dab tsi yog Kab Mob Aspiration Zoo Tshaj Plaws Hauv Kev Ntsuas?

3.2 Pob Txha Pob Txha Biopsy - Tshwj xeeb hauv "Tissue Layout"

3.2.1 Tus Qauv Zoo Li Cas?

Ib qho biopsy tsis tso kua dej - nws yields me megreyish-dawb strip txog 1.5-2 cm ntev thiab lub thickness ntawm ib lub noob hnav rau ib lub nplej nplej. Qhov no yog pob txha pob txha "core biopsy."

3.2.2 Dab tsi yuav tsum muaj qhov me me no hla dhau ua ntej nws tuaj yeem pom?

Cov ntaub so ntswg core tsis tuaj yeem kuaj ncaj qha - nws yuav tsum mus rau tag nrho "kev ua haujlwm" kav dej:

Soak hauv formalin (fixation): "Freezes" cov hlwb thaum lub sijhawm rho tawm, tiv thaiv kev lwj.

Decalcification: Pob txha muaj calcium ntau (xws li hauv cov pob txha nqaij), uas yuav tsum tau "tso tawm" kom cov nqaij mos.

Paraffin embedding: Cov ntaub so ntswg yog muab tso rau hauv paraffin wax thiab hlais rau hauv ultra-thin seem (li 1/20 lub thickness ntawm tib neeg cov plaub hau).

Staining: Cov dyes sib txawv xim cov seem kom tus kws kho mob pom cov hlwb thiab fibers.

Tag nrho cov txheej txheem yuav siv sij hawm3-7 hnub(nrog rau kev decalcification maj mam), yog li cov txiaj ntsig biopsy feem ntau rov qab los ob peb hnub tom qab tshaj li qhov kev xav tau.

3.2.3 Tus Kws Kho Mob Nrhiav Dab Tsi ntawm Tshooj?

Ua ntej: Qhov piv ntawm thaj chaw hematopoietic rau thaj tsam rog.

Nyob rau hauv ib tug neeg laus ib txwm, li ib nrab ntawm cov pob txha yog hematopoietic (pob liab liab) thiab ib nrab yog rog (daj leeg). Yog tias thaj chaw hematopoietic yuav luag tag nrho los ntawm cov rog, qhov ntawd yog aplastic anemia. Yog tias thaj chaw hematopoietic dhau lawm - nthuav dav thiab nthuav tawm cov rog, uas tuaj yeem qhia tias mob ntshav qab zib mellitus lossis myelofibrosis.

Qhov thib ob: Lub hlwb "tso" li cas?

Ntawm qhov chaw biopsy, tus kws kho mob tuaj yeem pom seb cov hlwb puas sib npaug, txawm tias lawv "ua ke" (cov pob zeb tawg), lossis seb lawv puas tau sib cais los ntawm cov ntaub so ntswg. Nws zoo ib yam li saib ntawm lub tsev hauv pem teb txoj kev npaj - koj tuaj yeem pom cov chav twg nyob qhov twg, txoj kev hauv tsev khiav li cas, thiab qhov twg muaj qhov thaiv.

Thib peb: Puas muaj "squatters"?

Yog tias cov qog nqaij hlav tau raug cuam tshuam los ntawm lwm yam mob qog noj ntshav (xws li, mob qog noj ntshav mis lossis mob ntsws uas tau kis mus), ntu kev kuaj ntshav yuav qhia cov "squatters" pawg hauv pawg. Cov stains tshwj xeeb (immunohistochemistry) tuaj yeem txiav txim siab seb lawv tuaj ntawm lub cev.

3.2.4 Cov kab mob dab tsi yog Biopsy zoo tshaj plaws ntawm kev kuaj mob?

IV. Txhua tus muaj nws "tsis muaj zog": Tsis muaj kev sim zoo meej

4.1 Peb "Frustrations" ntawm Bone Marrow Aspiration

Kev ntxhov siab 1: Lub architecture yog scrambled - koj nrhiav tsis tau "cov neeg nyob ze" lawm.

Thaum cov kua hauv plab tau nqus, tag nrho cov hlwb dhau los ua "cov tub rog tawg" - koj tsis paub tias leej twg zaum ntawm ib sab. Nws zoo li ncaws txhua tus tawm ntawm lub tsev mus rau txoj kev; koj qhia tsis tau tias leej twg nyob hauv pem teb los yog leej twg nyob ze nrog leej twg. Qhov no yog ib qho teeb meem loj thaum kuaj xyuas qee yam kab mob (xws li MDS nrog qhov txawv txav ua ntej hauv zos).

Kev ntxhov siab 2: Yooj yim "dej cia."

Thaum lub sij hawm aspiration, cov ntshav los ntawm cov hlab ntsha ntawm cov hlab ntsha (sinusoids) tau nqus heev - xws li ntxiv dej rau kua txiv. Yog tias "dej" ntau dhau lawm, cov hlwb tsis zoo uas yuav tsum muaj li 20% tuaj yeem tshwm sim tsuas yog 10% - ua rau muaj qhov tsis zoo. Yog li ntawd, cov kws kho mob tau ceev faj heev kom aspirate tsuas yog me me xwb.

Kev ntxhov siab 3: Qee zaum "tsis muaj dab tsi tawm."

Qhov no yog lub npe hu ua "dry kais." Cov ua rau tej zaum yuav yog cov pob txha uas nyuaj heev (fibrosis), tag nrho (cov qog nqaij hlav), los yog tuab heev (cov leukemic cell ceev). Thaum qhov no tshwm sim, aspiration "mus tawm tsam," thiab yuav tsum tau kuaj biopsy kom txuag hnub.

4.2 Peb "Regrets" ntawm Bone Marrow Biopsy

Kev tu siab 1: Cells tau ntim ua ke - nyuaj kom paub txog tus kheej "lub ntsej muag."

Nyob rau hauv ultra- ntu nyias, cov nuclei nquag sib sau ua ke, zoo li lub tsheb ciav hlau uas muaj neeg coob coob thaum lub sij hawm maj nrawm - nws nyuaj rau pom ib tus neeg lub ntsej muag kom meej. Yog li thaum biopsy tuaj yeem qhia koj "muaj ntau tus neeg nyob ntawm no," nws tsis tuaj yeem qhia koj tias "cov neeg no tshwj xeeb yog leej twg."

Kev tu siab 2: Cov ntsiab lus zoo hauv lub cev tsis meej.

Vim hais tias cov ntaub so ntswg raug kho formalin, decalcification, paraffin embedding, thiab lwm yam "kev tuav rawv," qee qhov muag hauv cov qauv (xws li cov granules me me los yog pas nrig -zoo li lub cev) tuaj yeem hloov pauv lossis ploj mus. Nws zoo li hloov cov txiv hmab txiv ntoo tshiab rau hauv cov txiv hmab txiv ntoo qhuav - cov duab dav dav, tab sis cov ntsiab lus zoo hloov.

Tu siab 3: Cytochemical stains tsuas yog "kwv yees."

Biopsy kuj tuaj yeem ua tau qee qhov cytochemical stains, tab sis vim yog kev ua haujlwm, cov txiaj ntsig tsuas tuaj yeem qhia tau tias "tam sim no" lossis "tsis tuaj," "ntau" lossis "tsawg" - lawv tsis tuaj yeem muab cov lej lej tseeb. Aspiration smears, los ntawm qhov sib txawv, tuaj yeem hais meej meej: "Cov enzyme no muaj nyob hauv 85% ntawm cov hlwb."

V. Tus kws kho mob yuav xaiv li cas?

5.1 Xov Xwm Zoo: Feem ntau, ob leeg ua tiav ua ke

Ntau tus neeg mob nug: "Kuv puas tuaj yeem ua ib qho xwb?" Cov lus teb yog:Yog tias muaj xwm txheej tso cai, ua ob qho tib si ua ke yog qhov zoo tshaj.

Qhov laj thawj yog yooj yim - lawv qhiaob sab sib txawv ntawm tib daim kab mob. Ib yam li kev yuav ib lub tsev, koj xav tau ob qho tib si "plam hauv pem teb" (biopsy) thiab "cov ntsiab lus sab hauv" (aspiration) - tsis yog siv tau.

Qhov xwm zoo yog: cov kws kho mob feem ntau ua ob qho kev ua haujlwm thaum lub sijhawmib zaug tshuaj loog, ntawm ib qhov chaw, ib qho tom qab lwm yam​ - aspiration ua ntej, ces biopsy. Yog li koj tsuas yog ua siab ntev ib rab koob tsim nyog ntawm qhov tsis xis nyob thiab tau txais ob qhov kev xeem.

5.2 "Qhov tseem ceeb" Raws li cov xwm txheej sib txawv

5.3 A Real-Zaj Dab Neeg

Yawg Zhang, 65 xyoos, tau hnov ​​​​ntxhiab heev, saib daj ntseg, thiab pom tus po loj. Nws CBC tau pom tias muaj ntshav liab, nrog cov qe ntshav dawb qis thiab platelets. Nws tus kws kho mob kom kuaj pob txha.

Thawj qhov kev sim yog kev ntshaw xwb. Cov qauv no tau diluted los ntawm cov ntshav, uas qhia tias "tsis muaj cellularity" - tsis txaus rau kev kuaj pom tseeb. Hmoov zoo, tus kws kho mob kuj tau txiav txim rau biopsy - ntu tau nthuav tawm cov ntaub so ntswg thiab cov cell txawv txav. Kev kuaj mob zaum kawg:thaum ntxov - theem pib myelofibrosis.

Yog tias tsuas yog kev xav tau ua tiav, Mr. Zhang tej zaum yuav raug kuaj pom tsis zoo nrog "kev mob ntshav tsis txaus," ncua kev kho kom raug. Qhov no yog lub zog ntawm ob qhov kev sim ua haujlwm ua ke.

VI. Cov Lus Nug Cov Neeg Mob Mob Txog Feem ntau

Q1: Nws puas mob?

A:Cov tshuaj loog hauv zos (feem ntau lidocaine) yog siv ua ntej, yog li cov koob txhaj tshuaj ua rau qee qhov mob thiab siab tab sistsis muaj mob hnyav. Lub sijhawm ntawm kev cia siab ua rau mob me ntsis (kwv yees li 1–2 vib nas this) - zoo li me me hluav taws xob poob siab, tab sis nws dhau tam sim ntawd. Kev sib hloov biopsy feem ntau zoo li lub siab thiab mob. Tag nrho cov txheej txheem feem ntau yuav siv sij hawm10-15 feeb.

Q2: Nws puas yuav tso kuv "lub zog tseem ceeb"? Puas yog "extracting marrow" ua rau kuv qaug zog?

A:Tsis yog kiag li. Ua ntej, aspiration tsuas yog tshem tawm 0.2-0.5 ml - tsawg dua ib teaspoon. Kev kuaj ntshav tshem tawm 1.5–2 cm ntev strip, 2–3 mm inch - piv rau koj lub cev 3 kg ntawm tag nrho cov quav, qhov no zoo li rub lub khob me me los ntawm lub pas dej da dej.Cov pob txha pob txha muaj peev xwm ua tau zoo heevthiab tag nrho replenishes nyob rau hauv hnub. Lub tswv yim ib txwm muaj ntawm "draining tseem ceeb lub zog" tsis muaj kev cuam tshuam rau cov txheej txheem no txawm li cas los xij.

Q3: Puas muaj kev pheej hmoo?

A:Bone marrow aspiration thiab biopsy yog cov txheej txheem zoo heev. Cov teeb meem loj heev yog tsawg heev. Tej yam txaus ntshai muaj xws li:

Ntshav: Yooj yim tswj nrog ob peb feeb ntawm compression. Cov neeg mob uas muaj coagulation ib txwm yuav luag tsis muaj los ntshav hnyav.

Kab mob: Tsis tshua muaj tshwm sim nrog cov tshuaj tua kab mob kom zoo.

Sternal nkag: Nyob rau hauv tsawg zaus nrog sternal puncture, tshaj - nkag mus yuav ua rau lub plawv - tab sis tam sim no, feem ntau cov kws kho mob xaiv lub posterior iliac qaum, zam qhov kev pheej hmoo tag nrho.

Q4: Kuv yuav tsum tau ceev faj dab tsi tom qab tus txheej txheem?

A:​ Yooj yim heev - tsuas yog peb txoj cai:

Siv compression: Tom qab cov txheej txheem, tus kws kho mob yuav muab cov ntaub nplaum thiab daim kab xev rau ntawm qhov chaw. Koj lossis ib tus neeg hauv tsev neeg nias rau nws ntxiv 15-30 feeb yog qhov zoo dua.

Cia qhuav rau 3 hnub: Tsis txhob cia qhov chaw ntub dej - daim txhuam cev da dej yog qhov zoo, tab sis tsis txhob da dej lossis da dej hauv qhov dej kub.

Khaws nws kom huv si: Yog tias cov ntaub qhwv ntog, muab povidone-iodine thiab siv cov ntaub nplaum tshiab.

Q5: Ntev npaum li cas kom txog thaum kuv tau txais cov txiaj ntsig?

A:Aspiration smear cov txiaj ntsig feem ntau rov qab los rau hauv1-3 hnub ua haujlwm(ntxiv 1-2 hnub ntxiv yog tias cytochemical stains raug txiav txim). Cov txiaj ntsig biopsy feem ntau yuav siv5-7 hnub ua haujlwmvim yog lub fixation, decalcification, embedding, thiab sectioning txheej txheem. Cov teeb meem nyuaj yuav siv sij hawm ntev dua. Thov ua siab ntev - ua haujlwm zoo yuav siv sijhawm.

VII. Ib -Sentence Summary

Cov pob txha pob txha aspiration "saib ntawm tes zoo li"; pob txha pob txha biopsy "saib cov ntaub so ntswg architecture." Lawv tsis yog ib qho - lossis kev xaiv - lawv yog "zoo meej 搭档 (cov koom tes zoo meej). Ib yam li kev yuav ib lub tsev xav tau ob qho tib si hauv pem teb thiab cov duab sab hauv, koj tus kws kho mob xav tau ob qho kev ntsuam xyuas kom muab qhov tseeb tshaj plaws rau koj.

Yog tias koj lossis ib tus neeg koj hlub tab tom yuav xeem cov ntawv xeem no, nco ntsoov:lawv muaj kev nyab xeeb, zoo- tsim, thiab tsim nyog.​ Koom tes nrog cov lus qhia muab tso rau, khaws lub xaib kom qhuav rau 3 hnub, thiab nqa tag nrho cov txiaj ntsig rau koj lub tsev kho mob hematology rau kev txhais lus tshaj lij - uas yog kauj ruam tom ntej tseem ceeb tshaj plaws.