Lymph node biopsy
Lymphoma, lymph node tuberculosis, metastatic cancer, kala-azar, fungal disease, etc., can be used for lymph node biopsy.Contraindications
Severe bleeding tendency. Extremely weak and uncooperative.Preoperative preparation
Supplies and preparation
Clean plate, 20ml syringe, 7th or 8th needle and 1 sterile bag, 1 vial of sterile saline, 2-5ml of 1%-2% lidocaine, and several slides.
(1) clotting time, platelet count, and prothrombin time were detected before puncture.
(2) fasting 4 to 6 hours before surgery. Coughers take oral antitussives, those who are too nervous to take sedatives.
(3) Before the pelvic lymph node biopsy, the bladder should be filled, and the oral contrast agent shows the intestine. CT enhanced scans were used to distinguish between lymph nodes and blood vessels and intestines.
2. Instruments and drug preparation needle biopsy kits, including disinfection surgical towel, 20 ~ 22G Chiba needle, 18 ~ 21G Surecut needle, syringe, surgical blade, sterile test tube, specimen bottle, glass slide. Tissue specimen fixative, local anesthetic.Surgical procedure
1. Retroperitoneal lymph node enlargement According to the anatomical location and size, a supine position is taken from the anterior wall of the abdomen or a prone position is taken from the spine. Superficial lymph node enlargement for local direct puncture. The puncture path should avoid substantial organs and large blood vessels. Fine needles should be used to puncture the anterior wall of the abdomen
2. According to the location of the enlarged lymph nodes displayed by CT and B-ultrasound, the puncture point and the puncture path are selected.
3. Conventional disinfection of the site to be puncture, after the puncture of the left thumb, index finger and middle finger with ethanol scrub, fix the lymph nodes to be puncture.
4, extract 2% lidocaine 1-2ml, on the surface of the point to be puncture, do local infiltration anesthesia.
5. Hold the syringe in the right direction, puncture the needle into the center of the lymph node in the vertical direction or 45° direction, fix the needle and the syringe in the left hand, and pull the plunger of the right hand to the 5ml scale, draw the negative pressure, and extract the contents 2-3 times. Then relax the piston and pull out the needle so that the aspirate does not get into the syringe. If you do not see any extract, you can take the syringe, take about 0.5ml of normal saline, inject it into the lymph nodes and then pump. If the extract is small, the syringe can be separated from the needle, and the air can be sucked on the needle, so that the liquid in the needle can be sprayed on the slide for smear staining. If the amount of extraction is large, it can be injected into 10% formalin fixative for pathological examination of concentrated sections. After the extraction, the needle was pulled out, and the iodine was applied partially, covered with a sterile gauze and pressed for a while (3 min).
6, extract the smear for pathological examination.
7, after surgery for more than 1h, no special discomfort can go home to rest.