直肠双平面超声引导下经会阴穿刺活检诊断女性盆腔占位性病变

Biplane transrectal ultrasonography-guided transperineal biopsy for diagnosing women pelvic space-occupying lesions

目的观察直肠双平面超声引导下经会阴穿刺活检诊断女性盆腔占位性病变的安全性及可行性。方法回顾性分析14例接受直肠双平面超声引导下经会阴穿刺活检的女性盆腔占位患者,记录盆腔占位分布位置、无法经腹及经阴道穿刺活检原因、穿刺操作时长、并发症及活检病理诊断。结果14例盆腔占位中,4例位于直肠、3例位于单侧或双侧卵巢、5例位于宫颈或子宫下段、1例位于阴道侧壁、1例位于膀胱后方;因阴道严重出血、真菌感染,阴道畸形、水肿或阴道切除术后,以及病变位置深在、损伤肠管风险高等原因而未能实施经腹或经阴道穿刺活检。14例直肠双平面超声引导下经会阴穿刺活检操作时长(29.50±6.05)min;操作过程中1例发生针道出血、1例出现迷走神经反射症状,之后随访6个月,未见其他相关并发症。穿刺活检病理诊断鳞状细胞癌5例、高级别浆液性癌2例,恶性黑色素瘤、低级别浆液性癌、腺癌及梭形细胞肿瘤各1例,以及慢性炎症3例,均与术后病理或随访结果相符。结论直肠双平面超声引导下经会阴穿刺活检诊断女性盆腔占位性病变安全、可行。

Objective To observe the safety and the feasibility of biplane transrectal ultrasonography-guided transperineal biopsy for diagnosing women pelvic space-occupying lesions.Methods Data of 14 female patients with pelvic space-occupying lesions who underwent biplane transrectal ultrasonography-guided transperineal biopsy were retrospectively analyzed.The location of pelvic space-occupying lesions,the causes for not performing biopsy transabdominally nor transvaginally,the time consuming and complications of biplane transrectal ultrasonography-guided transperineal biopsy as well as pathological results were collected.Results Among 14 cases,there were 4 cases of rectum mass,3 cases of unilateral or bilateral ovaries masses,5 cases of cervix or lower uterus mass,1 case of mass at the lateral wall of the vagina and 1 case of mass at the posterior part of the bladder.Since vagina abnormalities including severe bleeding,fungal infections,deformities,edema or after vaginal resection,or deep location of lesions and high risk of intestinal tubes injuries,transabdominal or transvaginal puncturing and biopsy were not performed.The time consuming of puncturing and biopsy were(29.50±6.05)min.During the procedures,bleeding in the puncturing tract and vagal reflex occurred each in 1 case,while no obvious complication was observed during 6-month follow-up.Biopsy pathology reported 5 cases of squamous cell carcinoma,2 cases of high grade serous carcinoma,1 case of malignant melanoma,1 case of low grade serous carcinoma,1 case of adenocarcinoma and 1 case of spindle cell tumor,as well as 3 cases of chronic inflammation,all were consistent to post operation pathology or follow-up results.Conclusion Biplane transrectal ultrasonography-guided transperineal biopsy was safe and feasible for diagnosing women pelvic space-occupying lesions.