CT透视下16G套管针穿刺活检纵隔及纵隔旁病灶

目的 探讨CT透视下同轴套管针穿刺纵隔及纵隔旁病灶的活检技术和临床应用价值.方法 CT图像结合激光定位灯确定穿刺点,取16G同轴套管针穿刺、18G自动活检枪摄取组织,同时作细胞学和组织学检查,部分加作免疫组化检查.全部病例的诊断经手术、病理或临床随访而得到证实.结果本组56例病灶,其中纵隔29例、纵隔旁27例,病灶最大径为12～40mm.穿刺到位率为100%.55例穿刺活检得到的组织细胞学报告与手术后病理或临床诊治结论相符合,1例无法作出明确的组织细胞学诊断,诊断准确率为98.2%.发生气胸4例,占7.1%（4/56）,其中1例作微创性胸腔闭式引流;少量咯血7例,占12.5%（7/56）;未发生血胸、感染、针道肿瘤种植等情况.结论采用16G粗针在CT透视下行纵隔及纵隔旁病灶穿刺活检是安全准确、经济实用的临床诊断方法.

Biopsy of mediastinal and paramediastinal lesions with 16G coaxial needle guided by CT fluoroscopy

Objective To evaluate value of CT fluoroscopy in guiding coaxial needle to make percutaneous biopsy of mediastinal and paramediastinal lesions. Methods Puncture site was determined by laser localized light comparing CT images. After puncturing with 16G coaxial needle, 18G automated biopsy gun was used to obtain tissues. The tissues then underwent cytological and histological exams, some of them underwent immunohistochemistrical test. All the diagnoses were confirmed by either surgical, pathological procedures or by clinical follow-up. Results 56 lesions including 29 medistinal and 27 paramediastinal underwent biopsies. The major diameters of the lesions ranged 12 mm~40 mm. The puncture success rate was 100%. 55 lesions got coherent results between the histocytological biopsy reports and the post-opera- tion pathological exam or clinical diagnosis. 1 lesion failed to get definitive histocytological diagnosis. The accuracy rate of this method was 98.2%. As for complications, 4(4/56:7.1%) cases suffered pnemothroax, one of them was relieved by closed miniinvasive thoracic drainage. 7(7/56:12.5%) cases experienced mild hemoptysis. No thoracic hematoma, infection, needle-path tumor implantation took place. Conclusion CT guidance 16G coarse needle percutaneous biopsy of medias- tinal and paramediastinal lesions is a safe accurate economical useful method.