CT引导下肺门及纵膈肿块穿刺活检100例分析  

CT guided biopsy of hilar and mediastinal masses:analysis of 100 cases

作　　者：张有智 郝显华 赵空军 聂良良 张英龙 董都选 张春峰 朱永平 Zhang Youzhi;Hao Xianhua;Zhao Kongjun;Nie Liangliang;Zhang Yinglong;Dong Duxuan;Zhang Chunfeng;Zhu Yongping(Department of Radiology,Baoji High Tech People's Hospital,Baoji,Shaanxi,721013,China)

机构地区：[1]宝鸡高新人民医院放射科,陕西宝鸡721013

出　　处：《当代医学》2020年第36期7-11,共5页Contemporary Medicine

基　　金：宝鸡市科学技术局社会发展攻关课题(16SFGG3-18)。

摘　　要：目的总结CT引导下肺门及纵膈肿块穿刺活检,特别是老年人的穿刺技巧。方法回顾性分析2012年5月至2020年1月取材成功并有完整资料的100例CT穿刺活检患者,全部使用半自动活检枪(18G)进行穿刺。参考CT平扫片及增强片,采用改良的体表标志定位法,薄层CT扫描确认针芯穿入病灶,必要时行MPR重建,调整到位后行活检术。结果肺鳞癌23例,小细胞癌23例,肺腺癌18例,胸腺瘤6例,胸腺癌1例,淋巴瘤2例,神经内分泌癌2例,转移癌2例,纵膈囊肿2例,黏液腺癌1例,间皮瘤1例,慢性肺炎6例,肺结核6例,淋巴结炎2例,结节病1例,肿瘤不能分类1例,甲状腺肿1例,胶原成分不能诊断1例,穿刺失败1例。并发症:咯血16例(16.0%),气胸8例(8.0%),心包积血1例(1.0%);所有并发症患者经保守治疗后好转。结论CT引导下肺门及纵膈肿块穿刺活检成功率为98.0%,肺门恶性肿瘤占83.3%(50/60),纵膈恶性肿瘤占75.0%(30/40),并未显著增加气胸和出血等并发症,值得推广应用。Objective To summarize CT-guided aspiration biopsy of hilar and mediastinal masses,especially the puncture skills of the elderly.Methods Analyze 100 cases with successful materials and complete data from May 2012 to January 2020.All were punctured with a semi-automatic biopsy gun(18G).With reference to plain CT scans and enhancement films,a modified body surface landmark positioning method was used.Thinlayer CT scans confirmed that the needle core penetrated into the lesion.If necessary,MPR reconstruction was performed,and biopsy was performed after adjustment.Results 23 cases of lung squamous cell carcinoma,23 cases of small cell carcinoma,18 cases of lung adenocarcinoma,6 cases of thymoma,1 case of thymic carcinoma,2 cases of lymphoma,2 cases of neuroendocrine carcinoma,2 cases of metastatic cancer,2 cases of mediastinal cyst.There were 1 case of mucinous adenocarcinoma,1 case of mesothelioma,6 cases of chronic pneumonia,6 cases of tuberculosis,2 cases of lymphadenitis,1 case of sarcoidosis,1 case of tumor unclassification,1 case of goiter,1 case of collagen composition could not be diagnosed,1 case failed to puncture.One puncture failed.Complications:hemoptysis in 16 cases(16.0%),pneumothorax in 8 cases(8.0%),and pericardial hemorrhage in 1 case(1.0%).All complications improved after conservative treatment.Conclusion CT-guided hilar and mediastinal mass biopsy success rate is 98.0%,hilar malignant tumors accounted for 83.3%(50/60),mediastinal malignant tumors accounted for 75.0%(30/40),did not significantly increase pneumothorax and Bleeding and other complications,this technology is worth popularizing and applying.

关 键 词：断层摄影术 X线计算机 介入性 活组织检查 肺门及纵膈肿块 

分 类 号：R734.2[医药卫生—肿瘤]