胆囊占位性病变的临床病理诊断教学思考

Thoughts on the Teaching of Clinicopathological Diagnosis of Gallbladder Space-Occupying Lesions

摘要: 胆囊占位性病变是囊括了一组胆囊良、恶性疾病在内的一系列囊内新生物的统称。具有起病和症状隐匿、发病机制各异、影像学特征不易区分等特点，易漏诊和误诊，胆囊占位性病变的教学是消化系统病理教学的重要组成之一，也是肝胆专科病理教学的重点授课内容，尽管一些典型病例可通过术前血清学等检查手段初诊，但显微镜下的病理诊断仍然是胆囊占位性病变定性的金标准。尤其是术中快速冰冻诊断，其教学质量将影响学员对病灶性质的判别以及后续正确的手术方式和切除范围。本文在胆囊外检的实际工作中探索出一条从临床表现–超声影像检查–大体标本–镜下形态–免疫组化–分子病理检测的系统教学方法，以期加强对该类病变的病理诊断教学效果，将有利于提高对胆囊疾病的认识，强化病理专科诊断人才队伍的建设，培养学员临床病理诊断能力和实践操作技能。

Abstract: Gallbladder space-occupying lesion is a general term for a series of neoplasms in the gallbladder, including a group of benign and malignant gallbladder diseases. It is characterized by hidden onset and symptoms, different pathogenesis, and indistinguishable imaging features, and is frequent to be missed or misdiagnosed. The teaching of gallbladder space-occupying lesions is one of the important components of the teaching of digestive system pathology, and it is also the key teaching content of the pathology teaching of the hepatobiliary department, although some typical cases can be primary diagnosed by means of preoperative serology and other examination. However, microscopic pathologic diagnosis is still the gold standard for the qualitative characterization of space-occupying gallbladder lesions. In particular, the teaching quality of the intraoperative frozen section diagnosis will affect the students’ judgment of the nature of the lesion and the subsequent correct surgical method and resection range. In the actual work of the gallbladder surgical examination, this paper explores a systematic teaching method from clinical manifestation-ultrasonic image examination-gross specimen-microscopic morphology-immunohistochemistry-molecular pathology detection, in order to strengthen the teaching effects of pathological diagnosis of this kind of lesions, which will be conducive to improving the understanding of gallbladder diseases and strengthening the construction of pathological diagnosis talents, and to cultivating students’ clinical pathological diagnosis ability and practical operation skills.