超声引导新型冠状病毒肺炎死亡患者肺组织穿刺病理取材方法探讨  

Ultrasound-guided pathological sampling of cadaver lung tissue in cases of COVID-19

作　　者：郑毅 余铖 王思桦 李想 周俊杰 聂秀[3] 张丹青 王静[1] 吕清[1] 张丽 杨亚利 邓京 谢明星[1] Zheng Yi;Yu Cheng;Wang Sihua;Li Xiang;Zhou Junjie;Nie Xiu;Zhang Danqing;Wang Jing;Lyv Qing;Zhang Li;Yang Yali;Deng Jing;Xie Mingxing(Department of Ultrasound,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology&Hubei Province Key Laboratory of Molecular Imaging,Wuhan 430022,China;Department of Thoracic Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Pathology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;University College London&UCL Hospitals,Barts Heart Centre London,London WC1E6BT,UK)

机构地区：[1]华中科技大学同济医学院附属协和医院超声影像科,湖北省分子影像重点实验室,武汉430022 [2]华中科技大学同济医学院附属协和医院胸外科,武汉430022 [3]华中科技大学同济医学院附属协和医院病理科,武汉430022 [4]University College London&UCL Hospitals,Barts Heart Centre London,London WC1E6BT,UK

出　　处：《中华超声影像学杂志》2020年第12期1077-1082,共6页Chinese Journal of Ultrasonography

摘　　要：目的探讨新型冠状病毒肺炎(COVID-19)死亡患者超声引导肺组织微创病理取材方法及其应用价值。方法超声引导对2020年2-3月华中科技大学同济医学院附属协和医院17例COVID-19死亡患者使用14G全自动活检针进行肺组织微创病理取材。①依据人体肺组织解剖分叶与体表投影,设计常规穿刺点10个。左锁骨中线第3、6肋间为左肺上、下叶内侧区组织取材穿刺点;右锁骨中线第3、4、6肋间为右肺上、中、下叶内侧区肺组织取材穿刺点;左腋中线第4、7肋间为左肺上、下叶外侧区肺组织取材穿刺点;右腋中线第4、5、7肋间为右肺上、中、下叶外侧区肺组织取材穿刺点。②根据各穿刺点尸体肺组织超声图像表现,将其分为含气肺、实变肺与压缩肺三种类型,针对不同类型肺组织,设计相应的取材方法,完成对左右肺各叶内外侧区的多点多次完整取材。③记录左右侧肺组织取材所需时间,测量取材组织长度,比较各穿刺点取材成功率及各类肺组织取材成功率。结果①17例COVID-19死亡患者双侧肺组织选取174穿刺点,穿刺获取肺组织病理取材288条。②各穿刺点取材成功率存在差异,左、右侧锁骨中线第6肋间穿刺点取材成功率低于其他穿刺点,差异有统计学意义(P<0.05);③不同类型超声表现的尸体肺取材成功率存在差异,其中含气肺取材成功率为74.4%,低于实变肺及压缩肺(86.8%,84.1%),差异有统计学意义(P<0.05);④压缩肺取材标本长度为11.4(10.6,12.3)mm,低于含气肺与实变肺[14.6(12.5,15.2)mm,13.5(12.5,15.0)mm],差异有统计学意义(P<0.05)。结论本研究介绍了一种尸体肺组织超声引导微创穿刺取材方法,可供新型冠状病毒肺炎临床尸体肺组织病理取材应用参考。Objective To investigate the method and application of ultrasound-guided post-mortem lung tissue sampling in cases of COVID-19.Methods Ultrasound-guided post-mortem lung tissue sampling was performed with 14G biopsy needles in 17 confirmed COVID-19 cases in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from Feb to Mar 2020.①Ten conventional puncture points were designed according to the anatomy of human lung lobes and the projections on the body surface.The 3rd and 6th intercostal spaces in the left midclavicular line were the puncture points for the tissues of the medial areas of the upper and lower lobes of the left lung,and the 3rd,4th,and 6th intercostal spaces in the right midclavicular line were the puncture points of the lung tissues taken from the medial areas of the upper,middle,and lower lobes of the right lung.The 4th and 7th intercostal spaces in the left midaxillary line were the puncture points of the lung tissues from the upper and lower lateral lobes,and the 4th,5th,and 7th intercostal spaces in the right midaxillary line were the puncture points of the lung tissues from the lateral areas of the upper,middle and lower lobes of the right lung.②According to the sonographic findings of the lung tissues at each puncture point,it was divided into three types:air-containing lung,consolidated lung and compressed lung.And the corresponding sampling methods were designed to complete multiple points of the medial and lateral areas of the left and right lung lobes.③The time required for each lung sampling was recorded,and the sizes of the specimens were measured.The success rates of all puncture points were compared and the success rates of various type lung tissues were compared.Results①In 17 COVID-19 death cases,174 puncture points were selected for bilateral lung tissues,and 288 lung tissue specimens were obtained by puncture.②There were differences in the success rates of the puncture points,and the success rate of the 6th intercostal puncture points on the

关 键 词：超声引导 尸体病检 新型冠状病毒肺炎 肺组织 

分 类 号：R445.1[医药卫生—影像医学与核医学] R563.1[医药卫生—诊断学]