CT引导下咽旁区经皮穿刺切割活检术探讨

目的 探讨CT引导下咽旁区经皮穿刺切割活检术的安全性和效果。方法 临床疑鼻咽癌咽旁区侵犯或咽旁区复发患者32例,均在CT引导下行咽旁区经皮穿刺切割术。对前、中、后咽旁间隙病灶,分别选取上颌窦外后侧脂肪间隙、下颌切迹、乳突前3条不同穿刺路径,采用16～18G切割针,经皮穿刺直达咽旁病灶区,行切割活检,95％无水酒精固定标本,送病检。结果 32例均1次穿刺成功,并获得足够的组织用于病理诊断。其中30例阳性,鳞癌21例,术分化癌5例,腺癌4例;另外2例阴性患者,经临床随访证实为放疗后纤维化。诊断准确率为100％1例患者术中穿剌点出血较明显,压迫20min后出血停止。3例患嚣术后出现痰中带血,经止血药物治疗后症状消失。全部穿刺活检患者均未出现神经损伤症状。结论 在CT引导下,根据病灶部何不同选取不同路径行咽旁区穿刺切割活组织检查安全、快捷。

Investigation of CT guided percutaneous incisional needle biopsy in parapharyngeal region for suspicious nasopharyngeal carcinoma

Objective To investigate the safety and efficacy of percutaneous incisional needle biopsy(PINB) in the parapharyngeal region under CT guide for highly suspicious nasopharyngeal carcinoma(NPC) or recurrence of NPC after radiotherapy.Methods PINB under CT guide was performed in 32 highly suspicious NPC or recurrence of NPC after radiotherapy through three puncture routes: posterolateral maxillary sinus fatty area,mandibular fossa area,and anterior-mastoid area.Specimens were fixed by 95% alcohol and then underwent pathologic examination.Results CT guided PINB was successfully performed in every patients with a technical successful rate of 100%.Definitive histopathologic diagnosis was obtained in 30 patients: squamous-cell carcinoma 21,undifferentiated carcinoma 5 and adenocarcinoma 4.The remaining two negative cases were confirmed as fibrosis after radiotherapy.Complications included persistent bleeding of puncture point in one patient and bloody sputum in 3 patients which subsided after symptomatic management.None of these patients was found to have symptoms of nerve injury caused by PINB procedure.Conclusion The CT guided percutaneous incisional needle biopsy in parapharyngeal region through the above three punctue routes for highly suspicious nasopharyngeal carcinoma is safe,rapid and effective.