CT引导下经皮胰腺穿刺活检和组织间植入治疗的径路及安全性

Feasibility and safety of CT-guided percutaneous needle biopsy and subsequent iodine-125 seed interstitial implantation for pancreatic cancer

目的 探讨CT引导下经皮胰腺穿刺活检和组织间植入治疗的径路及其安全性。方法临床资料较完整的35例cT引导下经皮胰腺穿刺活检患者，病变位于胰腺头部9例，体部20例，尾部6例。病变长径1．2—6cm，平均3．7cm。所用穿刺针直径16～21G，穿刺径路分别为前径路、左侧径路和后径路等。结果35例患者均行穿刺活检术，共用43针次完成穿刺操作。病理确诊为恶性肿瘤31例，炎症性病变2例，疑似肿瘤2例（1例最终确诊为恶性肿瘤，1例为假性胰腺囊肿），诊断准确率为94．3％。有14例患者再行胰腺肿瘤125I放射性粒子组织间植入治疗，共用65针次完成操作。35例患者108针次穿刺过程中，直接穿入肿块而不需要穿过重要器官者18例，穿过肝脏2例，穿过胃4例，穿过肠壁10例，穿过肠系膜血管1例。全组行穿刺活检35例43针次，其中胃、肠间隙出血1针次，发生率为2．3％（1／43）；而在行穿刺植入的14例65针次中，胃、肠间隙出血4针次，发生率为6．2％（4／65），两组并发症发生率差异无统计学意义（P=0．600）。采用16—18G活检针穿刺18例86针次，其中胃、肠间隙出血4针次，发生率为4．7％（4／86）；而20—22G活检针穿刺17例22针次，其中胃、肠间隙出血1针次，发生率为4．5％（1／22），两组差异无统计学意义（P=0．064）。结论CT引导下经皮胰腺病变穿刺活检或穿刺植入治疗胰腺肿瘤技术方法可行，且安全性可靠。

Objective To discuss the feasibility and safety of different approaches for CT-guided percutaneous needle biopsy and subsequent iodine-125 seed interstitial implantation for pancreatic cancer. Methods A retrospective study was carried out on the complete data of 35 patients with pancreatic cancer who have received CT-guided percutaneous needle biopsy with or without subsequent iodine-125 seed interstitial implantation. There were 9 lesions located in the head of pancreas, 20 located in the body, and 6 in the tail. The maximum diameter of the lesions varied from 12 mm to 60 mm （mean 37.1 mm）. The patients were treated with a needle in diameter of 16-21G. Operations were undertaken via anterior, posterior and lateral approaches. Results Thirty-five patients underwent 43 times of CT-guided percutaneous needle biopsies. Thirty-one cases were pathologically diagnosed as cancer, 2 cases inflammatory lesions, and 2 were suspected tumors （ one of which was finally diagnosed as cancer, while another was pancreatic pseudocyst）. The ratio of correct diagnosis was 94.3%. Fourteen patients were treated subsequently with CT-guided iodine-125 seed interstitial implantation therapy, with a total of 65 times of needle puncture. The operations were performed via direct approach to the tumor in 18 cases, transhepatic approach in 2 cases, transgastric approach in 4 cases, transintestinal approach in 10 cases, and through mesenteric vessels in one case. Incidence of complications in the biopsy group was 2.32% （1/43）, and in the implantation group was 6.15% （4/65）, with a statistically non-significant difference （P = 0. 600） between the two groups. Incidence of complications in the group using 16-18G needle was 4.65% （4/86）, while in the group using 20-21G needle was 4.55% （1/22）, also with a non-significant difference （P = 0.064）. The accuracy rate of needle biopsy in this study was 94.28% （33/35）. Conclusion CT-guided percutaneous needle biopsy and subsequent iodine-125 seed interstitial implantation are both feasible and safe for pancreatic cancer.