改良退针芯法在BARD活检针经皮活检肩胛骨区肺小结节的应用

Application of BARD Gun with Improved Recede Needle Method in Percutaneous Transthoracic Biopsy of Pulmonary Nodules under the Shoulder Blade Area

【目的】探讨应用BARD活检针改良退针芯法经皮活检肩胛骨区肺小结节(直径≤20 mm)的临床价值。【方法】回顾性分析2011年1月至2015年5月共83例肩胛骨区肺内单发小结节(直径≤20 mm)患者,按时间分为传统组31例(2012-05之前),采用传统退针法获取标本,改良组52例(2012年5月-2015年5月),采用改良退针芯法获取标本,所有病例均在CT引导下利用体表标记定位法进行定位,穿刺均由固定医师操作,应用18G BARD活检针取得2条以上组织标本送病检行HE染色、免疫组化检查,部分病例行基因检测,分别统计两组病人手术时间、穿刺成功率、诊断阳性率和并发症发生率。【结果】83例肩胛骨区肺小结节穿刺活检结果:传统组手术时间(63.6±7.6)min,穿刺成功率90.3%(28/31),诊断阳性率87.1%(27/31),并发症率22.6%(7/31);改良组手术时间(30.7±4.5)min,穿刺成功率98.1%(51/52),诊断阳性率96.2%(50/52),并发症率3.8%(2/52)。两组间手术时间和并发症率差异有统计学意义(P<0.05)。【结论】利用BARD活检针改良退针芯法经皮活检肩胛骨区肺小结节(直径≤20 mm)可以精确的获取组织标本,与传统方法相比节省手术时间,并发症减少,值得临床进一步推广应用。

[ Objective ] To investigate the value of BARD gun with improved needle method in percutaneous transthoracic biopsy of pulmonary nodules （d ≤ 20 mm） under the shoulder blade area. [ Methods ] 83 patients with solitary pulmonary nodules （d≤20 mm） from January 2011 to May 2015 in Guangdong No.2 provincial People＇s Hospital wererecruited. The BARD gun with traditional recede needle method was implemented in 31 patients in traditional group, BARD gun with improved recede needle method was performed in52 patients in improved group.With 18 G BARD biopsy gun, 2 or more tissue specimens were acquired for HE staining and immunohistochemical examination, some for further genetic testing.The statistics of two groups, including operation time, the success rate, the rate of positive diagnosis andcomplications, were recorded and analyzed. [ Result ] In the control group, the average operational duration was （63.6±7.6） rain, the success rate of puncture 90.3 % （28/31 ）, the positive diagnostic rate was 87.1% （ 27/ 31 ）, the incidences of complications was 22.6%（7/31 ）, in the experiment group, the average operational duration was （30.7 ± 4.5） min, the success rate of puncturewas 98.1% （51/52）. The positivediagnostic rate was 96.2% （50/52）. The incidences of complications was 3.8%（2/52）.The differences in duration and rates had statistical significance（P〈 0.05）. [Conclusion] BARD gun with improved needle method have accuracy, less operational duration and less complications in percutaneous transthoracie biopsy of pulmonary nodules under the shoulder blade area,and it deserves to be further spread in the clinic.