B超引导下芯针穿刺活检术诊断儿童实体肿瘤的临床分析

目的回顾性分析B超引导芯针穿刺活检术这一微创性获取肿瘤患儿病理组织标本技术在儿童实体肿瘤诊断方面的运用。方法重庆医科大学附属儿童医院2003年2月至2011年2月，通过CT或MRJ及B超等影像学检查筛选出元一期手术切除条件但有穿刺路径的实体肿瘤，检查出、凝血功能无异常，无麻醉禁忌症，在基础麻醉或局部麻醉下，采用自动同步负压活检取样装置在B超实时引导下行肿瘤芯针穿刺活检术，获取标本进行病理诊断。结果筛选出具有穿刺条件病例82例，年龄最小12d，最大19岁，平均4岁4个月；其中男42例，女40例。阳性标本75例，其中51例组织芯长度〉1．5em，24例组织芯长度介于0．5～1．5em，组织标本符合病理学检查要求并得出病理结论，其中，头颈部4例，胸部及纵隔3例，肝脏肿瘤15例，腹膜后肿瘤19例，盆腔肿瘤8例，骶尾部肿瘤8例，四肢长骨肿瘤8例，四肢软组织肿瘤11例；假阴性组织标本6例，其中软组织肿瘤2例，腹膜后肿瘤2例，盆腔肿瘤1例，骨肿瘤1例。本组病例总穿刺阳性检出率为91．5％。并发出血1例，肠穿孔1例，元穿刺道感染、肿瘤破溃、穿刺道肿瘤种植等并发症发生。结论B超引导下实体肿瘤穿刺活检术是一种安全、可靠、微创、简便、易于临床开展的操作技术，实时超声与穿刺活检术相结合，能准确获取理想的肿瘤标本，通过病理检查明确肿瘤来源、性质及分化程度，对儿童实体肿瘤尤其是晚期、无一期手术切除条件、需要新辅助化疗后再手术等综合治疗的患儿的诊断及治疗有重要价值，值得临床推广。

Application of ultrasound-guided core-needle biopsy in chindren with solid tumor

Objective The aim of the study was to evaluate the usefulness Ultrasound-guided core needle biopsy （USCNB） in children with solid tumor. Methods A retrospective review of patients performed core needle biopsy between February 2003 and February 2011 was performed. All patients received USCNB was evaluated before this procures by using CT or MPd and ultrasound tests, the tumors were unresectable straightway. There were no problem of coagulation function and no contradiction of anesthesia for all patients. Puncture biopsies were performed by using automatic biopsy device with negative pressure under the guidance of B-ultrasound. Results 82 patients were included with a mean age 4.3 years （ ranged from 12 days to 19 years. ） Pathological diagnosis was established in 75 patients, the distribution of tumor as follow： head and neck：4, mediastinum ：3, liver： 15, retroperitoneal： 19, pelvic ：8, sacrococygea1：8, bone ：8, soft tissue ： 11. The total positive ratio was 91.5%. Tile complication included bleeding （ n = 1 ） and intestinal perforation （ n = 1 ）, no infection of skin, rupture of tumor and neoplasm seeding was observed in all patients. Conclusion USCNB is a safe, reliable, less-invasive, simple, and efficient diagnostic procure. Combined with real-time ultrasound, ideal tumor specimen can be obtained accurately. It＇ s of great value for pediatric patients with advanced solid tumor, especially when onstage operation was impossible and neoadjuvant chemotherapy should be performed before surgery.