一项新型封闭穿刺技术应用于骨肿瘤穿刺活检中的价值

A new type of closed puncture technique for biopsy of bone tumors

目的探讨一种新的封闭穿刺活检技术在诊断骨肿瘤中的应用价值。方法建立兔VX2骨肿瘤动物模型,随机分为新型穿刺技术组(VX2实验组,18只实验兔)与传统穿刺技术组(VX2对照组,18只实验兔),实验组18只采用新型穿刺装置进行肿瘤部位的穿刺检查,穿刺后及时封堵穿刺留下的骨孔;对照组采用传统穿刺活检装置,穿刺后不封堵骨孔,仅行按压止血。采用B超检测穿刺后穿刺孔血肿形成情况,实时荧光定量PCR技术检测穿刺通道及周围组织中癌基因血管内皮生长因子(VEGF)基因的表达,并对穿刺通道及周围组织行病理学检查,进而评估与比较两组穿刺技术引起的肿瘤细胞通道扩散情况。结果穿刺2h后,B超显示实验组新型封闭栓均未脱落,其中2只(11.1%)穿刺孔少量出血,形成微小血肿,其余16只穿刺孔周围无明显液体渗出;对照组15只(83.3%)穿刺孔有明显出血形成血肿,与实验组穿刺孔出血率比较差异有统计学意义(P<0.05)。VX2实验组穿刺通道及周围组织中见VEGF基因表达量明显低于对照组,两组穿刺通道及周围组织VEGF基因表达比较差异有统计学意义(P<0.05),病理学检查VX2实验组穿刺针道软组织中2只发现肿瘤细胞,VX2对照组穿刺针道及周围组织中13只发现肿瘤细胞,两组穿刺通道肿瘤细胞扩散率比较差异有统计学意义(P<0.05)。结论该新型封闭穿刺技术安全,容易操作,可有效降低肿瘤穿刺后肿瘤细胞针道扩散,可应用于临床骨肿瘤的诊断。

Objective To explore and discuss the value of a new closed puncture biopsy technique in the diagnosis of bone tumors. Methods To establish a VX2 rabbit bone tumor model,which was randomly divided into the new puncture technique group（ VX2 experimental group） and the traditional puncture technique group（ VX2 control group）. In the experimental group,the new puncture device was used to check the tumor location and the bone hole was plugged after the puncture. In the control group,the traditional biopsy device was used,and the bone hole was not plugged after the puncture,just only apply the pressure to stop the bleeding. B-ultrasonography was used to detect the formation of hematoma of the puncture hole after the puncture. The real-time fluorescence quantitative detection PCR（ q PCR） was used to detect the expression of oncogene vascular endothelial growth factor gene（ VEGF） in needle-path tissue,and the pathological examination was performed for the needle-path tissue. Then the tumor cell path proliferation of two groups were evaluated and compared. Results The color ultrasonography showed no shedding in the new closed plug of the experimental group after 2 hours of puncture,in which 2 cases（ 11. 1%） occurred mild bleeding from puncture holes and formed micro hematoma and other 16 cases showed no obvious liquid exudation around the puncture holes. In the control group,the results showed that 15 cases（ 83. 3%） had obvious bleeding from puncture holes that formed hematoma,while the remaining 3 cases showed no obvious bleeding. There were significant statistical differences in the puncture hole bleeding rates between two groups（ P〈0. 05）. The expression of VEGF gene in the needle-path soft tissue of the experimental group was significantly lower than that of the control group（ P〈0. 05）. The pathological examination showed that 2 cases of tumor cells were found in the needle-path tissue of VX2 experimental group while13 cases of that in the needle-path tissue of VX2 control group（ P〈0. 05）. There were significant statistical differences in the tumor cells proliferation rate between the two groups（ P〈0. 05）. Conclusion The new closed puncture technique is safe and easy to operate,which can effectively reduce the tumor cells proliferation in the needle-path after tumor puncture and can be applied to the diagnosis of clinical bone tumors.