粗套管穿刺针在胸腰椎椎体病变穿刺活检中的应用

The application of thick trocar puncture biopsy in thoracic and lumbar vertebral lesions

目的：探讨粗套管穿刺活检针在胸腰椎椎体病变穿刺活检中的应用价值。方法：对2004年2月～2009年8月在我院行手术治疗并于术前行病变穿刺活检病理检查的54例胸腰椎椎体病变患者进行回顾性分析．患者年龄15～78岁，平均50．6岁；男30例，女24例。均有局部疼痛，12例伴下肢不同程度的放射痛；43例局部压痛，下肢不同程度的感觉异常。术前均行脊柱x线片和CT检查，均为单椎体病变，表现为不同程度的椎体骨质破坏，其中胸椎30例（T47例，T52例，T67例，T78例，T85例，T111例），腰椎24例（L11例，L28例，L34例，L45例，L56例），均在手术治疗前行CT引导下粗套管穿刺活检针病变穿刺活检。比较穿刺活检病理诊断与术后病理诊断的符合情况。结果：无穿刺活检并发症发生。穿刺活检病理诊断恶性肿瘤28例，良性肿瘤1例，可疑恶性肿瘤1例，正常组织1例，炎性病变23例，共52例有明确的病理诊断．穿刺活检病理诊断阳性率为96.3％；穿刺活检病理诊断与术后病理诊断一致51例，诊断符合率为98．1％。1例穿刺活检病理诊断为可疑恶性肿瘤，术后病理诊断为腺癌；1例穿刺活检病理诊断为正常组织，术后病理诊断为非特异性炎症：1例穿刺活检病理诊断为化脓性感染，术后病理诊断为结核。结论：粗套管穿刺活检针在胸腰椎椎体病变穿刺活检中能够取得较为充足的标本量，穿刺活检病理诊断阳性率及穿刺活检病理诊断与术后病理诊断符合率均较高。

Objectives： To evaluate the use of thick trocar puncture biopsy in thoracic and lumbar vertebral lesions. Methods： 54 cases（30 males and 24 females） with thoracic and lumbar vertebral lesions undergoing CT-guided percutaneous biopsy before operation between February 2004 and August 2009 were reviewed ret-rospectively. All cases had a mean age of 50.6 years（range, 15 to 78 years）. Local pain was the main com-plaint. 12 cases presented with different degrees of radiating pain in lower extremities, 43 cases presented with local pain and different degrees of paresthesia in lower extremities. Each case underwent X-ray and CT scanning before operation, and all presented with single level lesion in thoracic or lumbar spine with different degrees of vertebral body defect. 30 cases had defect in thorac（7 in T4, 2 in T5 7 in T6, 8 in T7, 5 in T8, 1 in T11）, and 24 cases had defect in lumbar（1 in L1, 8 in L2, 4 in L3, 5 in IA, 6 in LS）. All cases underwent CT-guided puncture biopsy. And the pathological results after operation were compared with the preoperative biopsy. Results： No complication was noted. After biopsy, malignant tumor was verified in 28 cases, benign neoplastic lesion 1 case, suspection of malignant tumor in 1 case, normal tissue in 1 case, in- flammatory lesion 23 cases. 52 cases had definite pathologic diagnosis, with the positive rate of 96.3%; more-over, after operation, 51 cases had the final pathological results as same as the preoperative biopsy, with the consistent rate of 98.1%. 1 suspection of malignant tumor after biopsy was verified as adenocarcinoma after general pathological test; 1 normal tissue after biopsy was verified as non-specificity inflammation; 1 pyogenic infection was verified as tuberculosis. Conclusions： Thick trocar percutaneous biopsy can ensure abundant specimens in thoracic and lumbar lesions, and the positive diagnostic value is high, which is consistence with general pathological tests.