全开放MR导航下经皮腹膜后肿块同轴穿刺活检的临床应用

Clinical application of full-open MRI-navigated percutaneous coaxial puncture biopsy of the retroperitoneal masses

目的探讨全开放MR导航系统辅助下经皮腹膜后肿块同轴穿刺活检术的效果和安全性。方法回顾性分析2014年1月-2018年12月81例MR导航下腹膜后肿块穿刺活检的病例。均采用磁兼容16 G活检套筒针穿刺,当套筒针尖到达目标穿刺区域时,采用同轴活检枪通过套筒针活检取材。穿刺活检成功的标准为取出完整的长条状组织。若活检失败调整穿刺套筒针,继续取材,直到取出完整的长条状组织。结果 81例穿刺均顺利完成,总体穿刺活检成功率100%(81/81),其中1次穿刺活检成功率91.4%(74/81)。穿刺诊断准确率为97.5%(79/81)。47例采取经皮腹侧入路穿刺,34例采取经皮背侧入路穿刺,6例经皮经肝入路穿刺,无经胃肠及肾穿刺病例。平均手术时间为(28.2±5.5) min。术后无腹腔活动性出血、腹膜后血肿及肠穿孔等不良事件发生,2例患者WTO疼痛分级Ⅱ级,予以止痛对症支持治疗后缓解。结论全开放MR导航下经皮腹膜后肿块穿刺活检术是一种精确而安全有效的诊断技术,且无辐射伤害,值得临床上推广。

Objective To evaluate the clinical effectiveness and safety of full-open MR-navigated percutaneous coaxial puncture biopsy of retroperitoneal masses. Methods The clinical data of 81 patients with retroperitoneal mass, who received full-open MR-navigated percutaneous coaxial puncture biopsy during the period from January 2014 to December 2018, were retrospectively analyzed. Magnetic compatible 16-gauge biopsy sleeve needle was adopted for puncturing. When the sleeve needle tip reached the target puncture area, coaxial biopsy gun was used to make biopsy sampling. The criterion for successful puncture biopsy was to obtain a long strip of tissue. If biopsy failed, the orientation of puncture sleeve needle was adjusted. The biopsy sampling was repeated until a complete long strip of tissue was obtained. Results Successful puncture biopsy was accomplished in all 81 patients, the overall success rate of puncture biopsy was 100%(81/81). The success rate with a single puncturing procedure was 91.4%(74/81). The diagnostic accuracy of puncture biopsy was 97.5%(79/81). Of the 81 patients, percutaneous puncture via ventral approach was adopted in 47, via dorsal approach in 34, and via transhepatic approach in 6. No puncture via transgastric approach or via transrenal approach was used. The mean time used for biopsy was(28.2±5.5) min.After biopsy, no adverse events such as active abdominal bleeding, retroperitoneal hematoma, or intestinal perforation occurred. Two patients developed pain of grade II of WTO criterion, which was relieved after analgesic and symptomatic treatment. Conclusion Full-open MR-navigated percutaneous coaxial puncture biopsy of retroperitoneal masses is an accurate, safe and effective diagnostic technique. It carries no radiation damage. Therefore, this technique is worthy of being popularized and used in clinical practice.