超声引导下细针穿刺不同直径甲状腺结节诊断的临床应用价值

目的 探讨超声引导下细针穿刺抽吸活检用于不同直径甲状腺结节的标本获取情况及诊断价值。方法 选取126例甲状腺结节患者，29例患者甲状腺结节直径<5 mm为A组，42例患者甲状腺结节直径5～10 mm为B组，55例甲状腺结节直径>10 mm为C组。比较三组超声引导下细针穿刺抽吸活检的细胞学检查结果；以常规病理学诊断或随访结果为金标准，以Kappa分析超声引导下细针穿刺抽吸活检诊断不同直径甲状腺结节良恶性与金标准的一致性。结果126个甲状腺结节穿刺成功率为100%,超声引导下细针穿刺抽吸活检诊断直径<5 mm、5～10 mm、>10 mm的甲状腺结节良恶性均有较好的价值，敏感性分别为85.7%、84.6%、88.2%,特异性分别为90.9%、93.1%、86.8%,Kappa值分别为0.731、0.777、0.716,细胞学检查结果显示，A组恶性结节8个、良性结节21个，B组恶性结节13个、良性结节29个，C组恶性结节20个、良性结节35个，三组超声引导下细针穿刺抽吸活检的细胞学检查结果差异无统计学意义(P>0.05);病理组织活检结果显示，A组恶性结节7个、...     

内镜超声引导下细针穿刺抽吸术在诊断上消化道及其周围占位病变中的价值

目的探讨内镜超声引导下细针穿刺抽吸术(EUS-FNA)对上消化道及其周围实质性占位病变诊断的准确性及其临床应用价值。方法回顾性分析2011年11月至2014年5月行超声内镜检查及超声内镜引导下的细针穿刺检查的87例患者的临床资料,对比细胞学和(或)病理学检查与术后病理结果及随访结果。结果本组86例患者成功进行了EUS-FNA,穿刺成功率98.85%。其中,病灶位于食管9例(10.35%),胃39例(44.83%),十二指肠球部10例(11.49%),胰腺18例(20.69%),腹腔10例(11.49%)。74例患者细胞学检查结果为阳性,阳性率85.06%。39例患者获得组织碎片或组织细条行病理学检查,组织获得率44.83%;其中,20例病理学检查结果为阳性,阳性率51.28%。与术后病理结果及术后随访结果对照,EUS-FNA对上消化道及其周围占位病变诊断的准确率为89.65%。对于病灶直径大小(>3 cm及≤3 cm)、穿刺针针号(19G及22G)及抽吸负压(5 ml负压及10 ml负压),两两比较发现,EUS-FNA诊断准确率差异均无统计学意义(P>0.05)。穿刺过程中无明显并发症发生。结论在上消化道及周围实质性占位病变中,EUSFNA是一项安全、有效、准确的诊断及鉴别诊断方法,穿刺诊断的准确性与病灶的大小,穿刺针的针号及穿刺抽吸负压大小无明显相关性。     

超声引导下徒手法肾组织穿刺活检的应用价值

目的 比较超声引导下徒手肾穿刺活检术与使用穿刺架肾穿刺活检术的优缺点,探讨超声引导下徒手法肾组织穿刺活检的应用价值.方法 使用18G巴德一次性自动活检枪对甲组226例慢性肾病患者行超声引导下徒手肾组织穿刺活检术,乙组261例慢性肾病患者行超声引导下使用穿刺架肾穿刺活检术,按相同的穿刺活检标准决定穿刺部位、穿刺次数,取出的肾组织标本能完成完整的病理诊断,视作活检成功;术中记录穿刺次数,术后观察并发症.结果 甲、乙两组患者平均每例的肾活检穿刺次数各为(2.97±0.43)次和(303±0.72)次、穿刺并发症发生率各为4.9％和2.7％、活检成功率各为98.2％和98.1％,两组间差异均无统计学意义;但两组患者穿刺失败的原因各有不同,使用穿刺架法穿刺失败主要是因为患者特别肥胖或肾脏位置特殊,徒手法穿刺失败主要与穿刺时穿刺枪的稳定性有关.结论 超声引导下徒手法肾穿刺活检术与使用穿刺架法肾穿刺活检术均是安全有效的操作技术;徒手法更适合特别肥胖及某些肾脏位置特殊的患者,可作为使用穿刺架法重要的补充手段.     

超声引导下粗针、细针穿刺活检在直径>1 cm可疑甲状腺结节中诊断应用

目的探讨超声引导下细针穿刺细胞学检查、粗针穿刺组织学检查在直径>1 cm可疑甲状腺结节诊断中的应用价值。方法选取自2016年10月至2019年8月曲靖市第一人民医院收治的176例直径>1 cm的可疑甲状腺结节患者为研究对象。所有患者均先在超声引导下进行细针穿刺细胞学检查或粗针穿刺组织学检查。记录两种方法诊断可疑甲状腺结节的大小,假阳性率、假阴性率、诊断符合率,以及并发症情况。结果 64例患者进行了粗针穿刺组织学检查,其中,12例患者结节直径1～2 cm,27例患者结节直径2～3 cm,25例患者结节直径>3 cm。112例患者进行了细针穿刺细胞学检查,其中,43例患者结节直径1～2 cm,48例患者结节直径2～3 cm,21例患者结节直径>3 cm。两种方法检测的假阳性率、假阴性率比较,差异有统计学意义(P<0.05)。两种方法检测的诊断符合率比较,差异无统计学意义(P>0.05)。粗针穿刺组织学检查的并发症发生率为40.6%(26/64),高于细针穿刺细胞学检查的8.9%(10/112),差异有统计学意义(P<0.05)。结论超声引导下粗针与细针穿刺活检诊断直径>1 cm的可疑甲状腺结节,均有效、可行。在保证患者安全的前提下,可根据患者要求及临床推荐、超声评估等多种手段,选择适当的穿刺活检方法对结节进行诊断。     

超声检查及引导细针穿刺活检在甲状腺结节良恶性中的鉴别诊断价值

目的探讨超声检查及引导细针穿刺活检在甲状腺结节良恶性中的鉴别价值。方法选取148例甲状腺结节患者(共计237个结节),均接受超声引导下细针穿刺活检、常规超声检查,将术后组织病理学诊断结果作为“金标准”,将术前应用的以上两种检查与之进行对照,计算并对比二者鉴别诊断效力及穿刺检查并发症发生情况。结果术后甲状腺组织病理学诊断恶性结节、良性结节比例为183∶54,常规超声诊断恶性、良性比例为171∶66,超声引导下细针穿刺活检诊断恶性、良性比例为182∶55;超声引导下甲状腺细针穿刺活检诊断准确度(97.89%)、灵敏度(98.36%)、特异度(96.30%)较常规超声(78.90%、83.06%、64.81%)更高,P<0.05;148例患者经穿刺检查后均未出现异常疼痛、穿刺点异常出血、皮下血肿等并发症。结论超声引导下甲状腺细针穿刺活检甲状腺结节,可判断结节良恶性性质。     

穿刺架在CT定位肿瘤多靶点穿刺中的应用

目的:探讨穿刺架在CT定位肿瘤多靶点穿刺操作中的应用。方法:对150例肿瘤患者应用穿刺架在CT定位下辅助肿瘤多靶点穿刺,其中氩氦刀冷冻手术86例,125I粒子植入术64例,共穿刺779针,均取得成功。结果:总体1次穿刺准确率80.62%(627/779),除肝、肺外的1次穿刺准确率达91.21%(353/387);穿刺角度平均误差为(1.0±0.62)°;靶点穿刺距离误差为(4±2.24)mm;单一靶标安置穿刺架至穿刺成功平均费时3min。结论:穿刺架辅助CT定位的肿瘤多靶点穿刺1次操作成功率高、误差小、并发症低、使用便捷,值得推广。     

CT导引穿刺定位装置的研制和实验研究

【摘要】 目的 实验评价一种新型穿刺定位装置在CT导引下经皮穿刺定位的精度。方法 采用体积约25 cm×20 cm×15 cm猪肉模拟正常人体肌肉组织,黏土制作数个棱长分别为5 mm、10 mm、15 mm的正方体模拟病灶,计划距体表深度分别为30 mm、50 mm、80 mm,将模拟病灶根据大小、深度分散放置在模拟正常肌肉组织的猪肉内,在同层面内计划进针角度为0°、25°、50°。对比CT导引下徒手穿刺与定位装置穿刺模拟病灶的进针角度误差和穿刺准确率。结果 CT导引下徒手穿刺、定位装置穿刺模拟病灶共578次。定位装置穿刺、徒手穿刺的准确率分别为94.8%、51.7%,进针角度误差分别为1°（0°,1°）、3°（1°,7°）,定位装置穿刺均显著优于徒手穿刺（P＜0.01）。结论 应用新型定位装置辅助穿刺可明显提高CT导引下穿刺准确率,提高穿刺精度。     

CT、MR三维重建在恶性肿瘤致梗阻性黄疸穿刺定位中的应用价值北大核心CSCD

目的 探讨CT、MR三维重建在恶性肿瘤致梗阻性黄疸穿刺定位中的应用价值。方法 选择2018年2月至2021年12月江苏省连云港市第一人民医院因恶性肿瘤致梗阻性黄疸行经皮肝穿刺胆道引流(PTBD)和(或)胆道支架植入患者154例,分为研究组81例,对照组73例。研究组术前行胆道系统CT、MR三维重建,根据重建图像明确胆道穿刺皮肤穿刺点、穿刺深度、穿刺水平及穿刺角度后在DSA下行胆道穿刺;对照组选用经典DSA引导下穿刺。比较两组首针穿刺成功率、总体穿刺成功率、穿刺次数、穿刺成功后手术完成率及穿刺并发症发生率,分析三维重建辅助下穿刺定位价值。结果 研究组首针穿刺成功率为90.91%,高于对照组的78.79%;穿刺次数为(1.26±0.54),少于对照组的(1.86±1.11),差异有统计学意义(P<0.05)。两组间总体穿刺成功率和穿刺成功后手术完成率差异无统计学意义。36例(23.38%)出现穿刺并发症,主要为出血、腹痛、气胸和感染等。研究组穿刺并发症发生率为13.58%,低于对照组的34.25%,差异有统计学意义(P<0.05)。结论 CT、MR三维重建技术辅助胆道系统穿刺,可提高首针穿刺的成功率,降低反复穿刺次数和穿刺并发症的发生率,在各级医院和不同年资术者中具有一定的普及意义。     

CT导引下骶骨病变穿刺活检

目的 探讨CT导引下对骶骨病变穿刺活检技术和应用价值.方法 在CT导引下对21例骶骨病变联合使用Ackermann骨钻针、切割式活检针和抽吸式活检针采集骨性标本和非骨性标本.结果穿刺成功率100%,除1例标本为含坏死组织和凝血块外,其余均获得病理结果,病理活检成功率95.2%.结论 CT导引下穿刺活检是对骶骨病变作出正确诊断的可靠方法,操作简便、安全,并发症少,为术前诊断提供重要的参考依据.正确合理使用操作方法可以提高穿刺的成功率和缩短穿刺时间.     

透视引导经皮细针穿刺活检肺癌假阴性的相关因素分析

目的探讨肺癌病灶经皮细针穿刺抽吸活检假阴性结果产生的相关因素和避免方法。资料与方法回顾性研究60例在电视透视下(有1例加用CT引导)行经皮针吸肺活检的病例．追踪肺穿刺细胞学结果与手术病理或临床随访结果。分类记录假阴性病灶的操作人员、病理结果、术中发现和病灶CT特征。结果发现假阴性14例(20．3％)。恶性病灶直径3～5cm,深度≥4cm,有坏死或继发感染．则易致穿刺假阴性。结论经皮细针穿刺抽吸活检肺内病灶时一定要仔细分析病灶特征并熟练掌握相应的穿刺技巧．尽量避免发生假阴性。     

超声引导联合腔内心电图定位在中心静脉置管中的应用

目的：探讨超声引导联合腔内心电图定位技术在中心静脉置管中的应用价值。 方法：回顾性分析我院2016年1月至2018年6月行超声引导下颈内静脉穿刺并经腔内心电图定位的52例中心静脉置管患者的临床资料,观察首次穿刺成功率、一次性置管到位率及置管并发症情况。 结果：52例患者首次穿刺成功50例,首次穿刺成功率为96.2%,首次穿刺失败需2次穿刺并置管成功2例。所有患者穿刺过程未出现颈动脉误穿、血气胸、空气栓塞等并发症。52例患者经腔内心电图定位后行胸部X线检查,均证实导管头端位置理想,置管深度一次性到位率100%。2例患者在调整最佳置管深度过程中出现一过性心律失常,均得到及时纠正。 结论：超声引导下颈内静脉穿刺可明确血管有无变异,准确引导穿刺,减少并发症,提高置管成功率。同时,腔内心电图可实时提示置管深度,便于及时、准确指导导管头端位置调整。     

血液病患儿透视导引锁骨下静脉置管方法学研究

目的 探讨通过透视导引锁骨下静脉置管术(SVC)提高置管成功率,更好地确定导管头端位置,减少手术相关并发症发生.方法 对183例1～16岁明确诊断为血液病患儿行透视下SVC术.观察置管成功率、穿刺针数、手术时间、透视时间和手术相关并发症发生情况.结果 183例患儿透视下SVC术均成功(100％).穿刺＜3针成功151例(82.5％),4～6针成功25例,7～10针成功7例,全部导管头端均成功置于上腔静脉与右心房交界处.手术时间5～25 min,平均(10.38±4.04) min.透视时间16～607 s,平均(65,46±55.86)s.术中穿刺动脉2次(2例).平均随访35 d,发生导管相关感染2例,未发生局部穿刺点血肿、血气胸、导管相关血栓形成等并发症.结论 血液病患儿透视导引SVC术置管成功率高,穿刺针数较少,导管头端置放位满意率高,手术并发症少,是安全有效的方法之一.     

CT引导下经皮肝穿刺诊断和治疗的临床应用

目的:提高CT引导下经皮肝穿刺抽吸活检及介入治疗的技术水平,并评价其临床应用价值。方法:26例肝内病变行经皮肝穿刺术,其中19例肝占位和弥漫性病变行活检术,7例临床确诊病例行相应介入治疗术。穿刺部位:肝左叶14例,肝右叶12例。病灶直径1.3～12.5cm。结果:26例患者均一次穿刺成功,穿刺成功率100%。其中19例行活体组织病理学检查,活检诊断符合率94.74%,1例未得出正确病理结果;7例行穿刺后介入治疗,操作成功率100%,并送细胞学检查,诊断符合率达100%。结论:CT引导下经皮肝穿刺为基础进行的抽吸活检及介入治疗对肝脏疾病诊断、鉴别诊断及治疗具有重要临床意义。     

Using a Motion Sensor-Equipped Smartphone to Facilitate CT-Guided Puncture

To demonstrate the use of “Smart Puncture,” a smartphone application to assist conventional CT-guided puncture without CT fluoroscopy, and to describe the advantages of this application. A puncture guideline is displayed by entering the angle into the application. Regardless of the angle at which the device is being held, the motion sensor ensures that the guideline is displayed at the appropriate angle with respect to gravity. The angle of the smartphone’s liquid crystal display (LCD) is also detected, preventing needle deflection from the CT slice image. Physicians can perform the puncture procedure by advancing the needle using the guideline while the smartphone is placed adjacent to the patient. In an experimental puncture test using a sponge as a target, the target was punctured at 30°, 50°, and 70° when the device was tilted to 0°, 15°, 30°, and 45°, respectively. The punctured target was then imaged with a CT scan, and the puncture error was measured. The mean puncture error in the plane parallel to the LCD was less than 2°, irrespective of device tilt. The mean puncture error in the sagittal plane was less than 3° with no device tilt. However, the mean puncture error tended to increase when the tilt was increased. This application can transform a smartphone into a valuable tool that is capable of objectively and accurately assisting CT-guided puncture procedures.     

XperCT辅助PTCD精准治疗恶性梗阻性黄疸的临床应用研究

目的探讨XperCT技术在恶性梗阻性黄疸经皮肝穿刺胆道引流术（percutaneous transphepatic cholangial drainage，PTCD）中提高手术精确性的临床应用价值。 方法选择我院2018年10月至2019年10月期间恶性梗阻性黄疸87例，按照随机数字表法将87例患者分为两组，A组（42例），PTCD术中行XperCT检查；B组（45例），PTCD术中不行XperCT检查。采用t检验、χ²检验，比较两组首次穿刺目标胆管成功率（术前拟穿刺的段级胆管）、成功规避重要器官率（包括肝内肿瘤）、穿刺次数及时间、暴露辐射剂量及术后并发症（出血、胆汁瘘、胰腺炎、感染等）。 结果两组均穿刺成功，首次穿刺目标胆管成功率：A组达到88%，B组51%，P<0.05有统计学意义；成功规避重要器官率，A组可95%规避，B组78%（1例穿刺肿瘤大出血死亡），P=0.018，差异有统计学意义；穿刺时间及次数，A组（14.02±3.23）s、（1.09±0.29）次，B组（63.20±6.22）s、（1.75±0.90）次。暴露辐射剂量A组（6.21±1.35）mGy、B组（21.33±7.38）mGy，术后并发症（出血、感染，胆汁瘘、胰腺炎等），A组（0.07±0.26）例，B组（0.17±0.38）例，以上A组均优于B组，P<0.05，差异有统计学差异。 结论XperCT在PTCD中加以应用可以弥补单一透视的不足，指导介入医师实施精确治疗，同时避免严重并发症的发生，最终改善PTCD治疗效果。     

导引通道辅助经皮置钉治疗无神经损伤胸腰椎骨折

目的 分析新型导引通道辅助经皮椎弓根置钉治疗无神经损伤胸腰椎骨折的手术时间、射线暴露时间及置钉准确性.方法 收集2010年7月至2012年10月采用新型导引通道辅助经皮椎弓根置钉技术治疗的35例无神经损伤胸腰椎骨折患者临床资料,同一术者共完成178枚椎弓根螺钉置钉.记录分析每枚椎弓根螺钉置人时间及术者射线暴露时间,根据术后连续2次手术节段CT扫描结果,对置钉准确性进行分级和评估.结果 本组置钉技术成功率为100％.单枚椎弓根螺钉平均置钉时间为(11.35±2.82) min,平均射线暴露时间为(8.06±2.15)s;156枚(87.64％)螺钉评定为A级,20枚螺钉(11.24％)为B级,1枚螺钉(0.56％)为C级,l枚螺钉(0.56％)为D级.结论 新型导引通道有助于辅助经皮椎弓根置钉过程中定位穿刺点,提高置钉准确性,明显减少置钉时间及射线暴露时间.     

Multicenter evaluation of a new laser guidance system for computed tomography intervention

PURPOSE: To measure the accuracy of laser-guided punctures and to evaluate the usefulness of the developed laser-guided system. MATERIAL AND METHODS: The study included 67 patients referred for computed-tomography-guided puncture. The majority of the punctured lesions were located in the chest (28 patients) or abdomen (19 patients). The mean diameter of the lesion was 3.1 cm, and the mean path length was 6.8 cm. The laser guide was movable along a horizontal or vertical rail and not physically connected to the CT unit. The angle of insertion was entered manually into the display of the unit by the interventional radiologist. A prospective multicenter trial was carried out. RESULTS: A mean of 1.1 needle passes were necessary to reach the target, and in 55 (84.6%) of the patients the target was reached on the first needle pass. The mean deviation of the needle from the preselected angle was 1.8 degrees. The mean targeting time (from the initial localizing scan until the needle was in the target) was 15.6 min. In every case, both the usefulness and the ease of use of the laser guidance system were subjectively evaluated on a 5-point scale; the mean usefulness score was 4.5, while the mean ease of use score was 4.7. CONCLUSION: Different users at four different centers found the laser guidance system useful and easy to use. A high level of accuracy of the puncture angle was obtained in most cases.     

Percutaneous nephrostomy: placement under laser guidance and real-time CT fluoroscopy

The purpose of this paper is to present our experience with real-time computed tomography (CT) fluoroscopy guided percutaneous nephrostomy (PNT) and to describe this technique involving puncture under laser guidance. We attempted 30 placements in 25 patients: puncture was directed by laser guidance and placement of the tube was made under real time CT fluoroscopy. 25 procedures were performed in prone position and 5 procedures in the supine position. The time necessary for the procedure ranged from 10 to 45 min (mean 25 min). The average duration of CT fluoroscopy per placement was 49 seconds (range 7–110 s). The PNT placement was successful as a sole procedure including puncture and catheter placement in 24 of 30 cases; in the remainder of cases, puncture was performed under CT guidance but the catheter was definitively positioned in conventional fluoroscopy. The CT fluoroscopy technique allows routine, efficient and safe PNT placement, especially when encountering difficult access to the pelvicaliceal system. Received: 9 June 1999; Revised: 12 November 1999; Accepted: 12 November 1999     

Electromagnetic-Tracked Biopsy under Ultrasound Guidance: Preliminary Results

Purpose

This study was designed to evaluate the accuracy and safety of electromagnetic needle tracking for sonographically guided percutaneous liver biopsies.

Methods

We performed 23 consecutive ultrasound-guided liver biopsies for liver nodules with an electromagnetic tracking of the needle. A sensor placed at the tip of a sterile stylet (18G) inserted in a coaxial guiding trocar (16G) used for biopsy was localized in real time relative to the ultrasound imaging plane, thanks to an electromagnetic transmitter and two sensors on the ultrasound probe. This allows for electronic display of the needle tip location and the future needle path overlaid on the real-time ultrasound image. Distance between needle tip position and its electronic display, number of needle punctures, number of needle pull backs for redirection, technical success (needle positioned in the target), diagnostic success (correct histopathology result), procedure time, and complication were evaluated according to lesion sizes, depth and location, operator experience, and “in-plane” or “out-of-plane” needle approach.

Results

Electronic display was always within 2 mm from the real position of the needle tip. The technical success rate was 100%. A single needle puncture without repuncture was used in all patients. Pull backs were necessary in six patients (26%) to obtain correct needle placement. The overall diagnostic success rate was 91%. The overall true-positive, true-negative, false-negative, and failure rates of the biopsy were 100% (19/19) 100% (2/2), 0% (0/23), and 9% (2/23). The median total procedure time from the skin puncture to the needle in the target was 30 sec (from 5–60 s). Lesion depth and localizations, operator experience, in-plane or out-of-plane approach did not affect significantly the technical, diagnostic success, or procedure time. Even when the tumor size decreased, the procedure time did not increase.

Conclusions

Electromagnetic-tracked biopsy is accurate to determine needle tip position and allows fast and accurate needle placement in targeted liver nodules.     

Ultrasound-guided fine-needle puncture of the thyroid

If properly performed, modern high-resolution real-time ultrasonography will disclose subtle differences in the texture of thyroid tissue and thereby enable the examiner to suggest a diagnosis. Nevertheless, there is often a need for a more specific diagnosis of solid or semisolid thyroid lesions - especially when the lesion might be malignant. Ultrasonically guided fine-needle aspiration biopsy (UG-FNB) allows a final cytological and/or histological diagnosis to be made in patients with benign or malignant space-occupying growths even if they are small. In its simplest form, thyroid nodules (diameter greater than 1.5 cm) with a uniform sonographic texture are punctured blind after determination of the site and size of the lesion on the basis of ultrasonic imaging. When the lesion is small and deeply situated (diameter less than or equal to 1.5 cm), this method will not be sufficiently accurate and more precise needle guidance is mandatory. In ultrasonically guided fine-needle puncture, the idea is to place the tip of an appropriate needle safely and accurately in the suspect lesion, so that representative specimens of solid tissue or fluid can be obtained and technical failures reduced. The main indication for biopsy of the thyroid gland is to differentiate between benign and malignant tumors. To compare the accuracy of conventional puncture techniques and ultrasonically guided puncture methods, 835 patients with benign or malignant space-occupying growth (even the small ones) were examined simultaneously with conventional and ultrasonically guided fine-needle aspiration biopsy over a period of 3 years (prospectively). Our results showed a significant difference in the sensitivity between conventional puncture without sonographic guidance and ultrasonically guided puncture techniques performed on patients with small and very small lesions (phi less than 2 cm). The size, macroscopic structure, and topographic-anatomical localization of the lesions were found to influence the diagnostic accuracy of the puncture techniques. UG-FNB is an excellent, effective, safe and painless method of treating uncomplicated thyroid cysts; it should be considered an alternative to surgery, if there are no clinical and cytological findings indicating malignancy and no severe space-occupying complications. Since the tip of the needle can be visualized on the scan, the needle may be advanced or withdrawn during aspiration so it is possible to empty the cyst completely. The use of ultrasound in the follow-up of patients with thyroid cyst puncture is mandatory to evaluate the results. Surgical therapy should be reserved for large cysts causing space-occupying complications.