人工气胸后CT引导下纵隔病变穿刺活检术的护理

目的:探讨接受人工气胸后CT引导下纵隔病变穿刺活检术患者的护理措施。方法:对36例做人工气胸后进行纵隔穿刺活检术的患者进行充分、积极的术前准备及护理、术中配合与术后护理。结果:36例患者均穿刺活检成功,除2例略感胸痛外无1例出现并发症。结论:人工气胸后纵隔穿刺活检是一种更安全,定位更精确、组织检出率高的新技术,充分的术前准备,积极的术中配合和术后护理对保证患者手术顺利、预防并发症的发生有重要意义。     

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。     

CT导向经皮肝穿刺活检的临床应用

目的：提高CB导向经皮肝穿刺活检的技术水平，并评价其临床应用价值。方法：采用SiemensSOMA－TOMHiQ-S型全身CT扫描仪及自动活检他（18G）对16例肝脏占位性病变患者行CT导向经皮肝穿刺活检术。穿刺部位；肝右叶10例，肝左叶5例，肝尾叶1例。病灶直径1．5－11．7cm。结果：16例患者均一次穿刺成功，穿刺成功率为100％。15例肝脏占位性病变得到病理学诊断，活检确诊率为93．75％（15／16），原发性肝癌8例、转移性腺癌5例，恶性肿瘤1例，炎性假瘤1例，1例未见肿瘤细胞。无1例发生出血等并发症。结论：CT导向经皮肝自动活检枪穿刺活检或功率和确诊率高，创伤小，并发症少，是肝脏占位性病变及鉴别诊断的一种操作简便、安全可靠重要手段。     

CT导向经皮肺部病变穿刺活检的临床效果

目的探讨CT导向经皮肺穿刺活检的临床应用和体会。方法 66例经CT导向做肺穿刺活检的患者,肺内肿块为62例,胸膜病变2例,肋骨及胸腺病变各1例,采用切割针和抽吸针。结果经一次穿刺成功诊断59例。穿刺后病理怀疑肺鳞状细胞癌,结果为肺脓肿1例;第一次穿刺假阴性6例,其中有2例再次穿刺成功诊断为肺腺癌和鳞状细胞癌。本组穿刺活检总的成功率为92.4%。结论 CT导向经皮肺穿刺活检是一项安全有效的诊断方法,CT的准确定位和良好的穿刺技术及病理科的配合和熟练的技术操作是提高活检成功率的重要因素。     

CT引导下经皮穿刺活检对肝部恶性肿瘤的诊断价值分析

目的探讨分析CT引导下经皮穿刺活检对肝部恶性肿瘤的诊断价值。方法收集接受CT引导下经皮穿刺活检,且经病理证实的120例肝脏恶性肿瘤患者的临床资料,统计穿刺成功率、穿刺并发症发生情况及与病理诊断符合情况。结果 120例患者1次定位成功率98.33%,1次穿刺活检成功率为95.83%;穿刺后穿刺部位出现轻度疼痛41例,2例低热,2例肝包膜少量出血;120例中经皮穿刺活检确诊为肝脏恶性病变108例,病理阴性12例,但经术后证实1例为肝细胞肝癌,3例为腺癌,2例为未分化癌,1例为神经内分泌癌,1例为鳞癌,1例为小细胞癌,3例为未分类癌,经皮穿刺活检与手术病理及随访结果符合度为90.00%。结论 CT引导下经皮穿刺活检诊断肝部恶性肿瘤与手术病理符合度高,定位及穿刺成功率高。     

超声引导穿刺活检和增强CT对AFP阴性肝脏占位性病变的诊断分析

目的探讨超声引导下经皮穿刺活检和增强CT对甲胎蛋白(AFP)阴性肝脏占位性病变的诊断价值。方法选取本院诊治的AFP阴性肝脏占位性病变患者108例为研究对象,在超声引导下穿刺活组织检查,比较CT增强对AFP阴性肝脏占位性病变的诊断结果与病理学检查标准之间的差异,分析其诊断价值。结果 108例患者行经皮穿刺活检病理学检查结果发现,恶性病变的有74例,良性病变的有34例。超声引导下穿刺活检病理学检查的灵敏度、特异度均为100%,增强CT为89.19%、82.35%。结论超声引导下经皮肝脏穿刺活组织检查对AFP阴性肝占位性病变具有操作简单、安全性高,适宜临床应用。     

肝内胆管细胞癌的CT诊断

目的：探讨肝内胆管细胞癌的CT表现及其诊断价值。方法对28例经手术或穿刺活体组织检查经病理证实为肝内胆管细胞癌患者的CT表现进行分析。结果28例肝内胆管细胞癌患者的30个病灶CT平扫均为低密度,病变区或其周围见胆管扩张,其中15例见肝包膜回缩征,11例为肝内胆管结石术后。增强扫描动脉期病灶边缘环形增强9例。门静脉期11例中央网格样增强。延迟期8例呈向心性增强,密度略高于正常肝实质。结论肝内胆管细胞癌CT表现具有一定特异性,有利于肝内胆管细胞癌诊断。     

肝脏占位性病变经皮穿刺活检术出血并发症的危险因素分析

【摘要】 目的 寻找影像引导肝脏原发或继发占位性病变经皮穿刺活检术后发生出血并发症的危险因素。方法 回顾性分析2015年1月至2020年7月515例肝脏占位性病变行超声或CT引导穿刺活检患者的临床资料。将术后出现腹腔或肝包膜下出血作为因变量，将患者性别、年龄、病变类型、病理结果、肿瘤大小、位置、是否位于肝包膜下、有无肝硬化、穿刺引导方式、穿刺组织条数、穿刺深度、术前血小板、凝血酶原时间国际标准化比值（INR）及血红蛋白作为自变量，所有自变量行单因素logistic回归分析，将P＜0.05自变量行多因素logistic回归分析，筛选肝脏占位性病变经皮穿刺活检术出血并发症的危险因素。结果 共纳入453例肝脏占位性病变行穿刺活检的患者，术后发生腹腔或肝包膜下出血者19例（4.2%）。单因素logistic回归分析显示肝硬化、穿刺组织条数及穿刺深度与术后发生出血有关。多因素logistic回归分析显示肝硬化与穿刺深度为出血并发症的危险因素（P＜0.05）。受试者工作特征（ROC）曲线预测肝硬化患者穿刺活检术后发生出血并发症的敏感性为32%，特异性为97.9%。结论 肝硬化及穿刺深度是肝脏占位性病变经皮穿刺活检术出血并发症的危险因素。     

膈顶部肝脏病变CT引导下切割针活检的准确性和安全性

目的评价膈顶部肝脏病变CT引导下切割针活检的准确性和安全性。方法25例患者在CT引导下用16 G或18 G切割针进行穿刺活检。结果组织学检查恶性病变17例,良性病变8例。总体检查假阴性2例(8%),未发现假阳性,恶性病变和良性病变诊断特异度分别为100%和75%,诊断总准确率92%。并发气胸者2例(8%);1例出现针道出血(4%),1例出现肝包膜下出血(4%)。结论CT引导下膈顶部肝脏病变切割针活检是一种可靠和相对安全的诊断方法。     

CT导向下纵隔肿瘤穿刺活检术

目的：评价CT导向下纵隔肿瘤穿刺活检的临床应用价植。方法：回顾性分析74例纵隔病变CT导向下纵隔穿刺活检术。芽刺针采用18G CHIBA针、18G切割针，74例均做病理组织学检查．8例作免疫组化。结果：①病变部位前纵隔62例，中纵隔8例，后纵隔4例；②63例病理诊断明确：胸腺瘤16例。恶性淋巴瘤12例．转移性腺癌7例、鳞癌4例、小细胞癌2例，畸胎瘤、恶性精原细胞瘤各5例、内胚窦癌2例。神经纤维瘤、恶性神经鞘膜瘤、节细胞神经纤维瘤各1例，3例诊断为小圆细胞恶性肿瘤，3例为异型细胞。1例诊断为结核；③11例病理诊断不确定：临床诊断为恶性淋巴瘤1例、纵隔淋巴结结核1例，经手术病理诊断为胸腺瘤、纵隔脂肪瘤、血管肉瘤、纤维肉瘤各1例，2例失访；④穿刺活检正确率为85．1％，假阴性率为14．9％，未见假阳性病例；⑤气胸发生率为5．4％。为少量气胸，3例术后痰带血丝．1例纵隔局限性血肿。结论：CT导向下纵隔肿瘤穿刺活检术是纵隔病变安全而有效的诊断方法。     

Combined utility of one lung ventilation and artificial pneumothorax in thermal ablation of hepatic dome tumor: a technical note

Radiofrequency ablation and microwave ablation are established treatment modalities for smaller (<3 cm) or isolated hepatic tumors. Transthoracic ablation of hepatic dome lesions is a well described technique. We report the use of one lung ventilation to facilitate the successful percutaneous transthoracic microwave ablation of a segment 8 hepatic dome lesion after induction of artificial pneumothorax. This involved the use of general anesthesia and insertion of a double lumen endotracheal tube to allow isolated ventilation of one lung, followed by creation of an artificial pneumothorax under computed tomography (CT) guidance. Complete ablation of the lesion was confirmed on CT liver at 1 and 7 months with no local recurrence. The combined techniques of one lung ventilation and artificial pneumothorax enabled a safe and accurate transthoracic targeting of the hepatic dome lesion.

Thermal ablation techniques such as radiofrequency ablation (RFA) and microwave ablation (MWA) are alternative treatment options for patients with small (<3 cm) or isolated lesions. Transthoracic ablation of lesions is safe and effective for treatment of hepatic dome lesions.Current standard of practice in most centers is the administration of local anesthesia with moderate conscious sedation for percutaneous RFA or MWA. Thermal ablation under sedation is poorly tolerated in patients whose lesions are more than 3 cm in size or in the sub-diaphragmatic location, commonly requiring conversion to general anesthesia due to pain on ablation and/or need for controlled apnea to allow for accurate targeting of the lesion (1). Additionally, incomplete ablation of tumors is more common in procedures with sedation compared to general anesthesia (1).Even under general anesthesia, hepatic dome lesion targeting is affected by the constant respiratory movements of the liver and diaphragm. We report the use of one-lung ventilation (OLV) to facilitate safe and successful transthoracic percutaneous computed tomography (CT)-guided MWA of a hepatic dome hepatocellular carcinoma (HCC) lesion after induction of artificial pneumothorax to avoid injury to the lung and visceral pleura.     

胃左动脉参与肝细胞癌供血的双源CT血管成像研究

目的:探讨胃左动脉(LGA)参与肝细胞癌(HCC)供血的影响因素。方法:采用双源CT对91例左叶HCC患者进行血管成像扫描,采用MPR、CPR、MIP、VR等后处理技术重建LGA。分析LGA参与HCC供血与病灶大小、位置、假包膜的完整性及接受经导管动脉化疗栓塞(TACE)治疗的关系。结果:91例患者共计104个HCC病灶,23个病灶有LGA参与供血,发生率为22.1%。23个有LGA参与供血的HCC病灶中,19个为巨块型,4个为结节型,22个突破了肝被膜,17个接受了TACE治疗,23个病例均无完整假包膜。LGA参与供血的形式包括:通过左叶肝动脉供血3个,通过左叶副肝动脉供血5个,直接发出分支进入瘤体15个。结论:LGA是常见的左叶HCC肝外侧支动脉,其发生与肿瘤较大、突破肝被膜、缺乏完整假包膜和接受TACE治疗有关。     

肝胆特异性磁共振对比剂Gd-EOB-DTPA在肝脏局灶性病变诊断中的应用研究

目的:探讨Gd-EOB-DTPA MRI增强扫描时肝局灶性病变的表现及此新型对比剂的诊断效能,提高对肝脏局灶性病变的诊断准确性。方法:已知或怀疑为肝脏局灶性病变的34例患者共90个病灶,病灶性质依次为肝囊肿20个、肝细胞肝癌16个、胆管细胞癌1个、肝脏转移性肿瘤37个、肝血管瘤9个、退变结节1个、肝脏局灶性结节增生1个、肝细胞腺瘤1个、肝脏炎性病变3个及肝脏淋巴上皮瘤样癌1个。所有患者依次行MRI平扫(抑脂TSE T2WI、抑脂3DVIBE、2DGRE T1WI)、Gd-EOB-DTPA三期(动脉期、门脉期和平衡期)增强扫描(抑脂3DVIBE)及延迟20min肝实质期扫描(抑脂2DGRE T1WI、抑脂TSE T2WI、抑脂3DVIBE)。测量并分析Gd-EOB-DTPA增强前后肝脏和病灶信号变化、病灶-肝脏对比噪声比绝对值(|CNR|)变化情况,并观察病灶Gd-EOB-DTPA增强扫描表现和特征。结果:Gd-EOB-DT-PA增强后各期肝实质信号及病灶-肝脏|CNR|均显著增加(P<0.001)。动脉期、门脉期和平衡期所有病灶符合应用常规含钆(Gd)对比剂时的强化表现和特征;延迟20min肝实质期扫描时,肝脏局灶性结节增生呈等信号-高信号,1个肝细胞肝癌呈相对高信号,其余肝囊肿、肝细胞肝癌、胆管细胞癌、肝脏转移性肿瘤、淋巴上皮瘤样癌、退变结节、肝细胞腺瘤、肝血管瘤和肝脏炎性假瘤等均呈相对低信号。结论:Gd-EOB-DTPA动态增强扫描与延迟肝实质期扫描联合应用,可以提供病变形态、血供、细胞来源及功能等更多相关信息,从而提高诊断信心及诊断准确性。     

CT引导肺内小结节经皮穿刺活检术的临床应用

目的：评价CT引导经皮穿刺肺内直径≤1.5cm小结节的临床价值。方法：65例肺内小结节患者行CT引导经皮穿刺活检术,分析其敏感度、特异度、准确度及并发症。结果：恶性肿瘤的诊断敏感度92.3%（36/39）,阳性预测值100%;良性病变诊断特异度100%,阴性预测值89.7%（26/29）,总诊断符合率92.3%（60/65）。气胸发生率7.7%（5/65）,肺内出血发生率10.8%（7/65）,术后均未作特殊处理。结论：CT引导经皮穿刺肺内小结节直径≤1.5cm病灶准确度较高且并发症发生率较低。     

CT引导下经皮肺穿刺切割活检的价值及安全性

目的：评价CT引导下经皮肺穿刺活检对肺部疑难疾病的诊断价值及安全性。方法：回顾性分析有手术病理、临床或影像随访结果的CT引导下经皮肺穿刺活检105例,其中97例为肺部局限性病灶（A组）,8例肺部弥漫性病灶（B组）。结果：2组共有101例穿刺物结果与手术病理、临床或影像学随访结果相符：穿刺诊断正确率96．2％。A组穿刺诊断正确率（99．0％）高于B组（62．5％）（P〈0．01）。A组肺癌占79．4％（77／97;B组肺癌占60．0％（3／5）;二组差异无统计学意义（P〉0．05）。两组合计发生气胸24例;出血34例,其中咯血18例。结论：cT引导下经皮肺穿刺切割活检穿刺诊断正确率高,是肺内疑难病变定性诊断的理想方法;使用18G穿刺针,可减少穿刺次数、降低出血的发生。     

磁共振弥散加权成像在肝脏占位性病变诊断中的应用

目的：探讨磁共振弥散加权成像（DWI）在肝脏占位性病变中的应用价值。方法：对30例无肝脏病变者的正常肝组织及92例肝占位性病灶（肝囊肿16例,肝血管瘤29例,肝细胞癌19例,肝转移瘤16例,胆管细胞癌12例）行DWI检查,并测量表观弥散系数值（ADC值）。结果：正常肝组织的ADC值为（0．0011790±0．0000960）mm^2／s。肝囊肿、肝血管瘤、肝细胞癌、肝转移瘤及胆管细胞癌的ADC值分别为（0．0029894±0．0003620）、（0．0021921±0．0006004）、（0．0016763±0．0003620）、（0．0020450±0．01302446）、（0．0011615±0．0002702）mm^2／s。结论：分析DWI图像及测量ADE值对肝脏占位性病变的鉴别诊断有一定价值,有利于小病灶的显示,可作为肝脏MRI检查的常规序列之一。     

Percutaneous Ethanol Injection via an Artificially Induced Right Hydrothorax for Hepatocellular Carcinoma in the Hepatic Dome

To evaluate the efficacy of sonographically (US) guided percutaneous ethanol injection (PEI) via an artificially induced right hydrothorax (transthoracic PEI) to treat US-invisible hepatocellular carcinoma (HCC) in the hepatic dome. Five cirrhotic patients with US-invisible HCC in the hepatic dome, who were poor surgical candidates, underwent transthoracic PEI. An artificial right hydrothorax was created by instilling 500 ml saline, and absolute ethanol was injected transhydrothoracically into the hepatic dome lesion under local anesthesia. The success and complications were assessed radiologically. The patients were followed up serologically and radiologically for 12–44 (mean 28.4) months. Twenty-five hydrothoraces were induced. All hydrothoraces enabled US visualization of the entire hepatic dome. Eight of the nine small lesions were treated successfully by the treatment. Two of the three local recurrences were eradicated by repeat transthoracic PEI. One large lesion was treated by a combination of transthoracic and regular PEI. The only complication was one clinically insignificant pneumothorax. Induction of a right hydrothorax is feasible and safe. The hydrothorax enables US visualization of the entire hepatic dome and permits US-guided PEI for HCC in the hepatic dome that otherwise would not be possible.     

改进的定位技术在胸部肿瘤穿刺活检中的应用

目的：探索CT-SIM三维定位系统、体模固定技术和PET-CT融合影像导引定位技术在胸部肿瘤经皮穿刺活检中的应用价值。方法：对380例胸部肿瘤患者行改进的CT定位技术下的经皮穿刺活检术。根据肿瘤的大小、深度、毗邻关系、活动度以及患者的心肺功能状态,综合运用CT-SIM系统、体模固定技术和PET-CT融合影像导引技术,为患者进行穿刺前定位。统计穿刺定位时间长度、成功率、确诊率、并发症发生情况,并与210例采用传统铅栅定位下胸部肿瘤穿刺活检的相应资料进行比较。结果：采用改进的CT定位技术的380例患者穿刺定位精确,平均定位时间（9.5 min）较传统方法（16.8 min）缩短7.3 min,活检成功率和确诊率分别是98.7%和95.3%,高于传统定位方法的93.3%和83.3%,两者差异均具有统计学意义（P〈0.05）。穿刺并发症发生率相似,气胸发生率分别为2.8%和2.9%,咯血发生率分别为11%和12.8%。结论：根据患者状态及肿瘤特点,在CT-SIM系统快速精确定位技术的基础上,综合运用体模固定技术和PET-CT融合影像导引技术,能显著缩短经皮穿刺活检的定位时间,提高活检成功率。     

Imaging-guided core needle biopsy of papillary lesions of the breast

OBJECTIVE: Our objective was to assess the incidence of papillary lesions of the breast diagnosed at imaging-guided core needle biopsy and the need for surgical excision after a benign diagnosis. MATERIALS AND METHODS: This retrospective study included 1374 patients with consecutive suspicious breast lesions that underwent either mammography or sonographically guided large-core needle breast biopsy. Fifty-seven lesions (4%) were classified as papillary lesions. Eleven of the 57 cases were lost to follow-up (n = 6) or had not yet shown 2 years of stability (n = 5) and were excluded from this study. The remaining 46 papillary lesions constitute our study population. RESULTS: Surgical excision was performed in 17 (37%) of 46 papillary lesions. In the group of patients whose lesions were recommended for excision because carcinoma was identified at core biopsy, surgical excision revealed one false-positive and two true-positive diagnoses. In four cases, histologic diagnoses of the excisional biopsy and the core needle biopsy were discordant. One false-positive finding at core needle biopsy initially was interpreted as invasive ductal carcinoma on the basis of core needle biopsy specimens. In three false-negative findings, the initial diagnosis at core needle biopsy was upgraded after surgical excision. Two cases of papilloma with adjacent atypical ductal hyperplasia and one of atypical papilloma were upgraded to ductal carcinoma in situ after surgical excision. Imaging follow-up was performed in the remaining 29 patients. All lesions were stable or had decreased in size during the 2-year follow-up period. The negative predictive value of core needle biopsy for excluding malignancy among the papillary lesions diagnosed in our study was 93%. CONCLUSION: When the histologic diagnosis is benign, our data suggest that papillary lesions may be safely managed with imaging follow-up rather than with surgical excision. However, atypical papillary lesions or those associated with atypia require surgical excision because histologic underestimation occurs at a frequency similar to that in other atypical lesions undergoing core needle biopsy.