锥形束CT引导同轴穿刺在胸部肿瘤活检中的应用

Application of cone-beam CT-guided coaxial needle puncture biopsy in diagnosing thoracic neoplasms

目的探讨锥形束CT的穿刺导航功能在胸部肿瘤活检中的应用价值。方法2019年7月至12月四川省肿瘤医院行胸部肿瘤穿刺活检术(percutaneous transthoracic needle biopsy,PTNB)患者139例。比较锥形束CT的穿刺导航功能引导同轴针穿刺针与常规CT引导非同轴穿刺针在PTNB中的有效性和安全性,分析不同引导穿刺方式与病灶大小、病灶深度和手术耗时之间关系。结果常规CT组平均耗时19.08 min,锥形束CT组平均耗时14.36 min,差异有统计学意义(t=-6.034,P<0.05)。活检时患者俯卧位平均耗时15.75 min,仰卧位平均耗时16.94 min,侧卧位平均耗时18.22 min,特殊体位平均耗时20.84 min,差异无统计学意义(P>0.05)。病灶位于不同肺段穿刺耗时比较,差异无统计学意义(P>0.05)。两组患者病灶大小、病灶深度和病灶位置比较,差异均无统计学意义(t=-1.621、-0.402、χ^(2)=24.222,P=0.107、0.687、0.114)。穿刺次数与并发症的发生率相关。结论锥形束CT引导联合同轴穿刺技术,可缩短操作时间,减少并发症,降低患者受照剂量,减少医疗费用,对于老年、配合度较差或病灶较小的患者具有明显的优势。

Objective To discuss the clinical application of cone-beam CT-guided navigation technique in coaxial needle puncture biopsy for diagnosing thoracic tumors.Methods The clinical data of 139 patients with thoracic tumors,who underwent percutaneous transthoracic needle biopsy(PTNB)at the Sichuan Provincial Cancer Hospital of China,were retrospectively analyzed.The effectiveness and safety in diagnosing thoracic tumors were compared between cone-beam CT-guided coaxial needle puncture biopsy and conventional CT-guided non-coaxial needle puncture biopsy.The relationships between the different puncture-guiding methods and the lesion size,lesion depth,surgical consuming time were analyzed.Results The average surgical consuming time in conventional CT guidance group and cone-beam CT group were 19.08 min and 14.36 min respectively,the difference between the two groups was statistically significant(t=-6.034,P<0.05).During biopsy,the average surgical consuming time was 15.75 min when the patient was in a prone position,which was 16.94 min when the patient was in a supine position,18.22 min when the patient was in a lateral position,and 20.84 min when the patient was in a special position;the differences between each other position were not statistically significant significant(P>0.05).There was no significant difference in surgical consuming time between the lesions located at different lung segments(P>0.05).No statistically significant differences in the lesion size,lesion depth,and lesion location existed between the two groups(t=-1.621,t=-0.402,χ^(2)=24.222;P=0.107,P=0.687,P=0.114,respectively).he number of punctures was highly correlated with the incidence of complications.Conclusion In coaxial needle puncture biopsy for diag nosing thoracic tumors,the use of cone-beam CT-guided navigation technique can shorten the operation time,reduce the complications,reduce the exposure dose of patients,and reduce the medical costs,which is more suitable for older patients with a poor coordination degree or with smaller lesions.(J Intervent Radiol,2022,31:979-981)