目的研究在不同角度下使用BioPinceTM活检针在CT导向肺肿块的穿刺活检,探讨其对穿刺活检的影响,进一步提高肺穿刺活检成功率。方法根据临床实际穿刺角度,对92例肺部肿块患者进行分组:垂直组50例,垂直角度使用BioPinceTM活检针切割肿块;斜角度组42例,斜角度使用活检针。对照两组一次穿刺取材满意率,穿刺次数和并发症发生率。结果两组一次穿刺取材满意率分别为94%和57%(χ2=17.41,P=0.000)。垂直组减少了二次穿刺的次数,进而减少了气胸的发生率,两组气胸发生率分别为4%和19%(χ2=3.89,P=0.048),尤其在肿块直径≤2cm组,两组间差异更明显。但垂直穿刺亦有缺点,由于BioPinceTM活检针手柄大且重,在垂直穿刺定位时后,CT扫描再次复核位置时,在胸壁薄、体质瘦弱患者穿刺针会自行向下滑进,增加穿刺风险。斜角度穿刺者,由于重力作用,进针后CT扫描时BioPinceTM活检针自行固定困难,手柄会下垂,导致穿刺角度发生偏移。结论使用BioPinceTM活检针在CT导向肺肿块的穿刺活检时,尽量选择垂直角度穿刺,一次穿刺取材满意率高,尤其在病灶小且远离胸壁时,可以提高穿刺的准确度,因而提高穿刺阳性率,减少手术多次取材及危险性,减少并发症。但对胸壁薄、体质瘦弱患者,要小心穿刺针自行下滑的风险。有必要结合使用针、柄可拆分的活检针,减少针柄的重力影响。
[目的]评价BioPinceTM活检针在CT引导下经皮胸部肿块穿刺活检的临床应用价值。[方法]对96例胸部肿块病人（92例为肺部,4例为纵隔肿块）进行CT引导下穿刺活检,分析病理结果,敏感度、特异度,不同大小肿块取材满意率以及穿刺并发症。[结果]胸部病变穿刺诊断的准确率（能作出准确定性诊断的例数/总例数）为94.8%（91/96）。最后确诊的恶性病变共87例中,1例穿刺诊断为慢性炎,最后确诊为鳞癌,3例为“不能定性”最后诊断腺癌。诊断恶性病变的敏感度为95.4%（83/87）,特异度为100%。病理示“不能定性”者4例。大病灶（直径＞2cm）首次穿刺取材满意率较小病灶者高,分别为81.8%（63/77）和63.1%（12/19）（P=0.14）。气胸发生率10.4%（10/96）。[结论]BioPinceTM活检针活检取材良好,对胸部肿块的诊断准确性相对较高,但因结构原因,使用时有局限性,可作为其他类型活检针的有益补充。
目的 探讨螺旋CT仿真膀胱镜(CTVC)对膀胱癌的临床应用价值.方法 对临床具备指征的26例患者,在常规盆腔平扫+增强CT后憋尿延迟15～30分钟,待膀胱充盈造影剂满意后取仰卧位扫描,行膀胱区域薄层螺旋CT扫描,应用工作站采集延长期扫描拆薄的图像行后期处理做成CTVC成像.全部病例有纤维膀胱镜(FC)对照,并将两种检查结果结合手术病理结果作对照分析.结果 26例患者CTVC共发现病灶结节30个,FC镜检发现病灶结节39个,对直径＞0.5cm肿瘤,CTVC可清楚显示,但对肿瘤周围小结节子灶及三角区小滤泡样肿物CTVC均不易捡出,对膀胱肿瘤的显示对比,结果有显著差异(x2=8.03,P=0.0046).对直径≤0.5cm的肿瘤,2例CT轴位像未能发现,但CTVC能显示.对膀胱癌的诊断CTVC的符合率为100%.结论 CTVC图像形象、直观,不仅看见膀胱腔内形状,对浸润范围结合CT轴位及冠矢状位重建也可清晰地显示,诊断膀胱肿瘤具有较好的应用价值.对临床高度怀疑膀胱肿瘤,而常规CT扫描未发现病灶者,应该行CTVC,以减少漏诊.而对于直径≤0.5cm的肿瘤,尽管CTVC可以发现部分病灶,但是相对于纤维膀胱镜,其敏感性仍不够满意.注意层厚、层距的选择,延长憋尿时间,使用合适的窗宽、窗位等,可能有助于提高小病灶的检出.
Objective To contrast the clinical practice characteristics with decomposable and indecomposable biopsy needle in the CT-guided lung puncture biopsy.Methods 50 patients with lung tumour carried on puncture biopsy under the CT guidance were divided in two groups randomly: Group A(25 examples): using the indecomposable BioPinceTM biopsy needle;Group B(25 examples): using the decomposable Precisa or Vitesse biopsy needle.The puncture biopsy organization quantity,the first time puncture success rate,the pathological diagnosis result and the incidence of puncture complication were compared in two groups.Results More striped structures were gained obviously in group A than in group B: 24 / 25 and 11/ 25 respectively(P 0.05),The pathological diagnosis serious extrusion amoebocyte and nature undetermined only occurred in group B.But the first time puncture success rate was lower in group A than in B: 52%(13 / 25) and 80%(20 / 25) respectively(P 0.05),The incidence of hemorrhage and pneumothorax in group A was higher slightly: 84% and 72%,16% and 4% respectively(P 0.05).Conclusion The indecomposable needle(BioPinceTM) was better in lung puncture biopsy,but the lower first time puncture success rate also increases the risk of operation and complication in some degree because of the structure of the needle.On the contrary,decomposable needle(the Precisa or the Vitesse) was not the best choice in lung puncture biopsy.But it had the original superiority,especially regarding the special patient such as patient with small tumour,thin thoracic wall,bad physique for its nimble operation.It is essential for us to use the two different types of biopsy needle rationally to enhance the level of CT-guided lung puncture biopsy.
