自主研发的三维激光引导装置在经皮肺小结节穿刺中的应用

Application of Self-developed 3D Laser Guidance Device in Percutaneous Puncture of Pulmonary Nodules

目的探讨自主研发的三维激光引导装置在CT定位下经皮肺小结节穿刺活检术中的应用价值。方法三维激光引导装置由不锈钢的双弓形支架、激光角度仪、滑块和引导支架组成。激光角度仪和引导支架固定在滑块上,激光角度仪可旋转,变换角度(与水平之间的角度),并在前端投射出相应角度的十字激光,即十字激光焦点的光线与地面之间的角度等于角度仪上显示的角度。采用配对对比研究,将2018年1~12月70例肺小结节分为观察组(三维激光引导下穿刺)和对照组(常规手法穿刺)。比较2组一次穿刺达预定位置率、穿刺过程中CT扫描次数、穿刺操作时间和并发症发生率。结果与对照组相比,观察组一次穿刺达预定位置率高[94.3%(33/35)vs.45.7%(16/35),χ^2=19.660,P=0.000],穿刺过程中CT扫描次数少[(3.1±0.2)次vs.(4.1±1.3)次,t=-4.731,P=0.000],穿刺操作时间短[(19.9±4.1)min vs.(28.3±9.8)min,t=-4.684,P=0.000],并发症发生率低但无统计学意义[8.6%(3/35)vs.22.9%(8/35),χ^2=2.696,P=0.101]。观察组中,肺结节≥1 cm的病例,一次穿刺达预定位置率为100%(28/28);肺结节<1 cm的病例,一次穿刺达预定位置率为71.4%(5/7)。结论采用此三维激光引导装置,可用激光束准确引导,提高肺穿刺的准确性,减少并发症,缩短操作时间,且制作成本低,适宜在临床上推广。

Objective To explore the application value of self-developed 3D laser guidance device in CT guided percutaneous puncture biopsy of pulmonary nodules.Methods The 3D laser guidance device was composed of a stainless steel double arch bracket,a laser goniometer,a slider and a guide bracket.The laser goniometer and guide bracket were fixed on the slider.The laser goniometer can rotate or change the angle(the angle between the laser and the horizontal),and project the cross laser at the corresponding angle at the front end.The angle between the ray of cross laser focus and the ground was equal to the angle shown on the goniometer.A total of 70 cases of pulmonary nodules from January to December 2018 were divided into observation group(3D laser-guided puncture)or control group(conventional puncture)by paired method.The rate of achieving the predetermined position,the number of CT scans during the puncture process,the puncture operation time and the incidence of complications were compared between the two groups.Results As compared with the control group,the observation group had higher rate of achieving the predetermined position on one session[94.3%(33/35)vs.45.7%(16/35),χ^2=19.660,P=0.000],fewer CT scans[(3.1±0.2)vs.(4.1±1.3)times,t=-4.731,P=0.000],shorter puncture operation time[(19.9±4.1)min vs.(28.3±9.8)min,t=-4.684,P=0.000],and lower incidence of complications[8.6%(3/35)vs.22.9%(8/35),χ^2=2.696,P=0.101].For cases with pulmonary nodules≥1 cm in the observation group,the rate of achieving the predetermined position was 100%(28/28).For cases of pulmonary nodules<1 cm,the rate of achieving the predetermined position was 71.4%(5/7).Conclusions With the 3D laser guiding device,the performance can be accurately guided by the laser beam to improve the accuracy of lung puncture,reduce complications and shorten the operation time.Its low cost is suitable for clinical application.