摘要
目的 探讨胸膜病变不同穿刺方法的临床应用。资料与方法 经X线和CT发现的 114例胸膜病变 ,在CT引导下采用不同的穿刺方法 ,包括 :(1)与胸膜相对垂直的进针方法 ;(2 )与胸膜相对平行的斜向进针方法 ;(3)经过积液的胸膜腔的肺外进针方法 ,同时抽取胸液。用Chiba 18～ 2 2G抽吸针和Tru cut 18～ 2 1G切割针取样 ,分别进行细菌培养 ,细胞学检查或病理切片。结果 114例胸膜病变 ,穿刺成功率 94 .7% (10 8/ 114 ) ,准确率 93.0 %(10 6 / 114 ) ,假阴性率 1.8% (2 / 114 ) ,无假阳性。穿刺病理结果 ,恶性病变占 70 .4 % (76 / 10 8)。并发症 ,气胸 6 .1%(7/ 114 ) ,伤及肋间血管 4 .4 % (5 / 114 )。结论 (1)CT导向是目前胸膜病变 ,尤其是肿瘤性病变穿刺活检的最佳引导手段。 (2 ) 3种进针方法各有优缺点 ,应合理选择。 (3)并发症与不同的穿刺方法有关 ,总体上少而轻。对于胸膜病变 ,CT引导下选用合理的方法穿刺活检 ,较为安全可靠 ,易推广应用。
Objective To discuss the clinical applications of several CT guided fine needle biopsy techniques for pleural lesions. Materials and Methods CT guided fine needle biopsy was performed in 114 cases for the pleural lesions discovered on plain radiography or CT scans using several different techniques. Three techniques were used in this study: (1) the puncturing direction was perpendicular to the pleura; (2) oblique puncturing direction, which was relatively parallel to the pleura; (3) extrapulmonary puncturing through the effused thoracic cavity, meanwhile the effusion was aspirated. Both Chiba 18～22G aspirating needle and Tru cut 18～21Gcore needle were used. The samples thus obtained were sent for bacteria culture, cytological exam or pathologic section.Results The successful rate of puncturing procedure was 94.7% (108/114). The diagnostic accuracy obtained from the puncture was 93.0% (106/114) with the false negative rate of 1.8% (2/114), no false positive occurred. Pathologically, malignancy made up 70.4% (76/108). Complications included pneumothorax (7/114, 6.12%) and intercostal vessel injury (5/114, 4.4%).Conclusion (1) CT is the best guiding means in puncturing biopsy procedure for pleural lesions, especially for pleural tumors. (2) Each of the three above mentioned puncturing techniques has its own advantages and disadvantages, they should be rationally used. (3) Generally, the puncturing techniques are safe, easy and reliable, with fewer complications, that are somewhat related to the puncturing technique used.
出处
《临床放射学杂志》
CSCD
北大核心
2003年第2期143-146,共4页
Journal of Clinical Radiology
