超声引导切割针穿刺活检在儿童腹部实体肿瘤中的应用研究  

Clinical application of ultrasound-guided cutting needle biopsy for pediatric abdominal solid tumors

作　　者：刘登辉[1] 向强兴 刘金桥[2] 黎明[1] 李勇[1] Liu Denghui;Xiang Qiangxing;Liu Jinqiao;Li Ming;Li Yong(Department of General Surgery,Children's Hospital of Hunan Province,Hunan Changsha 410007,China;Department of Ultrasonography,Children's Hospital of Hunan Province,Hunan Changsha 410007,China)

机构地区：[1]湖南省儿童医院普外科,湖南长沙410007 [2]湖南省儿童医院超声科,湖南长沙410007

出　　处：《腹部外科》2022年第3期213-216,共4页Journal of Abdominal Surgery

基　　金：湖南省儿童医院2021年新技术项目(2021-Y74);湖南省卫生健康委科研课题(202104081314);湖南省儿童医院2020年度院级科研项目(B类)。

摘　　要：目的 探讨超声引导下切割针穿刺活检在儿童腹部实体瘤中的应用价值。方法 回顾性分析2017年1月至2020年12月湖南省儿童医院普外科收治的43例经超声引导下切割针穿刺活检的腹部实体瘤患儿临床资料。其中男性26例,女性17例,中位年龄为6岁7个月(2岁3个月~13岁)。患儿均使用Bard 18G切割针穿刺4~6条组织标本,并分析患儿穿刺后致伤口感染、出血、穿刺针道瘤灶种植等并发症情况。结果 43例患儿中,40例通过超声引导穿刺活检获取肿瘤组织标本,另3例患儿穿刺失败以开腹手术肿瘤活检明确诊断(神经母细胞瘤2例,横纹肌肉瘤1例)。穿刺活检病理结果:神经母细胞瘤23例,肝母细胞瘤12例,肾母细胞瘤3例,非霍奇金淋巴瘤1例,横纹肌肉瘤1例。2例神经母细胞瘤明确诊断后家属放弃治疗,1例神经母细胞瘤在化疗期间出现肿瘤溶解综合征死亡;余40例患儿在化疗后接受手术,术后大体标本病理诊断与穿刺活检病理诊断结果一致。穿刺活检成功率为93.02%(40/43)。所有患儿无穿刺部位伤口感染、出血、穿刺通道瘤灶种植转移等并发症发生。结论 超声引导下切割针穿刺活检诊断儿童腹部实体肿瘤安全且准确性高,能够做出明确病理诊断,值得临床推广应用。Objective To explore clinical application of ultrasound-guided cutting needle biopsy for pediatric abdominal solid tumors.Methods From January 2017 to December 2020, retrospective analysis was performed for 43 children undergoing B ultrasound-guided cutting needle biopsy for diagnosing pediatric abdominal solid tumors. There were 17 girls and 26 boys with a median age of 6.7(2.25-13) years. An 18 G automatic core needle was utilized for 4 to 6 slices. Such complications as wound infection, bleeding, needle tract recurrence and pathological biopsy positive rate were recorded.Results Ultrasound guided biopsy was performed. The results of frozen pathology were neuroblastoma(NB, n=23), hepatoblastoma(n=12), nephroblastoma(n=3), non Hodgkin′s lymphoma(n=1) and rhabdomyosarcoma(n=1). Among 3 cases of failed pathological diagnosis by puncture biopsy, a definite diagnosis was made by laparotomy biopsy, including neuroblastoma(n=2) and rhabdomyosarcoma(n=1). Two cases of NB gave up treatment after a definite diagnosis and one case of NB died of tumor lysis syndrome during chemotherapy. Surgical resection was performed after chemotherapy and pathological diagnosis of resection specimens reconfirmed the biopsy results in 40/43(93.02%). During follow-ups, there was no onset of bleeding, wound infection or needle tract recurrence.Conclusion Ultrasound-guided cutting needle biopsy is both safe and reliable in the diagnosis of suspected pediatric abdominal solid tumors. Capable of making a definite pathological diagnosis, it is worthy of wider clinical applications.

关 键 词：超声引导 穿刺活检 儿童 腹部实体肿瘤 

分 类 号：R730.4[医药卫生—肿瘤]