纵隔病变CT引导下不同穿刺活检途径的探讨

目的 探讨纵隔病变的不同穿刺途径的临床应用及并发症处理。方法 经X线平片和CT发现的51例纵隔肿块样占位病变，在CT引导下采用不同的穿刺途径，包括：（1）直接；（2）经肺；（3）经胸膜腔膜径，用细针抽吸切割方法取样，标本块用10%甲醛溶液固定，病理切片观察。结果 51例纵隔病变，刺中率90.1%(46/51)，正确率88.2%(45/51),假阴性率11.8%(6/51)，无假阳性发现。穿刺病理结果，恶性病变占72.5%,并发症，气胸4例占7.8%，肺内出血现象3例占5.9%,1例伤及内乳血管。结论 （1）CT是目前纵隔病变穿刺活检的最佳手段。（2）纵隔病变穿刺活检多采用直接和经肺途径。（3）并发症一般不严重，门诊即可处理。

Evaluation of Alternative Approaches to CT-Guided Fine-Needle Biopsy of Mediastinal Lesions

Objective To evaluate the clinical applications of alternativeapproaches to CT-guided fine-needle biopsy of mediastinal lesions and the disposed complications.Methods The alternative approaches under CT guidance were adopted for X-ray or CT images of 51 cases with mediastinal mass-like lesions,including：① direct approach,② approach traversing lung,③ approach traversing pleural cavity.Samples obtained with fine-needle aspirating and cutting were fixated in 10％ formalin,and observed in pathological histology.Results Punctur rate 90.1％(46/51),accuracy rate 88.2％(45/51),false negative rate 11.8％(6/51),without false positive in the cases.Pathologically,the malignancy 72.5％.Complications,pneumothorax 7.8％(4 cases),intrapulmonary hemorrhage 5.9％(3cases),internal mammary vessels injured (1 case).Conclusion CT is the best guided method in biopsy of mediastinal lesions.② Direct and traversing lung were performed constantly in biopsy of mediastinal lesions.③ The Complications were not serious,and disposed in clinic.