立体定向脑内病灶活检的临床意义  

Clinical experience of stereotactic biopsy for the brain lesions

作　　者：田增民[1] 王亚明[1] 于新[1] 赵全军[1] 惠瑞[1] 刘锐[1] 李志超[1] 

机构地区：[1]海军总医院神经外科,北京100048

出　　处：《中华外科杂志》2010年第19期1459-1462,共4页Chinese Journal of Surgery

基　　金：国家高技术研究发展（863）计划资助项目（2007AA04Z246）

摘　　要：目的 探讨先进图像引导立体定向脑组织活检术方法 ,明确其在神经系统疾病诊断中的意义.方法 回顾性分析1987年12月至2009年1月立体定向脑内病灶活检的1187例病历资料,其中男性694例（58.5%）,女性493例（41.5%）;年龄1～85岁（平均39.7岁）.CT（含正电子发射断层扫描）引导活检607例,MRI（含氢质子磁共振波谱成像）引导活检580例;采用常规框架立体定向活检手术726例,采用无框架立体定向机器人活检手术461例（含定向引导神经内镜活检）.早期450例立体定向手术定位,采用CT或MRI图像测量靶点坐标方法 ,不能立体显示穿刺途径;后期737例立体定向手术定位,采用计算机三维重建病灶方法 ,能够立体显示穿刺路径.结果 活检明确组织病理学诊断1156例（活检阳性诊断率97.4%）.本组中983例（82.8%）获得肿瘤学病理诊断,主要包括神经胶质瘤、转移性肿瘤、原发性淋巴瘤、生殖细胞瘤等;173例（14.6%）为非肿瘤性病变,其中包括多发硬化和瘤样脱髓鞘病变、神经变性疾病、炎性病变、寄生虫病等.活检穿刺手术并发少量血肿（〈10 ml）而无神经功能障碍20例（1.7%）,较大血肿（〉10ml）需要外科处理（置管引流或开颅血肿清除）9例（0.8%）;活检出血导致死亡3例（0.3%）.本组无颅内感染病例.结论 先进影像技术引导的立体定向脑组织活检术是一种微侵袭、可靠的脑内疾病确定诊断手段.生化成像、功能成像技术的发展,为立体定向引导的活检技术赋予了崭新的内容.Objectives To investigate the methodology of diversified advanced image-guided stereotactic biopsy for the brain lesions, and its diagnostic significance and experience in nervous system diseases. Methods Retrospectively reviewed 1187 cases of brain lesions underwent image-guided stereotactic biopsy from December 1987 to January 2009. There were 694 male （58.5% ）and 493 female （41.5%）patients, aged from 1 to 85 years （average 39.7 years）. There were 607 cases in CT-guided,including positron emission computed tomography （PET）guided stereotactic biopsy; 580 cases in MRI-guided, including proton magnetic resonance spetroscopy （1H-MRS）guided stereotactic biopsy. Routine frame was used in 726 cases and frameless stereotactic biopsy in 461 cases, including neuroendoscopic biopsy in 28 cases, guided by computer assisted surgery （CAS）computer-assistant robot. In the early 450 cases,CT/MRI images films were employed to measure the coordinates of the target by hand, while in the late 737 cases, computer-assistant planning software rebuilded the CT/MRI images and figured out the optimal neurosurgical path for biopsy. Results The positive diagnosis rate of biopsy was 97.4% , 983 （82. 8% ）cases were diagnosed pathologically as brain tumors, and 173 （14. 6% ）cases as non-tumor diseases. The tumors mainly including neuroglioma, metastatic tumor, primary central nervous system lymphoma and germ cell tumors. In non-tumor diseases, mainly including multiple sclerosis, tumefactive demyelinating lesion,neurodegenerative disease, inflammation and parasite. The biopsy operation caused small hematoma without neurological deficits in 20 cases（1.7%）,and caused large hematoma （〉 10 ml）which need neurosurgical treatment （catherization or craniotomy evacuation of hematoma）in 9 cases （0. 8% ）. Hemorrhage associated with biopsy caused 3 cases（0.3% ）death. There were no severe intracranial infection cases. Conclusions The stereotactic biopsy with advanced image-guided technique represents a

关 键 词：脑疾病 活组织检查 针吸 立体定向外科 

分 类 号：R686[医药卫生—骨科学]