CT导向下细针引导技术及同轴技术在肺肿块穿刺活检中的临床应用

The Clinical Application of CT-guided Percutaneneous Lung Tumor Puncture Biopsy with a Thin Needle and the Same Axle Transfixion Technique

目的评价CT导向下细针引导技术及同轴技术在肺肿块穿刺活检中的临床应用价值。方法CT定位后,将20G×15 cm同轴分体式活检针插入18G×10 cm外套针内,避开重要脏器,两针一同穿刺,在20G活检针的引导下,推进18G外套针至肿块的边缘,建立20G活检切割针的工作通道,插入20G同轴分体式活检切割针的切割针芯即可切割活检。在同轴套管技术基础上,轻微、适度调整18G外套针角度,进行多点,多次活检,一般3-4次。标本固定后行病理学检查。结果60例患者,共穿刺96次,其中2例前后分别共穿刺4次,活检成功率为100%;57例获得准确病理组织学诊断,准确率95.0%,假阴性5.0%;气胸8.3%(5/60),咯血6.7%(4/60)。结论CT导向下细针引导技术及同轴技术穿刺在肺肿块活检(尤其对深在的小病灶)有重要临床意义,此该项技术简便易行,是一种安全、有效的诊断措施。

Objective To evaluate the clinical application of CT-guided pereutaneneous lung tumor puncture biopsy with a thin needle and the same axle transfixion technique. Methods After CT scanning chest and choosing the best puncture biopsy pathway to avoid important organs, the 20G × 15em transfixion needle is inserted 18G × 10cm transfixion troear , the two needle punctures are used together. Under the guidance of 20G needle, 18G troear is pushed to the edge of tumor to establish working pathway of 20G dissection needle. Then, a 20G semiautomatic dissection needle is used to make dessection through 18G trocar. Moderate adjusting 18G trocar angle to make multi-points and multi-dissections. It is usual 3 - 4 times. Results 60 eases were punctured 96 times, each of 2 eases among the 60 eases were punctured 4 times. The procedures were successful in all of 60 eases, The success rate of biopsy was 100%. The accuracy and false negative rate of the puncture biopsy were 95.0% （57/60） and 5.0% （3/60）. Complications included pneumothorax in 5 patients （8.3%） and hemoptysis in 4 patients （6.7%）. Conclusion CT-gnided pereutaneneous lung tumor puncture biopsy with thin needle and the same axle transfixion technique is of great value in clinical practice, especially, as the lung lesion is small and deep. It is an easy technique, safer and efficacious diagnostic measures.