摘要
目的探讨术中X射线与CT引导下经皮穿刺活检在胸腰椎占位性病变诊断中的应用价值。方法回顾性分析2011年5月至2016年7月我科收治的97例临床不能明确诊断的胸腰椎占位性病变患者的临床资料;所有患者均于本院Artis-Zeego复合手术室内在Artis-Zeego机器人引导下完成经皮椎体穿刺活检术。胸椎椎体穿刺活检患者46例作为T组,其中将X射线引导下椎体穿刺活检25例分为T-x组,CT引导下椎体穿刺活检21例分为T-ct组;腰椎椎体穿刺活检患者共51例作为L组,其中将X射线引导下椎体穿刺活检24例分为L-x组,CT引导下椎体穿刺活检27例分为L-ct组;所有患者分别在X射线或CT监视下,使用骨穿刺活检针,局部麻醉下经椎弓根途径取脊柱占位性病变骨质适量,通过变换工作通道方向或用不同直径的骨活检针进行多向多点取材,将钻取标本立即置于10%的福尔马林中保存,标本送病理检查及相应的病理细胞学检查。比较各组患者穿刺活检的成功率与诊断准确率以及穿刺活检并发症等相关情况。结果 T-x组5例患者由于术中X射线监视困难未成功取材,转为CT引导下成功取材,穿刺成功率80.0%(20/25),穿刺成功的患者中有6例患者病理检验未能明确诊断,T-x组患者穿刺活检总的诊断准确率70%(14/20);T-ct组穿刺成功率100%,明显高于T-x组(P<0.05);T-ct组患者中有3例患者病理检验未能明确诊断,其总的诊断准确率88.5%(23/26),明显高于T-x组(P<0.05)。L-x组患者有1例因术中疼痛,无法配合被迫终止穿刺,穿刺成功率95.8%(23/24),L-ct组患者穿刺活检均成功取材,穿刺成功率为100%,2组比较差异无统计学意义(P>0.05);L-x组有2例患者未能明确诊断,穿刺活检总的诊断准确率为87.5%(21/23),L-ct组有1例患者病理检验未能明确诊断,穿刺活检总的诊断准确率96.3%(26/27),2组比较差异无统计学意义(P>0.05)。并发症发生情况:T-x组1例患者术中疼痛不能耐受,局部追加麻药后完成穿刺,1例患者术后出现一过性双下肢感觉异常,1周后症状改善,1例患者术中出现穿刺部位疼痛,追加局麻药不能改善,被迫停止穿刺;所有在CT引导下行穿刺活检的患者均未出现并发症。结论 CT与X射线引导下穿刺活检术用于脊柱占位性病变诊断中,对指导治疗具有重要意义,但对于胸椎占位性病变CT引导下经皮穿刺活检安全性、诊断准确率较高,而对于腰椎占位性病变X射线或CT引导下经皮穿刺活检具有相同的安全性及诊断准确率。
Objective To investigate the value of intraoperative X-ray guided and CT guided percutaneous biopsy in the diagnosis of thoracic and lumbar space occupying lesions.Methods A total of 97 patients with thoracic and lumbar space occupying lesions who were not diagnosed clinically in our hospital from May 2011 to July 2016 were retrospectively analyzed.All patients underwent percutaneous vertebral biopsy under the guidance of Artis-Zeego robot in the Artis-Zeego complex operating room of our hospital.Thoracic vertebral body biopsy in patients with a total of 46 cases were divided into T group,in which X-ray guided percutaneous biopsy in 25 cases were divided into T-x group,CT guided percutaneous biopsy in 21 cases were divided into T-ct group.Lumbar puncture biopsy in patients with a total of 51 cases were divided into L group,in which X-ray guided percutaneous live review of 24 cases were divided into L-x group,CT guided percutaneous biopsy in 27 cases were divided into L-ct group.According to the packet respectively in X-ray or CT monitoring,the use of bone biopsy needle under local anesthesia,transpedicular approach for spinal lesions of bone amount,by changing the working path or direction bone biopsy needle of different diameter to save drilling samples which were immediately placed in 10%formalin,specimens were sent for pathological examination and corresponding pathological and cytological examination.The success rate,diagnostic accuracy and complications of percutaneous biopsy were compared between the two groups in X-ray and CT guided percutaneous vertebral biopsy.Results T-x group of 25 patients,5 patients with puncture failure for intraoperative X-ray monitoring difficulties were transferred to puncture under the guidance of CT,the success rate of puncture was 80%(20/25).Of the patients with success puncture,6 cases were unidentified by pathological examination,the total diagnostic accuracy rate of biopsy in T-x group was 70%(14/20).The success rate of puncture in T-ct group was 100%,significantly higher than that of T-x group(P<0.05).In T-ct group,3 cases were unidentified by pathological examination,the total diagnostic accuracy rate of biopsy was 88.5%(23/26),which was significantly higher than that of T-x group(P<0.05).In the L-x group,1 case with puncture failure for pain during the operation,the success rate of puncture was 95.8%(23/24),patients of L-ct group were successfully punctured,the success rate was 100%,the difference between the two groups was not significant(P>0.05).In the L-x group,2 patients failed to confirm the diagnosis,the diagnostic total accuracy rate of L-x group was 87.5%(21/23);of the L-ct group,1 cases failed to confirm the diagnosis,the diagnosis total accuracy rate of L-ct group was 96.3%(26/27),the difference between two groups was not significant(P>0.05).Complications:In the T-x group,1 cases received additional local anesthetic after puncture for pain;1 patients had transient lower extremity paresthesia,and the symptoms were improved 1 weeks later;1 case with intraoperation puncture site paining was not alleviated and had to stop the puncture.All patients with CT guided biopsy had no complications.Conclusion CT and X-ray guided percutaneous biopsy has important significance in diagnosis and treatment of spinal lesions,and CT guided percutaneous biopsy is safer for thoracic lesions with higher diagnostic rate,while for lumbar lesions fluoroscopy,X-ray or CT guided percutaneous biopsy has the same security and diagnostic rate.
作者
轩安武
王亚楠
李青松
谢雁春
李卓
赵阳阳
于海龙
XUAN Anwu;XUAN Anwu;LI Qingsong;XIE Yanchun;LI Zhuo;ZHAO Yangyang;YU Hailong(Department of Spine Surgery of Orthopedic,General Hospital of Shenyang Military Area Command,Shenyang Liaoning 110016,China)
出处
《局解手术学杂志》
2018年第3期209-213,共5页
Journal of Regional Anatomy and Operative Surgery
