脊柱肿瘤术前穿刺活检的价值

Value of CT-guided percutaneous biopsy before operation in the treatment of spinal tumors

目的 :探讨脊柱肿瘤术前采用CT监测下经皮穿刺活检获得病理诊断的方法 ,评价其在脊柱肿瘤诊疗中的作用。方法 :对脊柱破坏初诊为脊柱肿瘤的患者采用CT监测下经皮穿刺活检的方法获得病理诊断 ,并与其他的诊断方法相比较 ,结合影像学资料和临床制定综合的治疗方案。结果 :2 92例初诊为脊柱肿瘤的患者包括颈椎 136例 (寰枢椎 34例 )、胸椎 76例、腰椎 6 8例、骶椎 12例 ,经穿刺诊为结核 4 3例 ,转移瘤 93例 ,脊柱原发恶性肿瘤 5 9例 ,脊柱良性肿瘤 4 8例 ,肿瘤样病变 16例 ,化脓性感染 8例 ,骨质疏松病理骨折后骨修复改变 8例 ,Paget病 3例 ,其他 14例。活检阳性率 95 .2 1% ,手术 114例 ,手术后病理证实活检符合率 95 .6 1%。平均随访 37.7个月 ,活检的准确率为 92 .81% (2 71/ 2 92 )。无并发症发生。结论 :CT监测下经皮穿刺活检是脊柱肿瘤术前明确诊断的最有效方法 ,安全、准确率高、费用低 ,对制定脊柱肿瘤的综合治疗方案起重要的作用。

Objective:To make a definite pathologic diagnosis of spine lesions by the use of CT guided percutaneous biopsy before operation,and evaluate the effects of this method. Methods: 292 cases of spine lesions whose preliminary diagnoses were spinal tumors including 179 males and 113 females ranging in age from 2-83 years underwent CT guided percutaneous biopsy before operation. The procedure was compared with other diagnostic methods. By combining pathologic diagnosis with films data and clinical characters, the comprehensive treatment programs were formulated Results:271 of 292 cases had definite histological findings. The accuracy rate was 92.81% and the false positive rate 1.71%. 114 cases were treated operatively and their final pathological findings were 95.61% of what preoperative biopsy showed. 271 cases were considered accurate on 37.7 months follow up,15 cases were unavailable at follow up. No complications occurred. Conclusion:The diagnosis and treatment of spinal tumors are usually difficult,however,definitive histological diagnosis can be obtained through CT guided percutaneous biopsy. This procedure plays an important role in clinical treatment.