3D打印共面模板辅助CT引导下经皮肺穿刺活检技术的临床应用

目的 介绍北京大学第三医院3D打印共面模板(3DPCT)在CT引导下经皮肺穿刺活检术中的应用情况.方法 将24例进行3DPCT辅助CT引导下肺病变穿刺活检术的患者纳入分析,总结操作流程,分析操作时间、活检针调整次数、CT扫描次数、病理学检查结果和并发症的发生情况.结果 24例患者均采用2根固定针,其中15例(62.50%)取材1次,9例(37.50%)取材2次.平均操作时间为(26.45±5.73)min,平均活检针调整(0.13± 0.34)次,平均CT扫描(5.25±0.53)次.21例(87.50%)活检针1次到位,3例(12.50%)调整1次.20例(83.33%)病理结果为阳性.并发症方面,18例(75.00%)出现针道出血;4例(16.67%)出现气胸,其中1例(4.17%)需要进行胸腔闭式引流;3例(12.50%)出现术后咯血,所有发生并发症的患者经对症治疗后皆痊愈.结论 3DPCT辅助CT引导下经皮肺穿刺技术,在可接受的操作时间和CT扫描次数下,有较高的穿刺准确率,减少了肺内调整活检针的次数.熟练、规范的操作可以进一步提高肺穿刺的准确率和安全性,有较高的临床推广应用价值.

Clinical application of CT guided percutaneous lung biopsy assisted by 3D printing coplanar template

Objective To introduce the clinical application of three dimensional printing coplanar template(3DPCT) in CT-guided percutaneous needle lung biopsy.Method 24 patients who underwent CT-guided percutaneous lung biopsy assisted by 3DPCT in our department were included in the analysis.The procedures,operative time,frequency of punc-ture needle adjustment,number of CT scan,pathology results and complications were summarized and analyzed.Result All of the 24 patients had two fixed needles,15 cases(62.50%)were biopsied once,and 9 cases(37.50%)were biopsied twice.The average operative time was(26.5±5.73)minutes,and average frequency of puncture needle adjustments was (0.13±0.34)times,the average number of CT scans was(5.25±0.53)times.The biopsy needle was in place without adjust-ment in 21 patients(87.50%),while 3 cases(12.50%)were adjusted once.For pathology,20 cases(83.33%)had positive results.As for complications,18 cases(75.00%)had needle tract bleeding;pneumothorax occurred in 4 cases(16.7%), and the thoracic drainage was needed in 1 case(4.17%),and postoperative hemoptysis occurred in 3 cases(12.50%).All the patients with complications were cured after symptomatic treatment.Conclusion With acceptable operative time and CT scans,3DPCT assisted CT-guided lung biopsy technology has good puncture accuracy and reduced the frequency of puncture needle adjustment in lung.Skilled and standardized procedures can further improve the accuracy and safety of lung puncture,and the technology is clinically applicable.