简易棉纱固定装置在CT导向肺穿刺活检中的临床应用

Simple self-made cotton fixing device:the clinical applications in CT-oriented puncture

目的研制简易棉纱固定装置并探讨其在CT导向肺穿刺活检的临床应用价值。方法对64例肺部肿块患者进行CT引导下穿刺活检。患者随机分为两组:A组(32例)采用不可分解针体的活检针:BioPinceTM活检针行穿刺活检;B组(32例)使用该活检针穿刺定位过程中,加用简易棉纱固定装置固定针体。对比两组:首次穿刺成功率,针尖移位次数,穿刺并发症发生率,病理诊断结果。结果A、B两组在CT扫描核实时发现针尖下移分别是8例次和0例次(x^2=9.14,P=0.0025),针尖偏移原定靶点7例次和2例次(x^2=3.23,P=0.072),B组使用棉纱固定装置后,明显较少针体和针尖的移位,因此减少调整的次数,因而提高了首次穿刺成功率(x^2=8.57,P=0.0034),进而减少了气胸、穿刺针道出血等的并发症,统计学比较,P值均<0.05。最重要的是,棉纱固定装置固定了穿刺针,防止了针尖自行下滑误穿纵隔大血管的可能。两组最后均取得足量组织,病理诊断准确率分别为93.8%和96.9%(P>0.05)。结论简易棉纱固定装置,在穿刺定位过程中对因结构原因不可分解针体的从而会影响首次穿刺成功率以及增加操作的风险BioPinceTM等穿刺活检针,可以固定针体和针尖,减少移位,提高了肺部肿块CT导向穿刺活检的成功率,减少了并发症。

Objective To develop a simple cotton fixing device and evaluate its clinical application in CT-oriented lung puncture biopsy. Methods 64 patients with pulmonary mass were randomly divided into two groups, group A （n=32） and group B （n=32）, and examined by BioPinceTM biopsy needle with or without simple cotton fixing device to fix the needle body. The first puncture successful rate, times of needle tip migration, incidence of puncture-related complications, and pathological results were recorded. Results Downward migration of needle tip was confirmed by CT scanning in 8 patients in group A versus 0 patient in group B （X^2=9.14, P= 0.0025）; and deviation of needle tip from the original target occurred in 7 patients in group A and 2 in group B, respectively （X^2=3.23, P= 0.072）. In group B the simple cotton fixing device could obviously reduce the shift of the needle body and tip and the adjustment times, so as to improve the first puncture successful rate （X^2=8.57, P=0.0034） and decreased the puncture-related complications, i.e., pneumothorax, hemorrhage of pin tract （P 〈 0.05）. Most importantly, it could protect puncture needle from automatic downward migration so that it could avoid the potential risks of mediastinum puncture. Finally the accuracy of pathological results were 93.8% and 96.9%, respectively （P 〉 0.05）. Conclusion For BioPinceTM biopsy needle which will lower first puncture successful rate and increase operational risk because of its inseparable needle body, our self-made simple cotton fixing device can fix the needle body and tip, so as to reduce migration of needle body and tip, improve successful rate of CT-oriented lung puncture, and decrease the incidence of puncture-related complications.