同轴套管针穿刺活检联合超声造影在肝脏占位性病变中的应用价值

Application value of coaxial needle biopsy combined with contrast-enhanced ultrasound for focal liver lesions

目的探讨超声引导下同轴套管针穿刺活检联合超声造影在肝脏占位性病变中的应用价值。方法回顾性分析2018年3月至2019年3月在中山大学附属第三医院采用超声引导下同轴套管针穿刺联合超声造影行肝脏肿物穿刺活检的165例患者临床资料。其中男109 例,女56例;平均年龄(56±11)岁;病灶直径(3.4±1.2)cm。患者均签署知情同意书,符合医学伦理学规定。采用超声引导下同轴套管针穿刺联合超声造影进行肝脏肿物定位穿刺活检。观察穿刺和取样情况、病理诊断、穿刺后并发症等指标。结果同轴套管针一次穿刺可多点、多次、多方向取样。穿刺成功率100%(165/165),平均取样次数为3~4次。病理结果确诊率为100%(165/165),其中肝细胞癌98例,胆管细胞癌12例,炎性假瘤3例,上皮源性肿瘤2例,结核2例,结节性肝硬化9例,转移瘤18例,海绵状血管瘤3例,肝腺瘤5例,炎症性改变5例,局灶性结节性增生6例,胆管错构瘤1例,透明血管型Castleman病1例。穿刺后并发症包括局部轻度疼痛,发生率33.9%(56/165);出血,发生率0.6%(1/165)。结论超声引导下同轴套管针穿刺联合超声造影进行肝脏肿物穿刺活检操作简单易行,能清晰显示穿刺目标,辨认病灶活性,且可一次穿刺,多点取材,穿刺成功率高,并发症发生率低,具有较高临床应用价值。

Objective To explore the application value of ultrasound-guided coaxial needle biopsy combined with contrast-enhanced ultrasound for focal liver lesions.Methods Clinical data of 165 patients with focal liver lesions who underwent percutaneous liver biopsy with ultrasound-guided coaxial needle and contrast-enhanced ultrasound from March 2018 to March 2019 at the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed.Among them,109 patients were male and 56 female,with a mean age of(56±11)years.The mean diameter of lesions was(3.4±1.2)cm.The informed consents of all patients were obtained and the local ethical committee approval was received.The liver lesions were localized and punctured with ultrasound-guided coaxial needle and contrast-enhanced ultrasound.The puncturing and sampling,pathologic diagnosis,and post-puncture complications were observed.Results Coaxial needle can get samples from multiple sites and directions for several times through a single attempt.The success rate for puncture was 100%(165/165)with an average of 3-4 times of sampling.The confirm diagnosis rate by pathological finding was 100%(165/165),including 98 cases of hepatocellular carcinoma,12 cholangiocellular carcinoma,3 inflammatory pseudotumor,2 epithelialderived tumor,2 tuberculosis,9 nodular cirrhosis,18 metastases,3 cavernous hemangioma,5 hepatic adenoma,5 inflammatory changes,6 focal nodular hyperplasia,1 cholangiocarcinoma and 1 hyaline vascular Castleman's disease.Post-puncture complications included mild local pain,with an incidence of 33.9%(56/165)and bleeding with an incidence of 0.6%(1/165).Conclusions Puncture biopsy of hepatic mass by ultrasound-guided coaxial cannula needle and contrast-enhanced ultrasoud is a simple and easy operation that provides clear manifestation of puncture target,clear observation of the activity of lesion.Samples can be extracted from multiple sites by single attempt with a high puncture success rate and low incidence of complications,which is of high clinical application value.