人工气胸在CT引导下纵隔病灶穿刺中的应用

Application of artificial pneumothorax in CT guided puncture of mediastinal lesions

目的探讨人工气胸在CT引导下纵隔病灶穿刺中的应用。方法对22例纵隔占位患者行CT引导下经胸膜腔路径纵隔病灶穿刺,其中19例接受CT引导下经皮穿刺组织(芯)活检,2例接受125I粒子植入,1例接受纵隔脓肿抽吸。采用22G小儿腰穿针制造人工气胸,调整患者体位,使穿刺针道尽可能位于胸腔内相对高位。注入足量气体,压缩穿刺路径上的肺组织,再行CT引导下病灶穿刺。活检或治疗完成后,抽出等量气体。结果所有病例均成功制造人工气胸,顺利完成活检及治疗。术中1例患者发现胸膜粘连,但仍完成活检。术后未发现大出血、需引流的气胸等严重并发症。结论人工气胸为CT引导下纵隔病灶穿刺提供了经胸膜腔路径,是一种安全的方法。

Objective To evaluate the utility of artificial pneumothorax under CT-guided puncture of mediastinal masses.Methods Totally 22 patients with mediastinal occupying lesions underwent CT-guided percutaneous puncture by path of pleural cavity.Ninteen patients underwent CT-guided percutaneous core biopsies,2 patients underwent brachytherapy of 125I seeds implantation,the rest one underwent aspiration of mediastinal abscess.The 22 Gauge lumbar puncture needle was used to make artificial pneumothorax.The patient＇s position was adjusted for making the needle path as high as possible in the thoracic cavity.Adequate air was injected untill the lung was displaced from the path of the biopsy needle.Then CT-guided punctures of mediastinal lesions were performed.After biopsy or therapy,similar amount air was aspirated.Results Artificial pneumothorax was initiated in all patients.Biopsy and treatment were completed successfully.Pleural adhesion was found in one patient during procedure,but the biopsy still was completed successfully.No severe complication such as bleeding,pneumothorax required drainage occurred.Conclusion Making artificial pneumothorax is a safe method for obtaining the access of traversing pleural space for CT-guided puncture of mediastinal lesions.