扫描架倾斜CT定位下对肋下肺内孤立性结节经皮穿刺活检

PERCUTANEOUS NEEDLE BIOPSY SOLITARY PULMONARY NODULES BENEATH THE RIB UNDER CT GUIDANCE WITH GANTRY TILT

目的评价位于肋下的周围型孤立性肺结节肺活检中运用扫描架倾斜定位的有效性和安全性。方法对2005年9月-2007年9月262例肺结节患者在CT引导下经皮穿刺肺活检,通过改变体位和改变上肢的位置,肋骨仍然阻挡了活检路径,常规方法无法完成定位和穿刺。为此采用扫描架倾斜的方法定位,并对小结节的特点、获得标本的成功率、判明孤立性肺结节的良恶性的能力、明确特定细胞类型的能力以及操作过程中遇到的并发症进行研究。结果运用组织切割针活检的方法,25例均获得了足够数量的标本,用于组织病理学检测。确诊了其中24例的良恶性,其中19例明确了细胞学类型,未发生严重的并发症。结论扫描架倾斜CT引导定位下穿刺肺活检,对位于肋下的肺内孤立性小结节的活检是有效、安全和实用的。

Objective To evaluate the efficacy and safety of gantry tilting for the performance of lung biopsy of peripheral solitary pulmonary nodule located beneath the rib. Methods Twenty five of two hundred and sixty two nodules for which percutaneous needle biopsies of lung were performed under CT scan guidance in our department between September 2005 and September 2007. For these twenty five nodules,a rib blocked the biopsy route even after trials to change the relationship between the target and the rib,so a biopsy was performed under CT guidance with gantry tilt. The characteristics of each nodule, the success rate for obtaining an adequate specimen and the ability to determine whether the nodule was malignant or benign were investigated,specific cell types were characterized and the complications that were encountered were identified. Results In all twenty five nodules, adequate specimens for histopathology evaluation were obtained using fine needle tissue core biopsy. In 24 nodules, whether the nodule was malignant or benign was determined. No serious complication occurred. Conclusion Percutanous needle biopsy under CT guidance with gantry tilt is a useful and safe technique for the biopsy of singular pulmonary nodule located beneath the rib.