CT导向经皮肌肉骨骼穿刺活检的临床应用

目的：探讨ＣＴ导向经皮肌肉骨骼穿刺活检的方法并评价其临床应用价值。材料与方法：采用Ｓｉｅｍｅｎｓ　ＳＯ－ＭＡＴＯＭ ＨｉＱ－Ｓ型 ＣＴ扫描仪及Ａｎｇｉｏｍｅｄ自动活检枪行 ＣＴ导向经皮肌肉骨骼穿刺活检 １２例。穿刺部位：骨骼系统 １０例,肌肉系统２例。结果：１２例均一次穿刺到位,穿刺成功率为１００％。１２例均得到定性诊断,活检确诊率为１００％。无一例发生并发症。结论：ＣＴ导向经皮肌肉骨骼自动活检枪穿刺活检成功率和诊断准确率高,并发症少,是一种简便安全的介入性诊断的微创伤性新技术。     

CT引导下经皮肺穿刺活检失败27例原因分析

目的 探讨CT引导下经皮肺穿刺活检失败的原因和预防措施.方法 山东省临朐县人民医院2007-05-2011-11进行了156例CT引导下肺穿刺活检术,其中27例第一针未取出肿瘤组织.对27例病例进行回顾性分析,分析穿刺失败的原因,并探讨预防措施.结果 27例第一针穿刺失败病例中穿出正常肺组织12例；坏死组织8例；慢性炎症4例;空针3例.12例穿出正常肺组织病例主要是由于术者操作不当、肿块位置较深、肿块体积小及患者不能配合造成的;8例穿出肿瘤坏死物是由于未能区分肿块实性部分及坏死部分；4例慢性炎症是由于肿块与周围阻塞性炎症区别不清;3例空针是由于穿刺针道偏离后修正不正确或活检针凹槽短有关.结论 在穿刺活检的操作过程中,失败的概率比较大.术者操作不当是导致穿刺失败的主要原因,操作中应不断完善穿刺技巧和熟练程度,最大限度避免穿刺失败,减少患者痛苦和并发症的发生.将会使此项技术得到更广泛的应用.     

CT引导下抽吸针引导活检枪经皮穿刺肺活检的临床应用（附70例报告）

目的 探讨抽吸针引导活检枪的临床应用价值。方法 对70例肺部疾病患者进行CT导引下抽吸针与活检枪联合应用经皮穿刺肺活检。结果 70例肺部穿刺均一次成功。取材成功率94．3％，活检诊断正确率92．9％，气胸发生率14．3％，咯血发生率7．1％。结论 CT导引下抽吸针与活检枪联合应用经皮穿刺肺活检对肺部疾病的诊断有着重要的价值。     

CT导引下腹部细针穿刺抽吸活检的临床应用

目的:探讨CT导引下腹部细针穿刺抽吸活检技术方法并评价其临床应用。材料与方法:男20例,女7例,年龄7～88岁。穿刺部位包括肝内肿物10例,胰头肿物3例,脾脏肿物、肾脏病灶各1例,腹、盆腔内肿物9例,腹膜后肿物3例。使用岛津SCT3000TC全身CT扫描机作导引,选用18-22G(150mm)Chiba活检针,选择最佳层面、进针路径及取材点穿刺抽吸。结果:腹部细针穿刺抽吸活检阳性率88.9％,2例首次活检为阴性结果,再次活检得到阳性结果,首次活检阳性率82.8％。无任何并发症。结论:CT导引下腹部细针穿刺抽吸活检正确率高、安全,活检方法简便、实用,可为临床制定治疗方案提供可靠依据。     

CT引导下经皮胸部穿刺活检术的临床应用研究

目的:探讨CT引导下经皮胸部穿刺活检术的准确性、并发症及临床意义。材料与方法:96例病变,其中肺部病变88例,胸膜病变5例,纵隔病变3例。病变大小1.0cm×1.2cm×2.0cm～9.0cm×10.5cm×8.5cm。在CT引导下用细针经皮胸部穿刺活检,病变经手术病理、细胞学及临床随访证实。结果:96例病变中,肺癌68例,肺转移瘤3例,结核6例,胸膜间皮瘤5例,胸腺瘤3例,炎症11例。穿刺准确率为91.7%(88?96),发生气胸14例。结论:CT引导下经皮胸部穿刺活检是一种相对安全、简单准确的诊断方法。     

自动活检枪经皮肺及胸膜活检的临床应用

目的探讨超声引导下自动活检枪经皮肺穿刺及胸膜活检在临床中的价值。方法110例肺周围型病变(A组)及102例不明原因胸腔积液(B组)行穿刺活检。结果A组病理确诊率95.5%,B组病理确诊率91.2%。结论超声引导下自动活检枪经皮肺活检及胸膜活检安全、方便,确诊率高、并发症少。     

X线导向经皮骨穿刺活检价值

目的:探讨X线导向经皮骨穿刺活检对骨病的诊断价值。材料和方法:骨穿刺活检79例,通过观察X线片及确定活检的最佳部位。在X线导向下进行多点和不同深度的骨穿刺活检取材。结果:79例行骨穿活检82次。因3例穿刺2次。76例穿刺活检结果能作出诊断,阳性率为96.2%。没有发生并发症。结论:本法的优点是适应证广、简单、安全、快速、可靠、经济,并发症少及缩短诊断时间。医生在穿刺活检过程中不受X线辐射,而病人只有短暂的透视定位。     

超声引导下经皮肺穿刺活检的临床应用探讨

目的探讨超声引导下经皮肺穿刺活检术的临床应用方法及价值。方法应用Aloka SSD 500超声诊断仪,配置专用穿刺架,选用18—20 G切割式自动活检穿刺针,在B超引导下对39例胸部影像学检查显示的肺周边型肿块需明确诊断者行超声引导下经皮肺穿刺活检术。结果39例病人均穿刺成功,成功率100％。病理诊断结果：肺癌28例（其中鳞癌14例,腺癌7例,小细胞癌4例,大细胞癌1例,难以分类的恶性肿瘤细胞2例）,结核6例,炎症5例。术后随访,诊断准确率达97％。结论超声引导下经皮肺穿刺活检术具有定位准确、操作简便、安全性好、并发症少及重复性强等优点,可作为肺周边型肿块的首选诊断方法。     

CT导引下经皮胸部穿刺活检196例分析

目的探讨CT导引下经皮胸部穿刺活检技术的应用价值。方法回顾性分析196例（207个病灶）CT导引下经皮胸部穿刺活检结果、并发症及手术病理结果、临床转归。结果 196例患者均穿刺成功,取得组织满足病理学检查,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100%。常见并发症为气胸。结论 CT导引下经皮胸部穿刺活检技术是安全、准确、有效的检查方法。     

超声引导下经皮细针穿刺活检诊断胰腺病变

目的 探讨超声引导下经皮细针穿刺活检诊断胰腺病变的临床应用价值。方法 选取本院胰腺病变患者104例,均于超声引导下用20 G自动切割针行经皮穿刺活检。104例患者中16例以手术后病理做最终诊断,88例以活检病理结合影像学检查及随访结果做最终诊断。评价穿刺活检取材满意率,诊断符合率及术后并发症情况。结果 104例患者中胰腺局灶性病变97例(97/104,93.27%),其中实性病变84例(84/97, 86.60%),囊实性病变13例(13/97,13.40%),弥漫性病变7例(7/97,6.73%)。104例患者共接受112次穿刺活检,97次取材满意并得到病理诊断,其中实性病变取材满意率(89/97,91.75%)高于囊实性病变(8/15,53.33%),优势比为9.973。97例取材满意标本中得到的病理诊断与最终诊断相符者89例,8例诊断不相符者均误诊为胰腺炎。活检诊断的准确率、敏感度、特异度分别为91.75%(89/97)、90.12%(73/81)、100%(16/16)。患者活检后7例发生并发症,均为轻-中度腹痛,无严重并发症发生。结论 超声引导下经皮细针穿刺活检胰腺病变安全、有效,其对胰腺实性病变取材满意率优于囊实性病变。     

CT导引下腰神经根周围抗炎治疗坐骨神经痛探讨

目的 探讨CT引导下经皮穿刺治疗腰椎间盘突出引起坐骨神经痛的疗效。方法 CT、MR检查发现有腰椎间盘突出伴明确临床体征90例，CT引导下经皮穿刺至相应椎间孔附近注射得宝松、维生素B12和利多卡因混合药，使药液均匀分布椎管内硬膜外。结果 CT引导下经皮穿刺注药成功率100％。经3个月随访观察，在1、2、3个月止痛有效率分别为92．22％、87．77％、80．00％。结论 CT引导治疗腰椎间盘突出引起坐骨神经痛是一种安全、可靠、有效的新疗法，其远期疗效有待进一步观察。     

介入治疗在妇科恶性肿瘤中的临床应用

目的:研究介入治疗在妇科恶性肿瘤中的临床应用价值,并对其并发症进行探讨。方法:对37例经病理证实的妇科恶性肿瘤共作了78次介入治疗,每人1～3次。全部病例均采用Seldinger穿刺术,经一侧股动脉插管(一般为右侧股动脉),行一侧或两侧盆腔动脉内灌注化疗药物和(或)栓塞的方法。结果:所有病例DSA造影均表现为相应区域内的肿瘤染色和供血血管增粗。8例获得了根治性手术切除,术中出血明显减少,总有效率达82%。本组病例介入治疗后有1例(占2.7%)出现了臀部、外阴部皮肤组织缺血坏死较为严重的并发症。结论:介入治疗中晚期妇科恶性肿瘤是一种安全而有效的姑息性疗法。     

Value of percutaneous needle biopsy of small renal tumors in patients referred for cryoablation

Purpose: To retrospectively evaluate the safety and diagnostic yield of needle biopsy of small renal tumors, and the clinical consequences of performing needle biopsy in patients referred for percutaneous cryoablation before their treatment.

Material and methods: Biopsy was performed for 120 tumors (mean diameter, 2.2?cm) in 119 patients. All procedures were divided into diagnostic and non-diagnostic biopsies. Various variables were compared between the two groups. All cryoablation procedures were divided into two groups: procedures with or without simultaneous biopsy. The rates of benign or non-diagnostic tumors in each group were compared.

Results: After performing 120 initial and eight repeat biopsies, Grade 1 bleedings occurred in 44 cases. Six tumors were non-diagnostic and 114 were pathologically diagnosed. There were no significant variables between the diagnostic and non-diagnostic biopsies. Unnecessary cryoablation was avoided in nine benign lesions by performing biopsy in advance. Cryoablation performed simultaneously with biopsy included significantly more benign or non-diagnostic tumors than cryoablation performed after biopsy (15.2% vs. 1.4%; p?=?.01).

Conclusions: Percutaneous biopsy of small renal tumors referred for cryoablation was a safe procedure with high diagnostic yield. The confirmation of pathological diagnosis prior to cryoablation is necessary because patients with benign tumors can avoid unnecessary treatment.     

CT导引下胸部病变穿刺活检 ——影响诊断正确率因素分析

目的:探讨影响CT导引下胸部病变穿刺活检诊断正确率的因素。方法:回顾复习有手术病理、临床随诊的胸部病变CT导引下穿刺活检244例,观察因素包括患者相关因素(性别、年龄、有无肺气肿)、病灶相关因素(病灶良恶性、大小、位置、病灶深度及有无空腔)、操作相关因素(病人的体位)。对所有观察因素分别进行单因素和多元逐步Logistic回归分析观察其对诊断正确率的影响。结果:①244例胸部病变最终诊断165例为恶性、79例为良性,CT导引下穿刺活检诊断正确率为82.4%(201/244)。单因素统计分析显示,CT导引下穿刺活检对良、恶性病变诊断正确率分别为69.6%(55/79)和88.5%(146?蛐165),χ2=13.1,P=0.003;诊断正确组和非正确组病灶大小分别为(3.97±1.80)cm和(3.11±1.44)cm,F=8.81,P=0.033。②应用多元逐步Logistic回归分析亦显示病灶的良恶性(Wald χ2=7.126,P=0.008)、病灶大小(Wald χ2=4.951,P=0.026)是活检诊断正确率的影响因素。其它因素对穿刺活检诊断正确率的影响无统计学意义。结论:病灶的良恶性和病灶大小是影响CT导引下胸部病变穿刺活检诊断正确率的主要因素。     

开放式磁共振介入系统在头颈部病变穿刺活检中的应用价值

目的介绍iPath200辅助MRI引导下头颈部病变穿刺活检的操作方法,并评价其应用价值。方法所用设备为Philips公司生产的开放式0．23T磁共振检查仪（Proview）,并配有iPath200光学引导系统。27例头颈部病变患者,均在iPath200辅助MRI引导下进行介入穿刺活检操作,其中13例为颌下及颈部淋巴结肿大,5例为甲状腺肿物,4例为颌面部肿物,3例为眼眶内肿物,2例为头颈部间隙囊性肿物。27例患者中的13例术中行MR对比增强检查。结果所有患者均一次穿刺成功,切取出病变组织,全部获得了组织病理学诊断,与手术后病理结果或随访结果相符,活检诊断正确率达100％（27／27）。所有病例术中及术后均未出现明显并发症如严重出血、神经损害等。结论iPath200辅助MRI引导下的头颈部病变经皮活检是一种安全、准确、有效的新技术。     

Future of advanced guidance techniques by interventional CT and MRI

Summary

Minimally invasive techniques using endoscopes for image-guided therapy are common in the surgical field and in internal medicine. Interventional procedures in the past were performed with either fluoroscopic, sono-graphic or CT-guidance, but now MRI-guided interventional procedures are being developed. Combining these technologies will improve surgical access and reduce complications. In today's minimally invasive therapy, tomography technology (CT, EBT, MRI) can be used for precise and transparent guidance of endoscopes and surgical instruments inside the body. This will offer a safe and effective access into the body, especially in high risk areas and lead to the new field of ‘Surgical Tomography'.     

Robotic systems for percutaneous needle-guided interventions

Several groups have developed robotic systems for invasive medical procedures. In this article we will focus on selected robotic systems for percutaneous needle-guided interventions using CT or MR imaging. We present six interventional robotic systems designed to work with imaging modalities such as CT, Cone-beam CT and MRI. The details of each system are given along with any phantom, animal, or human trials performed with each particular robot. Although each of these systems has specific features, they are all of great clinical value since they provide very stable needle guidance -- even for angulated approaches, they may allow access to lesions when the width of the CT- or MR- gantry would limit the access for a biopsy needle or other interventional tools such as thermal ablation probes. Then, such a robot may be able to guide the needle into the most promising region of the lesion without the need for a second contrast injection. Thus, more efficacious characterization and treatment, particularly for lesions that are difficult to target, can be anticipated. Although more research and clinical trials are certainly needed, it is, however, our belief that robotic systems will be an important part of future interventions.     

CT导引下经皮肺穿刺活检的临床应用

目的 :探讨CT导引下经皮肺穿刺活检的技术方法及临床应用价值。方法 :对 5 8例肺内病变CT导引下经皮肺穿刺活检的技术方法及资料进行回顾性分析。结果 :5 8例中 ,穿刺成功率 10 0 % ,活检诊断准确率 93% ,2例发生轻度气胸。结论 :CT导引下经皮肺穿刺活检术对肺内病变的定性诊断具有较高的有效性和安全性