3D打印共面穿刺模板辅助CT引导下肺原发小微结节穿刺临床研究

Clinical application of 3D printing coplanar puncture template assisted CT guided percutaneous biopsy of primary lung small nodules

目的评价3D打印共面穿刺模板(3D-PCPT)辅助CT引导经皮穿刺活检术在肺原发小微结节诊断中的应用价值。方法对43例肺原发微小结节患者行经皮肺穿刺活检及诊断,评价3D-PCPT辅助CT引导下肺穿刺活检的穿刺成功率、恶性肿瘤诊断率及并发症发生率,并对与上述指标可能有关的因素进行相关性分析。结果43例患者均顺利完成穿刺操作。穿刺病灶直径为0.45~2.00 cm,中位直径为1.50 cm。35例患者采用1~2根定位针,8例患者未应用定位针;36例患者进行了1~2次活检,7例患者因取材不满意进行了3~4次活检。病理学诊断有1例患者无阳性结果,穿刺成功率为97.7%(42/43),恶性肿瘤诊断率为69.8%。并发症:针道出血发生率为62.8%(27/43),气胸发生率为30.2%(13/43),1例(2.3%)患者需胸腔闭式引流,2例(4.7%)患者出现术后咯血,所有并发症经对症处理后均康复。病灶直径与1次活检成功率、恶性肿瘤诊断率、针道出血发生率相关(P﹤0.05),病灶越小,1次活检成功率及恶性肿瘤诊断率越低,针道出血发生率越高。定位针与1次活检成功率相关,应用定位针者的1次活检成功率明显高于未应用定位针者(P=0.006)。结论 3D-PCPT辅助CT引导技术具有良好的临床应用可行性,有助于使穿刺技术流程标准化,值得进一步推广,有较好的临床应用前景。

Objective To evaluate the clinical application of three dimension printing coplanar puncture template（3 D-PCPT） in CT guided percutaneous biopsy of primary lung small nodules. Method A total of 43 patients with primary lung small nodules who underwent CT-guided percutaneous lung biopsy assisted by 3 D-PCPT were included in the study. The success rate, pathological result and complications of puncture, as well as the factors influencing these indexes were analyzed. Result All the 43 cases had completed biopsy successfully. Median nodule diameter was 1.5 cm（0.45-2.00 cm）. 35 cases were applied with positioning needle, while another 8 cases were not; 36 cases were biopsied 1-2 times, and 7 cases were biopsied 3-4 times due to substandard specimens. For pathology, only 1 case was observed with no positive results, the success rate of puncture was 97.7%（42/43）, and the diagnosis rate of malignant tumor was 69.8%.For complications, the incidence rate of puncture wound bleeding was 62.8%（27/43）, the incidence rate of pneumothorax was 30.2%（13/43）, and the thoracic drainage was needed in 1 case（2.3%）, hemoptysis occurred in 2 cases（4.7%）, all the complications were cured after symptomatic treatment. The diameter of nodule was related to the success rate of first biopsy,the diagnosis rate of malignant tumors, and the incidence of complications for puncturing. Smaller lesion is associated with lower success rate of first biopsy, lower diagnosis rate of malignant tumors, and higher incidence of puncture wound bleeding, besides, the success rate of first biopsy in those administered with positioning needle was significantly higher than those without（P=0.006）. Conclusion 3 D-PCPT assisted CT guided lung biopsy puncture is a clinically feasible technology which helps to standardize the puncture procedures, and it is clinically applicable and promising.