3D打印共面模板结合固定针技术在肺小结节经皮精准活检中的应用

Application of 3D-printed coplanar template combined with fixed needle technique in percutaneous accurate biopsy of small pulmonary nodules

背景:经皮肺穿刺活检是明确肺结节性质的重要方法和手段,但是由于呼吸运动的存在,肺脏的活动度较大,经皮肺活检尤其是针对肺小结节的活检存在一定难度。目的:介绍3D打印共面模板结合固定针技术在肺小结节经皮活检术中的应用。方法:选择徐州医科大学第二附属医院2018年7月至2019年4月经皮肺活检术患者24例,影像学检查均存在肺小结节,结节直径在8-30 mm之间,根据恶性肿瘤概率评估均为中-高危级,存在经皮肺活检的适应证。采用随机数字表法分为2组,对照组进行徒手穿刺活检,观察组进行3D打印共面坐标模板结合固定针引导穿刺活检,每组12例。统计两组患者术中穿刺针调整次数、CT扫描次数、标本阳性率、并发症发生率等情况。试验获徐州医科大学第二附属医院伦理委员会审批。结果与结论:①观察组术中活检针调整次数、CT扫描次数、气胸发生率明显低于对照组(P<0.05),两组标本取材阳性率与出血并发症比较差异无显著性意义(P>0.05);②结果表明,在肺小结节的经皮活检中应用3D打印共面坐标模板结合固定针技术,针对靶病灶起到相对固定作用,能减少术中调整进针次数和CT扫描次数,减少医源性辐射,降低并发症尤其是气胸的发生率。

BACKGROUND:Percutaneous lung biopsy is an important method to clarify the nature of lung nodules.However,the lungs are more active due to the presence of respiratory motion.Percutaneous lung biopsy,especially for small lung nodules,is difficult.OBJECTIVE:To introduce the application of 3D-printed coplanar template combined with fixed needle technique in percutaneous biopsy of small pulmonary nodules.METHODS:A total of 24 patients who had percutaneous lung biopsy in the Second Affiliated Hospital of Xuzhou Medical University from July 2018 to April 2019 were enrolled.Imaging examination indicated small pulmonary nodules with a nodule diameter of 8-30 mm in all the patients.According to the probability of malignancy,all tumors were of the middle and high risk grade,and there were indications for percutaneous lung biopsy.All the patients were randomized into two groups(n=12 per group):the control group underwent free hand biopsy,and the observation group underwent percutaneous lung biopsy guided by 3D printed coplanar template combined with fixed needle.The number of puncture needle adjustments,number of CT scans,positive rate of specimens,and incidence of complications were recorded and compared between the two groups.Approval for this trial was obtained from the Ethics Committee of the Second Affiliated Hospital of Xuzhou Medical University.RESULTS AND CONCLUSION:The number of puncture needle adjustments,the number of CT scans and the incidence of pneumothorax during the operation were significantly lower in the observation group than the control group(P<0.05),whereas there were no significant differences in the positive rate of specimens and incidence of bleeding complications between the two groups(P>0.05).These findings indicate that the 3D-printed coplanar template combined with fixed needle technique can relatively fix the target lesion,reduce the number of needle adjustments and number of CT scans,reduce iatrogenic radiation,and reduce the incidence of complications,especially pneumothorax.