经皮椎体成形术中取材活检在脊柱肿瘤诊疗中的应用

Biopsy During Percutaneous Vertebroplasty for Diagnosis of Spinal Tumor

目的探讨经皮椎体成形术中取材活检的方法及其临床意义。方法收集2003年1月～2005年11月我院收治的脊柱骨质破坏初诊为肿瘤的病例94例120节椎体,包括颈椎3节、胸椎41节、腰椎72节、骶椎4节。溶骨性破坏91节,成骨性破坏9节,混合性破坏20节。其中76例87节脊柱转移癌的原发灶病理诊断在术前已获得。全部病例行经皮椎体成形术,术中病理取材检查。统计病理检查的阳性率。结果经皮椎体成形术与病理取材穿刺成功率100%。阳性诊断率95.0%(114/120);脊柱转移癌的阳性率93.1%(81/87)。无神经、血管损伤,无血肿形成,无感染。80例平均随访36.4月(4～68个月),无沿针道肿瘤播散或皮肤种植转移并发症发生。结论经皮椎体成形术中病理取材复合技术节省治疗时间,降低费用,提高手术安全性和病理诊断效率。

Objective To study the technique and clincal value of biopsy during percutaneous vertebroplasty for the diagnosis of spine lesions. Methods From January 2003 to November 2005, 94 patients that had been diagnosed with spinal tumors were admitted to our hospital. In these cases, totally 120 vertebrae were involved, including 3 cervical vertebrae, 41 thoracic pieces, 72 lumbar segments, and 4 vertebrae. Among the vertebrae, lytic lesions were found in 91, blastic in 9, and mixed in 20. Before operation, primary lesion of the spinal metastatic tumor had been confirmed in 76 patients （ 87 vertebrae）. All the cases received percutaneous vertebroplasty, and biopsy was perfromed during the surgery. The positive rate of the pathological diagnosis was then analyzed. Results The percutaneous vertebroplasty and biopsy were completed in all the cases with a success rate of 100% . Of the 120 vertebrae, the primary diagnosis was confirmed in 114 （positive rate 95.0% ） , and the positive rate for metastasis cases were 93. 1% （81/87）. No injuries to the nerve and vessels were found in this series, no patient developeed hematoma or infection after the operation. A mean of 36.4-month follow-up was achieved in 80 patients （range, 4 to 68 months） , during this period, no tumor cells spreaded along needle tract or implanted into the skin. Conclusions Biopsy during percutaneous vertebroplasty can not only shorten treatment time and save medical cost, but also increase the safty of the surgical treatment as well as the accruracy of pathological exmaination.