Computed tomography-guided pulmonary nodule localization before thoracoscopic resection

Purpose: To assess the success rate and complication rate of a CT-guided pulmonary nodule-marker system before thoracoscopic resection.

Material and Methods: In 24 patients (15 M, 9 F; age range, 18-71 years) a total of 25 pulmonary nodules (in 1 patient 2 lesions simultaneously) were marked with a special wire under CT-guidance and then thoracoscopically resected. We evaluated lesion size, lesion distance to the pleura, the time of intervention, complications, and thoracoscopic success rate.

Results: Mean lesion size was 7 mm (range 4-15 mm) and mean lesional distance to the pleura was 13 mm (range 2-31 mm). The pulmonary nodule-marker system was positioned successfully in all 25 pulmonary nodules within 5-11 min (mean 7.5 min). Minimal pneumothoraces were observed in five patients with no requirements of chest drains. In addition, no bleeding complications or hematothorax were observed. All 25 pulmonary nodules could be resected thoracoscopically. However, in one patient (4%), the guide-wire dislocated during thoracoscopy, but the lesion could be successfully resected during thoracoscopy.

Conclusion: The CT-guided placement of the pulmonary nodule-marker system used here offers a safe and accurate guide for the localization of small pulmonary nodules during thoracoscopic resection.     

Osseous Kaposi sarcoma in an HIV-positive patient

A case of osseous Kaposi sarcoma in a 35-year-old man is described. The patient (HIV-positive for 8 years) suffered from cutaneous Kaposi sarcoma and presented with right-sided chest pain. He underwent a chest CT scan that revealed three osteolytic lesions involving rib and vertebra with large soft tissue masses, without cutaneous lesions at these sites. CT-guided core needle biopsy led to a histological diagnosis of Kaposi sarcoma.     

Acute Coronary Artery Air Embolism Following CT-Guided Lung Biopsy

CT-guided needle biopsy is a common procedure for obtaining a tissue diagnosis and consequently correctly managing patients. This procedure has many potential complications, ranging from simple pneumothorax or self-limiting hemoptysis to life-threatening pulmonary hemorrhage and air embolism. Though the latter is a rare complication of CT-guided needle biopsy, it has attracted a lot of interest. We report a case of right coronary air embolism resulting in myocardial infarction after a CT-guided percutaneous needle biopsy of the lung.     

CT导引下突出物内及盘内联合注射胶原酶治疗腰椎间盘突出症

目的探讨CT导引下突出物内及盘内联合注射胶原酶治疗腰椎间盘突出症的临床疗效。方法对143例腰椎间盘突出症的患者采取CT导引下注射胶原酶于突出物内及盘内，术后随访3个月～1a，观察其疗效。结果疗效优者49例。良者83例，可者7例，差者4例，优良率92．3％。随访期间32例进行了CT复查，其中15例原椎间盘突出物明显缩小或消失，14例有不同程度的缩小，无明显改变者3例，1例并发椎间盘炎。结论CT导引下突出物内及盘内联合注射胶原酶治疗腰椎间盘突出症具有定位准确，优良率高等优点，是一种安全。有效的方法。     

CT导引下^125粒子组织间植入治疗恶性肿瘤中的应用和进展

CT导引下植入^125I粒子治疗恶性肿瘤是一种新的治疗方法，它应用TPS计划系统，按照治疗计划将^125I粒子在CT导引下穿刺植入到恶性肿瘤内，在术后用CT检查观察粒子在瘤体内的分布、有无并发症及疗效。主要适用于未经治疗的原发肿瘤、手术难以切除的侵犯重要功能组织及器官的肿瘤、复发或转移的肿瘤治疗。此种治疗方法安全、有效，可行，并发症发生率低．目前已成为治疗恶性肿瘤的重要手段之一。     

CT引导下经皮肺活检诊断孤立性肺结节分析

目的 提高CT引导下经皮肺活检对肺周边孤立结节诊断的敏感性和准确性。方法 对14例痰细胞学及纤维支气管镜检查阴性患者均使用Siemens Somatom HiQ型CT机薄层扫描定位，拟定穿刺点，选择最佳进针角度及深度，局麻后在胸部定位尺指导下穿刺。穿刺针采用COOK公司的16、18、20G的软组织活检针或弹簧自动芯状取材活检针。CT扫描核实活检针尖已达病灶后取材，将得到的组织碎片固定、包埋，常规HE染色，必要时行组织化学及免疫化学染色，行病理学诊断。结果 14例全部穿刺成功，一次穿刺活检成功率达71．4％（10／14）。病理学诊断结果：恶性病变11例，其中肺腺癌7例，鳞癌1例，小细胞癌1例，未分型癌细胞2例。良性3例，其中结核球2例，炎性假瘤1例。结论 对于痰细胞学及纤维支气管镜检查不能确诊的肺周边孤立结节病灶，行CT引导下经皮肺活检具有安全准确、诊断迅速的特点，具有较高的诊断价值，值得推广。     

CT引导穿刺活检及介入治疗定位仪的研制

目的：为了提高CT引导一次穿刺的成功率.方法：先把CT引导穿刺活检及介入治疗定位仪置于病灶部位,利用该定位仪找出通过病灶中心的体外两个点,使三点处于一直线上,并在该定位仪的引导下,行穿刺活检及介入治疗.结果：利用该定位仪,稳定性好,避免了穿刺的盲目性,大大提高了一次穿刺的成功率.结论：CT引导穿刺活检及介入治疗定位仪安全、稳定性好,值得推广应用.     

CT引导肺穿刺组织学与印片细胞学的联合应用

目的评价CT引导下肺穿刺同时行组织学与印片细胞学检查的诊断价值和并发症。方法收集134例CT引导肺部穿刺活检病例作回顾性分析。统计印片细胞学、组织学以及2者结合的敏感性和并发症,并分析其影响因素。结果110例穿刺确诊为恶性肿瘤。穿刺未发现癌细胞者22例,后经手术和随访证实其中假阴性2例。组织学敏感性为82.1%(92/112),印片细胞学敏感性为87.5%(98/112),二者结合敏感性为98.2%(110/112),假阴性率为9.1%(2/22)。气胸发生率为7.5%(10/134),出血、喀血率为11.9%(13/134),仅有2例出血较多,需紧急处理。结论CT引导经皮肺穿刺是敏感性高和安全的定性诊断方法,如同时行组织学及印片细胞学检查,可提高诊断的敏感性,降低假阴性。     

CT引导下经皮肺细针抽吸活检术的临床应用价值

目的评价CT引导经皮肺细针抽吸活检术的临床应用价值。方法对110例CT引导下经皮肺细针抽吸活检术，病理检查证实93例。结果93例患者中，与病理检查相吻合的肺癌85例，穿刺确诊77例，8例为肺部良性病变。诊断灵敏度90．6％，特异度100．0％，诊断准确率91．4％。并发气胸9．1％，肺内出血10．9％，均自行吸收。结论CT引导经皮肺细针抽吸活检术临床应用准确性较高，并发症较少，有助于肺部病变的诊断。     

精细针多点取材在CT引导经皮肺活检的临床价值

目的探讨精细针多点取材在CT引导下经皮肺活检对肺部周围性病变的诊断价值,评价其安全性。方法对102例经无创检查或纤维支气管镜检查未能确诊的肺部周围性病变患者,在CT引导下使用精细针经皮肺活检,其中55例进行多点取材,47例进行单点取材,分析其诊断准确率、并发症发生率。结果多点取材组均能获取组织标本;单点取材组有4例未能获取组织标本。病理显示多点取材组有42例为恶性病变,10例为良性病变(误诊1例),3例无明确结果,诊断准确率为92.7%;单点取材组有31例为恶性病变,9例为良性病变(误诊4例),7例无明确结果,诊断准确率为76.6%。活检后两组均未出现严重并发症;多点取材组并发气胸8例,肺内出血4例;单点取材组并发气胸6例,肺内出血3例,咯血2例。结论CT引导下使用精细针经皮肺活检对肺部周围性病变的诊断具有重要价值,安全性高;通过多点取材可提高其诊断准确率。