CAJ | 학술논문

目的比较螺旋CT引导下手动式及弹枪式两种经皮肺穿刺活检法在诊断准确率、并发症及操作流程等方面的差异.方法对广东顺德第一人民医院呼吸科2006年6月至2010年5月住院、在CT引导下行经皮肺穿刺活检并经手术病理或临床随访结果证实的原因不明的肺部占位性病变患者97例,男61例,女36例;年龄19～87岁,平均(50±17)岁.采用抽取信封随机分组法将患者分为手动式活检法组(简称手动组)和弹枪式活检法组(简称弹枪组).手动组53例,男32例,女21例,平均(49±20)岁,采用手动式操作活检针进行经皮肺活检.弹枪组44例,男29例,女15例,平均(52±16)岁,采用传统弹枪式操作活检针进行经皮肺活检.所有病例均由同1名医师操作.两组均采用德国Optimed公司生产的Vitesee穿刺活检针,直径为18 G,弹枪组所使用的活检弹枪为德国Optimed公司生产的Vitesse活检枪.全部病例均排除相关禁忌证,在CT导管光栅条定位下,依据CT即时横断面影像设定穿刺点、穿刺角度及深度.原则上采用肿块病灶距胸壁最近点垂直进针.结果手动组诊断准确率为91%(48/53),气胸发生率为11%(6/53),出血发生率为15%(8/53).弹枪组诊断准确率为75%(33/44),气胸发生率为30%(13/44),出血发生率为27%(12/44).结论手动组诊断准确率明显高于弹枪组,气胸发生率相对减少,并且操作流程简单易掌握,值得临床推荐使用.
목적 비교라선CT인도하수동식급탄창식량충경피폐천자활검법재진단준학솔、병발증급조작류정등방면적차이.방법 대엄동순덕제일인민의원호흡과2006년6월지2010년5월주원、재CT인도하행경피폐천자활검병경수술병리혹림상수방결과증실적원인불명적폐부점위성병변환자97례,남61례,녀36례;년령19～87세,평균(50±17)세.채용추취신봉수궤분조법장환자분위수동식활검법조(간칭수동조)화탄창식활검법조(간칭탄창조).수동조53례,남32례,녀21례,평균(49±20)세,채용수동식조작활검침진행경피폐활검.탄창조44례,남29례,녀15례,평균(52±16)세,채용전통탄창식조작활검침진행경피폐활검.소유병례균유동1명의사조작.량조균채용덕국Optimed공사생산적Vitesee천자활검침,직경위18 G,탄창조소사용적활검탄창위덕국Optimed공사생산적Vitesse활검창.전부병례균배제상관금기증,재CT도관광책조정위하,의거CT즉시횡단면영상설정천자점、천자각도급심도.원칙상채용종괴병조거흉벽최근점수직진침.결과 수동조진단준학솔위91%(48/53),기흉발생솔위11%(6/53),출혈발생솔위15%(8/53).탄창조진단준학솔위75%(33/44),기흉발생솔위30%(13/44),출혈발생솔위27%(12/44).결론 수동조진단준학솔명현고우탄창조,기흉발생솔상대감소,병차조작류정간단역장악,치득림상추천사용.
Objective To evaluate the difference in diagnostic accuracy and complication rate and operational procedures between manual and coaxial automated percutaneous lung biopsy under CT-guidance.Methods Ninety-seven patients [ aged from 19 -87 (50 ± 17 ) years ], with undiagnosed pulmonary lesions underwent CT-guided percutaneous lung biopsy from June 2006 to May 2010 in this hospital. The final diagnosis was confirmed by surgical pathology or clinical follow-up. Fifty-three patients (32 males and 21 females) underwent manual percutaneous lung biopsy, while 44 patients (29 males and 15 females) underwent percutaneous lung biopsy by using a coaxial automated biopsy device( biopsy gun). Biopsies were carried out by the same physician in all cases with the 18G vitesse needle made by optimed company in German. Biopsy guns made by the same company were used in coaxial automated biopsy group. The puncture point, angle and depth were set according to the CT images under the guidance by CT grating. Generally, the puncture was directed vertically towards the lesions closest to the chest wall. Results In the manual biopsy group, the diagnostic accuracy was 91% (48/53), the pneumothorax rate was 11% (6/53), and the hemorrhage rate was 15% (8/53), while in the coaxial automated biopsy group, they were 75% (33/44),30% (13/44)and 27% (12/44), respectively. Conclusion The diagnostic accuracy was higher while the pneumothorax rate was lower in the manual biopsy as compared to the coaxial automated biopsy group.