CT引导下肺部 纵隔 胸膜肿块经皮穿刺活检术的临床研究  

The clinical application of CT guided the lungs,mediastinum,pleura mass percutaneous biopsy

作　　者：沈世田[1] 杨亚芳[1] 刘剑[1] 史永平[1] 朱成红[1] 殷福花[1] 万谦[1] 

机构地区：[1]南京医科大学第二附属医院,210011

出　　处：《实用医技杂志》2012年第10期1025-1027,共3页Journal of Practical Medical Techniques

摘　　要：目的探讨CT引导下肺部、纵隔、胸膜肿块经皮肺穿刺活检术的临床应用及并发症的分析、预防与处理。方法以18 G的切割针或抽吸针,选择最佳层面、进针点及进针角度和深度,行多点取材,对我院2008年9月至2012年2月100例肺部、纵隔、胸膜性质难定的肿块行CT引导下经皮穿刺活检术,计算其阳性率,分析并发症的种类、主要并发症发生的影响因素,以及并发症的预防和处理措施。结果100例均穿刺成功,活检阳性率100%,与临床及影像学符合率100%,其中恶性肿瘤78例,良性病变22例,并发症主要为气胸13例,肺出血10例,除l例气胸较多外,其余均为少量。仅3例出现咯血症状,有并发症的病例行抗炎、止血处理后自行恢复,1例中等量气胸患者吸氧后恢复,未见后遗症。气胸的发生与病灶大小、部位、深度、穿刺次数以及患者的配合关系密切,出血与病灶大小、血供多少及术前是否增强有关。结论CT引导下经皮穿刺活检术对于性质不明的肿块的定性具有很高的应用价值,而且在准确性、安全性方面具有很大的优势,是一种有效的获得病理组织的方法。穿刺活检术的并发症,应以预防为主,而预防的关键在于术前准确的定位和对血管的评估,以及术中熟练的操作。Objective To explore the clinical application of CT guided the lungs, mediastinum, pleura mass percutaneous lung biopsy and analysis of complications, prevention and treatment. Methods One hundred cases of CT guided the lungs, mediastinum, pleura mass percutaneous biopsy, selected from september 2008 to February 2012 in our hospital, were taken by the 18 G cutting needle or needle aspiration with the best level, the point, angle and depth of puncture to calculate the positive rate and analyze the type, affecting factors, prevention and the treatment measures of complications. Results 100 cases were successfully punctured, biopsy of the positive rate was 96%, of which 78 cases of malignant tumor, benign lesions in ：22 cases, the major complications of 13 cases of pneumothorax, pulmonary hemorrhage in 10 cases, except for 1 ease with pneumothorax more outside, the rest are small. Pulmonary hemorrhage in 14 cases, but only appeared in 4 cases of hemoptysis symptoms, complications of a anti-inflammatory, hemostatic treatment after its restoration, a case of moderate pneumothorax treated with oxygen after recovery, no sequelae. The occurrence of pneumothorax was erlationhip with lesion size, location, depth, number of puncture and patients relationship with close, hemorrhage was relationship with lesion size, blood supply and how the preoperative is related to enhanced. Conclusion CT guided percutaneous needle biopsy for properties of unknown mass qualitative has very high application value, but also in the accuracy, security has great advantages, which is an effective method to obtain pathological tissue. Biopsy complication, should give priority to prevention, and prevention is the key to accurate localization before operation and on the vascular assessment, as well as skilled operation.

关 键 词：肺 纵隔 胸膜 活组织检查 吸针 体层摄影术 螺旋计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学]