CAJ | 학술논문

目的：探讨立体定向活检术在颅内多发病变诊断中的临床价值，研究手术方法、技术要点及降低手术并发症的方法．方法回顾性总结2009年1月至2013年6月间昆明医科大学第一附属医院神经外二科收住院并行立体定向活检术的23例病例，患者年龄11～73岁（平均34.6岁），其中男性患者12例，女性患者11例；手术采用螺旋CT薄层扫描、ASA-602S和Leksell-Frame-G高精度脑立体定向仪、Sedan侧方开口的活检针、Backlund活检针、STORZ神经内窥镜；活检标本术后行常规病理学检查，必要时行免疫组化检查．结果病理诊断阳性率91.3%（21例），其中炎性肉芽肿1例，感染性病变1例，钙化1例，胶质增生6例，星形细胞瘤WHOⅠ～Ⅱ级1例，星形细胞瘤WHOⅡ级2例，星形细胞瘤WHOⅡ～Ⅲ级1例，混合型少突-星形细胞瘤WHOⅠ～Ⅱ级1例，多形性胶质母细胞瘤WHOⅣ级3例，生殖细胞瘤1例，转移瘤1例，弥漫性大B细胞淋巴瘤1例，颅内肉芽肿性动脉炎1例，阴性2例．无术后昏迷、偏瘫、感染、颅内出血等严重并发症．结论立体定向活检术是颅内多发病变诊断的重要方法之一，定位精确、创伤小、安全可靠、有效减少并发症的发生、值得推广．
목적：탐토입체정향활검술재로내다발병변진단중적림상개치，연구수술방법、기술요점급강저수술병발증적방법．방법회고성총결2009년1월지2013년6월간곤명의과대학제일부속의원신경외이과수주원병행입체정향활검술적23례병례，환자년령11～73세（평균34.6세），기중남성환자12례，녀성환자11례；수술채용라선CT박층소묘、ASA-602S화Leksell-Frame-G고정도뇌입체정향의、Sedan측방개구적활검침、Backlund활검침、STORZ신경내규경；활검표본술후행상규병이학검사，필요시행면역조화검사．결과병리진단양성솔91.3%（21례），기중염성육아종1례，감염성병변1례，개화1례，효질증생6례，성형세포류WHOⅠ～Ⅱ급1례，성형세포류WHOⅡ급2례，성형세포류WHOⅡ～Ⅲ급1례，혼합형소돌-성형세포류WHOⅠ～Ⅱ급1례，다형성효질모세포류WHOⅣ급3례，생식세포류1례，전이류1례，미만성대B세포림파류1례，로내육아종성동맥염1례，음성2례．무술후혼미、편탄、감염、로내출혈등엄중병발증．결론입체정향활검술시로내다발병변진단적중요방법지일，정위정학、창상소、안전가고、유효감소병발증적발생、치득추엄．
Objective To investigate the clinical value of stereotactic biopsy in the diagnosis of the multiple intracranial lesions, and explore the operation methods, technical points and clinical experiences to reduce surgical complications. Methods Twenty-three patients in the first affiliated hospital of Kunming Medical University underwent stereotactic biopsy from January 2009 to June 2013 were analyzed retrospectively. The patients were aged between 11 and 73 years (the mean age of 34.6 years) . There were 12 males and 11 females. Operations were performed by thin thickness of spiral CT scan, ASA-602S and Leksell-Frame-G stereotactic frame, Sedan side-cutting needle, Backlund side-cutting needle and neuroendoscope of STORZ. Routine histopathological examinations of specimens were conducted. The immunohistochemical staining of the histopathological section of specimens was performed if necessary. Results The diagnostic yield was 91.3% (21 cases) . The result of pathological diagnosis was inflammatory granuloma in 1, inflammatory lesion in 1, calcification in 1, hyperplasia of colloid cells in 6, astrocytoma in 1 (WHOⅠ-Ⅱ), astrocytoma in 2 (WHOⅡ), astrocytoma in 1 (WHOⅡ-Ⅲ), mixed oligoastrocytoma in 1 (WHOⅠ-Ⅱ), glioblastoma multiforme in 3 (WHOⅣ), germinoma in 1, brain metastases in 1, diffuse large B-cell lymphoma in 1, intracranial granulomatousarteritis in 1 and negative in 2. There were no serious complications, such as coma, hemiparalysis, infection and intracranial hematoma. Conclusion Stereotactic biopsy is an important method in the diagnose of multiple intracranial lesions. It has the advantages of precise location, less damage, safe performance, and reducing the complication effectively. It is worth promoting.