超声引导下液体隔离技术辅助细针穿刺活检在颈IV区颈动脉鞘区异常淋巴结定性诊断中的应用  

Ultrasonic-Guided Fluid Isolation Assisted Fine Needle Puncture Biopsy in the Qualitative Diagnosis of Abnormal Lymph Nodes in the Carotid Sheath Region of the Cervical Region

作　　者：王肖辉 周霖[2] 赵瑞华[3] 荆自伟 穆晓伟[1] 高珂[1] WANG Xiaohui;ZHOU Lin;ZHAO Ruihua;JING Ziwei;MU Xiaowei;GAO Ke(Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Pharmacy,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;不详)

机构地区：[1]郑州大学第一附属医院超声科,河南郑州450052 [2]郑州大学第一附属医院药学部,河南郑州450052 [3]郑州大学第一附属医院肿瘤科,河南郑州450052

出　　处：《中国医学影像学杂志》2022年第7期733-737,共5页Chinese Journal of Medical Imaging

基　　金：河南省科技发展计划(212102311107);河南省医学科技攻关计划(LHGJ20210348)。

摘　　要：目的评价超声引导下液体隔离技术辅助细针穿刺活检在颈IV区颈动脉鞘区异常淋巴结定性诊断中的应用价值。资料与方法回顾性选取2017年5月—2020年12月在郑州大学第一附属医院发现颈IV区颈动脉鞘区异常淋巴结的155例恶性肿瘤患者,均在超声引导下进行细针穿刺活检,根据有无辅助液体隔离技术分为常规穿刺组79例共83枚病灶和液体隔离穿刺组76例共83枚病灶。记录患者临床数据和随访结果,比较两组的取材成功率、取材阳性率、进针次数及穿刺后并发症发生情况,并将液体隔离穿刺组患者的结果与常规二维超声诊断进行比较,比较2种方法诊断准确率的差异。结果76例患者共83枚病灶局部注射生理盐水+利多卡因混合液后均实现病灶与相邻大血管的有效分离,并完成细针穿刺活检操作,穿刺活检取材成功率、取材阳性率分别为100%(83/83)、98.80%(82/83);79例常规穿刺组的穿刺活检取材成功率、取材阳性率分别为91.57%(76/83)、80.72%(67/83),液体隔离穿刺组的穿刺活检取材成功率、取材阳性率均高于常规穿刺组(χ^(2)=2.695,P=0.007;χ^(2)=4.195,P<0.001)。液体隔离组和常规穿刺组进针次数差异有统计学意义(Z=9.382,P<0.01)。液体隔离组术后无穿刺部位疼痛>3 d者,无病灶周边或内部出血、无声音嘶哑、进食或饮水呛咳、呼吸困难等严重并发症发生。常规穿刺组共9例发生并发症,其中3例穿刺部位疼痛>3 d,5例局部瘀斑或血肿,1例声音嘶哑,两组差异有统计学意义(χ^(2)=3.075,P=0.002)。液体隔离穿刺组患者的常规二维超声诊断准确率为71.08%(59/83),液体隔离穿刺结果准确率为98.80%(82/83),差异有统计学意义(χ^(2)=4.976,P<0.001)。结论运用超声引导下液体隔离技术在颈IV区颈动脉鞘区淋巴结细针穿刺活检中能够显著提高穿刺的取材成功率和阳性率,并减少穿刺并发症的发生。Purpose To evaluate the clinical application value of ultrasonic-guided fluid isolation technique assisted fine needle biopsy in the qualitative diagnosis of abnormal lymph nodes in the carotid sheath region in the IV region of the neck.Materials and Methods A total of 155 patients with malignant tumor who were found abnormal lymph nodes in carotid sheath region IV in the First Affiliated Hospital of Zhengzhou University from May 2017 to December 2020 were retrospectively selected as the research subjects.All patients underwent ultrasound-guided fine needle biopsy,and were divided into conventional biopsy group(79 cases,83 lesions)and fluid isolation puncture group(76 cases,83 lesions).The sampling success rate,sampling positive rate,number of needle injections and post-puncture complications of the two groups were compared according to the follow-up results.The results of the fluid isolation puncture group were compared with conventional two-dimensional ultrasound diagnosis,and the difference in diagnostic accuracy of the two methods was compared.Results In 76 patients(a total of 83 lesions),effective separation of lesions from adjacent large vessels was achieved after local injection of saline+lidocaine mixture,and fine needle biopsy was completed.The success rate and positive rate of biopsy were 100%(83/83)and 98.80%(82/83),respectively.However,the success rate and positive rate of the 79 cases in the conventional puncture group were 91.57%(76/83)and 80.72%(67/83),respectively.The success rate and positive rate of the fluid isolation puncture group were higher than those in the conventional puncture group(χ^(2)=2.695,P=0.007;χ^(2)=4.195,P<0.001).The number of injections in the liquid isolation group and the conventional group showed statistically significant difference between the two groups(Z=9.382,P<0.01).In the liquid isolation group,the pain at the puncture site was less than 3 days after operation,and no severe complications such as peripheral or internal bleeding,hoarseness,choking on food or water,and

关 键 词：超声引导 液体隔离技术 细针穿刺活检 异常淋巴结 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]