影像引导胸椎病变经皮同轴穿刺活检的穿刺途径选择

The Choice of Puncture Approach for Image Guided Percutaneous Coaxial Biopsy in Diagnosing Thoracic Vertebral Lesion

目的探讨胸椎病变经皮穿刺活检的穿刺途径选择,评估影像引导下胸椎病变穿刺活检的临床应用价值。方法在透视或CT引导下对34例患者的胸椎病变行经皮同轴穿刺活检。其中19例于透视引导下接受19次经皮穿刺活检,另15例于CT引导下接受17次穿刺活检。结果 34例共接受36次胸椎病变穿刺活检,其中2例各接受两次穿刺活检。采用经椎弓根途径穿刺22次,采用经肋椎关节途径穿刺10次,采用经肋间隙途径穿刺4次。影像证实36次活检穿刺针均位于病灶内,穿刺成功率100%。其中31次活检病理结果与临床最终诊断一致,无假阳性结果发生,穿刺活检最终诊断成功率86.1%。所有病例无穿刺相关的严重并发症发生。结论影像引导胸椎病变同轴穿刺活检是一种安全、准确、微创的介入诊断技术,选择合适的穿刺途径有助于提高穿刺及诊断的成功率。

Objective To explore the puncture approach and to evaluate the clinical value of percutaneous coaxial biop- sy in the diagnosis of thoracic vertebral lesion. Methods X-ray fluoroscopy or CT guided pereutaneous coaxial biopsies were performed in 34 patients with thoracic vertebral lesions ,including 19 procedures performed in 19 patients under X-ray fluoroscopy guidance, 17 procedures performed in 15 patients under CT guidance. Results A total of 36 percutaneous coxial biopsies were performed in 34 patients with thoracic vertebral lesions. Two patients received twice punctures respec- tively. 22 biopsies were performed through the transpedicular approach, 10 biopsies were performed through the transcosto- vertebal approach, 4 biopsies were performed through the transiatercostal approach. The puncture biopsy needle was placed into the spinal lesions, which was conformed by CT scan or X-ray fluoroscopy, with the success rate of puncture was 100%. The pathological results of 31 biopsies were completely in agreement with the final clinicaldiagnoses, with a diag- nostic success rate of 86.1% , no false positive case was found in this group. No serious puncture related complications oc- curred. Conclusion Image guided pereutaneous coaxial biopsy is a safe, accurate and minimally invasive interventional technique for the diagnosis of thoracic vertebral lesions. Selecting appropriate puncture approach may improve the success rate of puncture and the diagnosis.