椎体骨质破坏行同轴穿刺活检298例分析  

Percutaneous Coaxial Transpedicular Biopsy of Vertebral Body Destructive Lesions: A Study of 298 Cases

作　　者：黄雨 何仕诚[2] 杜瑞杰[2] 虞文辉 朱海东[2] 方文[2] 郭金和[2] 邓钢[2] HUANG Yu;HE Shicheng;DU Ruijie(Department of Radiology,Zhongda Hospital,Southeast University,Nanjing 210009,P.R.China)

机构地区：[1]东南大学医学院医学影像系,南京210009 [2]东南大学附属中大医院介入与血管外科

出　　处：《临床放射学杂志》2018年第7期1196-1199,共4页Journal of Clinical Radiology

基　　金：国家自然科学基金项目(编号:81171434);江苏省临床医学科技专项(编号:BL2013029)

摘　　要：目的探讨经皮经椎弓根同轴活检术在椎体骨质破坏性病变诊断中的应用价值。方法搜集胸腰骶段椎体骨质破坏共298例356节,影像学均提示为脊椎转移癌,其中239例（279节）有脊椎外原发肿瘤切除史,59例（77节）无原发肿瘤史。骨质破坏类型包括溶骨性258例,混合性40例。均采用C臂DSA透视监视下经患侧椎弓根入路,当骨穿针头端抵达椎体破坏区边缘时置入活检针多方向、多次切取组织送病理检查。结果 356节椎体穿刺均获成功,无严重并发症发生。取出的组织量不足以行病理组织学诊断有32例（10.7%）,明确病理诊断266例（89.3%）,符合脊椎转移癌243例（91.4%）。有脊椎外原发肿瘤史239例,病理诊断包括转移癌208例（87.0%）,化脓感染1例,结核2例,余28例未获取明确病理诊断;无脊椎外原发肿瘤史59例,病理诊断包括转移癌35例（59.3%）,浆细胞瘤12例（20.3%）,侵袭性血管瘤2例（3.4%）,结核3例（5.1%）,化脓感染3例（5.1%）,余4例未获取明确病理诊断。溶骨性病变破坏的诊断阳性率为91.5%（236/258）,混合性破坏为75.0%（30/40）,差异有统计学意义（P〈0.05）。有脊柱外肿瘤病史的转移癌检出率为87.0%（208/239）,无肿瘤病史检出率为59.3%（35/59）,差异有统计学意义（P〈0.05）。结论经皮椎弓根入路行椎体同轴活检操作方法简单、安全,对于溶骨型椎体骨破坏的病理检出率更高。Objective To evaluate the clinical value of percutaneous coaxial transpedicular biopsy in the diagnosis of destructive lesions of vertebral body. Methods 298 patients who had undergone percutaneous coaxial transpedicular biopsy for 356 vertebral body destructive lesions on CT/MRI were evaluated from March,2008 to November,2016 in our institution. Among them,239 patients（ 279 lesions） had a history of a tumor beyond the spine,while 59 patients（ 77 lesions）had no history of a tumor. There were 258 patients with osteolytic destruction and 40 patients with mixed. All procedures were performed under C-arm flouroscopy guidance. Transpedicular approach was adopted in the thoracic,lumbar and sacral vertebrae. When the tip of the trocar was placed in the edge of the destructive lesions in the vertebral body,the biopsy needle was introduced coaxially through the trocar,and core biopsy samples were extracted under differently directive incisions.These samples were sent to have a pathologic examination. Results All procedures of coaxial transpedicular biopsy of vertebral body destructive lesions were successful. No complications were observed. There were 32 patients（ 10. 7%） in which the tissue volume removed was insufficient to conduct histopathological diagnosis,266 patients（ 89. 3%） with a clear pathological diagnosis and 243 patients（ 91. 4%） with metastasis. Among 239 patients with tumor history,the pathologic evaluations were definitive in 208 patients with metastasis（ 87. 0%）,1 patient with suppurative infection,2 patients with tuberculosis and the remaining 28 patients with no diagnosis. Among 59 patients with no history of a tumor,the pathologic evaluations were definitive in 35 patients with metastasis（ 59. 3%）,12 patients with plasmacytoma（ 20. 3%）,2 patients with aggressive hemangioma（ 3. 4%）,3 patients with tuberculosis（ 5. 1%）,3 patients（ 5. 1%） with suppurative infection and the remaining 4 patients with no diagnosis. The positive diagnosis rate of osteolytic and mix

关 键 词：椎体 经椎弓根活检 病理学 转移瘤 

分 类 号：R730.44[医药卫生—肿瘤] R738[医药卫生—临床医学]