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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。
Objective To investigate the biopsy technique and clinical value of coaxial trochar puncturing mediastinal and mediastinal lesions under CT fluoroscopy. Methods CT images were combined with laser locator to determine puncture point. 16G coaxial needle puncture and 18G automatic biopsy gun were used to take the tissue. Cytological and histological examinations were performed at the same time, and some of them were used for immunohistochemistry. The diagnosis of all cases was confirmed by surgery, pathology or clinical follow-up. Results The group of 56 lesions, of which 29 cases of mediastinal, 27 cases of mediastinal side, the maximum diameter of 12 ~ 40mm. Puncture in place rate of 100%. 55 cases of biopsy obtained histopathology report and postoperative pathology or clinical diagnosis and treatment are consistent, 1 cases can not make a clear diagnosis of histiocytology, the diagnostic accuracy was 98.2%. There were 4 cases of pneumothorax, accounting for 7.1% (4/56), of which 1 case was minimally invasive closed thoracic drainage. A small amount of hemoptysis occurred in 7 cases (12.5%, 7/56). No hemothorax, infection, Planting and so on. Conclusion 16G thick needle in the CT perspective of mediastinal and mediastinal paraplegia lesions biopsy is safe and accurate, economical and practical clinical diagnosis.