微创可视化下技术在经皮胸腰椎椎体病变穿刺活检中的临床应用

Clinical application of minimally invasive visualization percutaneous puncture biopsy for thoracic and lumbar vertebral lesion

目的 探讨椎间孔镜工作通道可视下穿刺活检在胸腰椎椎体病变的临床应用。方法 对2012年12月-2014年4月在该院行病变穿刺活检病理检查的28例胸腰椎椎体病变患者资料进行分析。患者年龄19~78岁,平均56.4岁;男16例,女12例。术前均行脊柱X线片、CT和MRI检查,为单椎体或者相邻椎间盘病变,提示椎体骨质不同程度破坏。其中,胸椎4例（T112例,L122例）,腰椎24例（L13例,L24例,L35例,L45例,L57例）,均在局麻下行C臂引导下辅助椎间孔镜成像系统穿刺活检术,工作通道下穿刺取出病变组织并病理检查。统计穿刺成功率,同时比较穿刺活检病理诊断与术后病理诊断的符合情况及并发症情况。结果 穿刺活检病理诊断恶性肿瘤13例,良性肿瘤3例,炎性病变11例,正常组织1例,穿刺活检病理诊断阳性率为96.4%。26例患者行手术治疗,穿刺活检病理诊断与术后病理诊断一致,诊断符合率为92.3%;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。1例穿刺活检病理诊断为炎性肉芽组织,术后病理诊断为骨的嗜酸性肉芽肿。胸11椎体活检术后患者出现肋间神经刺痛,随访未见肿瘤种植等并发症。结论 微创可视化下穿刺活检术在胸腰椎椎体病变穿刺活检中能够在可视下取得较为充足的标本量,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,是一种诊断和治疗为一体的微创技术。

[ Objectives ] To evaluate the clinical application of working channels of percutaneous puncture transforaminal endoscopic biopsy in the thoracic and lumbar vertebral lesions. [Methods] 28 cases （16 males and 12 females） with thoracic and lumbar vertebral lesions undergoing minimally invasive visualization percutaneous biopsy before operation between December 2012 and April 2014 were reviewed retrospectively. All cases had a mean age of 56.4 years（range, 19 to 78 years）, Each case underwent X-ray, CT scanning and MRI before operation, and all pre- sented with single level lesion or adjacent intervertebral disc disease in thoracic or lumbar spine with different de- grees of vertebral body defect. 4 cases had defect in thorac （2 in Tu, 2 in TIE）, and 24 cases had defect in lumbar（3 in L1, 4 in L2, 5 in L3, 5 in L4, 7 in Ls）. All cases underwent minimally invasive visualization percutaneous biopsy. And the pathological results after operation were compared with the preoperative biopsy. Data collection and statistical of the successful rate and complication of preoperative biopsy was analyzed. [ Results ] All cases were obtained confirmed pathologically, and 11 cases of malignancy, 2 cases of benign tumors, 8 cases of inflammatory lesion, 1 cases of normal tissue. Biopsy pathology diagnosis positive rate was 96.4%. 26 cases was performed surgical treat- ment, biopsy pathological diagnosis is consistent with the postoperative pathological diagnosis, the diagnosis coinci- dence rate was 92.3%. 1 normal tissue after biopsy was verified as non-specificity inflammation; 1 Inflammatory granulation tissue was verified as eosinophihc granuloma of bone. They did not have been operation. All cases was no complication except for 1 case of Tll vertebral biopsy after operation appeared intercostals nerve tingling. [Conclusions ] Minimally invasive visualization of biopsy in the thoracolurnbar vertebral body lesions biopsy can obtain more sufficient amount of specimen under visual, biopsy pathologic diagnosis positive rate and biopsy pathology diagnosis and postoperative pathological diagnosis coincidence rate is high, is a kind of diagnosis and treatment of minimally invasive techniques.