PreoperativePreoperativeFluidFluiddiuresisBloodpressureBiochemicalprofileCompletebloodcountCoagulationprofileBloodproductsAimsGoodualitysamples2Safeandlittletraumatic安全和23Berepresentative有代表Sampletheright在正確的區(qū)域采Diffusevsdiscrete散發(fā)vsVisibleornotDirectvisualisation直接可UltrasoundNecroticcentre?Largeenough夠??細(xì)針抽吸Tru-cut，手 結(jié)Notdamaged不損CrushingartefactCauteryartefact=PercutaneousMinimallyinvasive最小SurgicalBiopsyhandling活檢操SampleSampleProcessingPercutaneousbiopsiesLaparoscopicbiopsies腹腔Apical,superficialbiopsies尖端的,淺表的活檢percutaneousbiopsy,partial經(jīng)皮的活檢,部分脾臟percutaneousbiopsySurgicalbiopsies手術(shù)活LargesamplesGoodcontrol大的樣品好控DeeplesionsPercutaneousliverForgeneralizeddiseases(lipidosis,lymphoma,mastcellandmyeloproliferativeneoplasia,124dogsandcatsFNABwedgebiopsy-48%Wangetal.(2004):Accuracyofultrasoundguidedfine-needleaspirationoftheliverandcytologicfindingsindogsandcats:97cases(1990-2000).JAVMA224:75-78Coleetal.(2002):Diagnosticcomparisonofneedleandwedgebiospyspecimensoftheliverindogsandcats.JAVMA220:1483-PercutaneousPercutaneousbiopsiesPercutaneousPercutaneousbiopsiesPercutaneousbiopsies經(jīng)皮活LaparoscopicLaparoscopicliverbiopsyExpensiveAnaesthesiaMassmaynotprotrudeontotheLaparoscopicbiopsiesComplicationsComplications0.1-1%0.1-1%人類腹腔鏡肝臟活Haemorrhage0.1-1%withlaparoscopicliverbiopsyinBarnesetal(2006):ComparisonofBiopsySamplesObtainedUsingStandardEndoscopicInstrumentsandtheHarmonicScalpelduringLaparoscopicandLaparoscopic-AssistedSurgeryinNormalDogsSurgeryofthehepatobiliarysystemNeoplasmsSurgeryofthehepatobiliarysystemNeoplasmsSurgicalliverbiopsy??FNAB??Accuracyofsplenicspecimens38%ContraindicatedincavitarylesionsMiyaboyashiT(2001):WorldSmallAnimalVeterinaryAssociation,WorldVancover,HepaticandSplenicWithendoscopiclinearcutters使用內(nèi)鏡線性切割器Withendoscopiclinearcutters使用內(nèi)鏡線性切割器LaparoscopicspleenComparisonofbiopsysamplesobtainedusingstandardendoscopicinstrumentsComparisonofbiopsysamplesobtainedusingstandardendoscopicinstrumentsandtheharmonicscalpelduringlaparoscopicandlaparoscopic-assistedsurgeryinnormaldogs.VetSurg35:243-251.Cup-typeCup-typebiopsyVeterinaryEndoscopyforthesmallanimalpractitioner.VeterinaryEndoscopyforthesmallanimalpractitioner.McCarthyp360EndoscopicLinearCuttersEZSurgicalspleenPieceoftissueinsizetoobtain2ndoperationnecessaryifmalignSampleSample>>5cmscoredatseveralsitesrenalbiopsy Chronicrenalfailure慢性腎Uncorrectable凝血功能Severeanemia嚴(yán)重貧HydronephrosisUncontrolled無法控制的高AbscessesPyelonephritis腎盂腎Onekidney?

IndicationrenalAcuterenalGlomerularVadenSL(2005):RenalBiopsyofDogsandCats.ClinicalTechniquesinSmallSampleSampleprocessing-1pieceplacedin一個(gè)放 1pieceplacedinfixativesuitableforelectromicroscopy一個(gè)放在電子顯微鏡1piecefrozenforimmunofluorescentNeedlebiopsykidney針活檢—Ultrasoundguided超聲引Laparoscopic腹腔鏡檢查的DisposableDisposableloadedbiopsyAvoidinterarcuatevessels!SurgicalSurgicalbiopsy–Dogs5kg狗Depth5timesmorelikelytobegoodClosedwithmonofilament,absorbablesuturematerialComplicationsComplicationsMicroscopichematuria20-70%ofdogsMacroscopichematuria1-4ofdogsandPerirenalhematomas腎周圍的Severehemorr