“立体定向三点一线择优穿刺法”在甲状腺结节微创组织病理活检术中的应用价值

目的探讨“立体定向三点一线择优穿刺法”在超声引导甲状腺结节微创组织病理活检术中的应用价值。方法总结分析2009年9月—2012年4月我科应用“立体定向三点一线择优穿刺法”完成甲状腺结节微创组织病理活检921例（共1030个结节）的临床资料。结果 921例穿刺术用时6～26分钟,平均13分钟。结节直径0.3～2.3cm,平均0.92cm。结节直径〈0.5cm 165例,占17.9%。结节紧邻颈部大血管、神经、气管及食道（“危险区”）135例,占14.6%。921例患者活检取材,穿刺成功率为100%（921/921）。活检诊断为甲状腺癌的269例,良性病变652例。活检后行手术治疗385例,病理符合率98.4%。假阴性（甲状腺癌误诊为良性疾病）6例,假阴性率1.6%（6/385）。无假阳性。活检后患者均未出现明显不适,发生腺体表面及肌间少许渗出34例,无明显血肿形成,未经特殊处置,平均1个月后自行吸收。结论 “立体定向三点一线择优穿刺法”应用简便、准确,缩短了手术时间,同时提高了病理的检出率,降低了手术风险。提高了手术的成功率。

The value of "stereotactic three-point-one-line optimal puncture "in thyroid nodule minimally invasive biopsy surgery

Objective To investigate the value of “stereotactic three-point-one-line optimal puncture”in ultrasound- guided thyroid nodule minimally invasive biopsy surgery. Methods Take clinical data of 921 cases（1030 nodules） from September 2009 to April 2002 applying“stereotactic three-point-one-line optimal puncture ” minimally invasive biopsy into analysis. Results Operation time were 6 ～26 minutes in all cases,with an average of 13 minutes. Nodule diameter ranged in 0.3 ～ 2.3 cm,with an average of 0.92 cm. In 165 cases,nodule diameter were lower than 0.5cm,aecounting for 17.9 %. In 1 35 cases, nodules tightly close to cervical vessels, nerves, trachea and esophagus （as the “danger zone”） accounting for 14.6 %. All of 921 patients accepted puncture biopsy with success rate of 100 % （921/921）. Biopsy diag- nosed 269 cases of thyroid carcinoma,652 cases of benign lesions. 385 cases underwent surgical treatment after biopsy, and pathological, coincidence rate reached to 98.4 %. Six cases confirmed false negatives （thyroid cancer misdiagnosed as benign disease） ,with false-negative rate of 1.60/00 （6/385）. No false positive cases. Afte biopsies patients showed no ob vious discomfort,no obvious hematoma formation,although 34 cases occurred little effusion on the gland surface or in- termuscle without special treatment,and finally selbabsorbed within an average of one month. Conclusion “Stereotactic three-point-on-line optimal puncture” is simple, accurate, shortening the operation time. Additionally, the method im prove the pathological detection rate and success rate of surgery,and reduce the risk of surgery.