机器人辅助靶向穿刺技术在骨肿瘤活检中的初步应用  

Preliminary application of robot-assisted core-needle biopsy for the bone tumors

作　　者：陈宇 徐立斌 孟小童 丛琳[1] 朱悦[1] Chen Yu;Xu Libin;Meng Xiaotong;Cong Lin;Zhu Yue(Department of Orthopaedics,First Hospital of China Medical University,Shenyang 110000,China;Department of Orthopaedics,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]中国医科大学附属第一医院骨科,沈阳110000 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院骨科,北京100021

出　　处：《中国医师进修杂志》2024年第10期870-874,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的拟评价机器人辅助穿刺技术在骨肿瘤活检中的应用价值,并与传统技术进行对比。方法回顾性分析2019年2月至2021年2月中国医科大学附属第一医院收治的行穿刺活检的102例骨病变患者的病历资料,其中男57例,女45例,年龄45.9(10~79)岁。采用机器人辅助穿刺8例(机器人辅助组),采用C臂及CT引导穿刺94例(传统穿刺组),记录两组活检操作时间、穿刺方向调整次数等,比较两组活检与手术病理学检查结果。结果病理诊断包括转移瘤33例,骨肉瘤12例,软骨肉瘤12例,骨巨细胞瘤12例,纤维异常增殖症7例,慢性骨髓炎7例,淋巴瘤4例,多发性骨髓瘤4例,陈旧骨折3例,软骨母细胞瘤2例,多形性未分化肉瘤2例,平滑肌肉瘤及朗格汉斯细胞组织细胞增生症各1例。肿瘤部位包括四肢87例(85.29%)和躯干15例(14.71%)。与传统穿刺组相比,机器人辅助组的病灶多位于躯干[7/8比11.70%(11/94),P<0.01],术中较少调整穿刺路径[(0.4±0.1)次比(3.1±1.5)次],差异有统计学意义(P<0.01),且手术时间较长[(48.8±8.8)min比(29.6±6.0)min],差异有统计学意义(P<0.01)。机器人辅助组和传统穿刺组在性别构成、年龄、术前病理骨折、确诊率、切开活检率和手术并发症方面比较差异无统计学意义(P>0.05)。结论机器人辅助靶向穿刺技术安全有效,有助于降低手术难度,可用于穿刺难度较大的病例,如骨微小病变和脊柱、骨盆病灶等。Objective To assess the usage of the robot-assisted core-needle biopsy for the bone tumors,moreover to compare its outcomes with the manual technique.Methods A retrospective study was conducted from February 2019 to February 2021,the medical records of the patients with bone lesions that had received core-needle biopsy were collected.There were 57 males and 45 females,the age was 45.9(10~79)years.Eight patients received robot-assisted biopsy,whereas 94 patients underwent C-arm/CT guided biopsy,the recorded data included operational duration,aspirational direction adjustment,etc.The pathological diagnosis reports of the biopsy specimens and the operational specimens were compared.Results The diagnosis outcomes included metastases(33 cases),osteosarcoma(12 cases),chondrosarcoma(12 cases),giant cell tumor of bone(12 cases),fibrous dysplasia(7 cases),chronic osteomyelitis(7 cases),lymphoma(4 cases),multiple myeloma(4 cases),chronic fracture(3 cases),chondroblastoma(2 cases),pleomorphic undifferentiated sarcoma(2 cases),leiomyosarcoma(1 case),and Langerhans cell histiocytosis(1 case).Eighty-seven cases(85.29%)lesions were found in the limbs,whereas 15 cases(14.71%)were in the axial locations.Compared with the manual group,the robot-assisted group had more axial locations:7/8 vs.11.70%(11/94),P<0.01;fewer aspirational direction adjustment:(0.4±0.1)times vs.(3.1±1.5)times,P<0.01;longer operational duration:(48.8±8.8)min vs.(29.6±6.0)min,P<0.01.There were no statistical differences between the two groups regarding the sex,age,pathological fracture,diagnostic accuracy,open biopsy rate and complications(P>0.05).Conclusions The robot-assisted core-needle biopsy is a reliable technique,it helps decrease the operational difficulty.The usage of this technique is recommendable for the bone lesions with great difficulty for biopsy,such as the minimal bone tumors and the lesions in the spine and the pelvis.

关 键 词：骨肿瘤 穿刺术 影像引导活检 机器人外科手术 

分 类 号：R738.1[医药卫生—肿瘤]