摘要
目的 探索肺结节序贯穿刺模式、双针提插活检方式的临床应用价值.方法 纳入2020年3月至2023年2月收治的孤立性肺结节患者57例.采用序贯穿刺模式和双针提插方式对肺结节进行穿刺和活组织检查.记录同轴针退针率、脱靶率、靶周率、靶心率,活检组织条长度和肺结节活检成功率,以及并发症.结果 57例患者中,肺结节穿刺退针2例(3.5％).针尖与肺结节空间位置:靶心52例(91.2％),靶周5例(8.8％),脱靶0例.切割槽内活检组织条长度:等于靶结节直径42例(73.7％),≥靶结节半径11例(19.3％),＜靶结节半径4例(％),组织条缺如0例.肺结节活检成功57例(100％).并发症:气胸12例(21.1％),肺针道出血 10例(17.5％),活检区出血 14例(24.6％).结论 受内应力影响,现行同步穿刺模式和活检方式不是理想的肺结节穿刺模式和活检方式.针尾挂线方法可消除内应力影响,序贯穿刺模式可增加肺结节穿刺精度,双针提插法可提高活检成功率,并发症发生率在可接受范围.
Abstract
Objective To evaluate the clinical application of sequence puncturing and double-needle pulling-inserting technique in CT-guided biopsy of small pulmonary nodules.Methods A total of 57 admitted patients with solitary pulmonary nodule from March 2020 to February 2023 were enrolled in this study.With the help of sequence puncturing and double-needle pulling-inserting technique CT-guided puncture biopsy of the pulmonary nodule was carried out for all patients.The pulling-back rate,off-target rate,target periphery rate and target center rate of the coaxial needle,the length of biopsy tissue strip,the success rate of lung nodule biopsy,and complications were recorded.Results Among the 57 patients,pulling-back of needle was seen in 2 patients(3.5％).The needle-tip was located at the center of pulmonary nodule in 52 patients(91.2％)and at the periphery of pulmonary nodule in 5 patients(8.8％),and no off-target of needle-tip occurred.The length of biopsy tissue strip in the cut groove was equal to the diameter of the target nodule in 42 patients(73.7％),≥radius of the target nodule in 11 patients(19.3％),＜radius of the target nodule in 4 patients(7.0％),and no absence of biopsy tissue strip was seen.The success rate of pulmonary nodule biopsy was 100％.The complications included pneumothorax(n=12,21.1％),needle tract bleeding(n=10,17.5％),and biopsy area bleeding(n=14,24.6％).Conclusion Due to the influence of internal stress,the currently adopted synchronous puncture mode and biopsy pattern are not an ideal method.The tail hanging-thread method of coaxial needle can eliminate the influence of internal stress,the sequential puncturing mode can improve the puncture accuracy of pulmonary nodules,and the double-needle pulling-inserting technique can improve the success rate of biopsy,while the incidence of complication is within the acceptable range.(J Intervent Radiol,2024,33:528-532)
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