電腦斷層導引針吸穿刺切片對診斷胸腔疾病之100例經驗

CT-Guided Aspiration Biopsy of Thoracic Lesions: Experiences in 100 Cases

許居誠(Giu-Cheng Hsu) ； 藍功堯(Gong-Yau Lan) ； 許清寅(Chin-Yin Sheu) ； 周定遠(Ting-Ywan Chou) ； 李三剛(San-Kan Lee) ； 何善平(Peter S. P. Ho) ； 柯萬盛(Wang-Sheng Ko) ； 沈建業(Chien-Yeh Shen) ； 李世俊(Shich-Chun Lee)

《中華放射線醫學雜誌》 16卷3期 (1991/09) Pp. 237-242

摘要

經皮穿胸針吸穿刺生檢術(percutaneous transthoracic needlc aspiration biopsy)是一項簡單，安全且可迅速獲得診斷的檢查方式，但是文獻報告多以X光透視(fluoroscopy)爲主要穿刺導引工具；爲了改善穿刺技術，提高診斷率，減低併發症，我們選用電腦斷層掃描儀(CT scanner)作爲穿刺導引的工具。檢討過去兩年中的100例胸腔病灶經驗，結果發現對於惡性病灶的診斷率爲94.4%，良性病灶的診斷率爲91.7%，最常見的併發症爲氣胸(11%)，但僅2%需放置胸管治療。電腦斷層導引針吸穿刺生檢的主要優點包括：(1)輕易偵測2公分以下病灶並可準確進行針吸穿刺生檢。(2)精確的局部麻醉，減少病患痛苦。(3)選擇最短、最安全的穿刺途徑，減低併發症。(4)選取病灶內最具診斷價值的區域進行針吸穿刺生檢以提高診斷率。(5)操作者不需接受輻射線照射(ionizing radiation)。此外醫師間的相互合作亦是影響針吸生檢成功的重要因素。因此我們建議，充分利用電腦斷層的影像特性並加強醫院間的團隊合作，可使電腦斷層導引針吸穿刺生檢術成爲一項精確，安全，較少痛苦且迅速的診斷方式。

關鍵字

電腦斷層導引 ； 胸腔部位生檢術

並列摘要

In an effort to ensure safety and diagnostic precision of percutaneous transthoracic biopsy, CT scanner was used as a guide for the biopsy procedure. From June 1988 to August 1990, 100 cases (74 cases of intrapulmonary lesion, 23 cases of mediastinal lesion and 3 cases of pleural lesion) underwent CT-guided biopsy to confirm the diagnosis in 73 cases (93.6%), including 51 of 54 maligant lesions (94.4%) and 22 of 24 benign lesions (91.6%). Complications included pneumothorax (n=11) and hemoptysis (n=7). This study confirms the benefits of CT guided biopsy which include:
1). easy detection and biopsy of the lesion smaller than 2.0cm in size;
2,) the ability to measure the depth of the chest wall for local anesthesia where the needle should pass;
3.) the ability to select the shortest distance and safest route from the skin to the lesion;
4.) the ability to choose the most significant part of the lesion for needle biopsy; and
5.) the ability to prevent the radiologist from ionizing radiation.
In addition, team-work (including a physician, an experienced radiologist and a cytopathologist) is found to be an integral part of this procedure.
It not only contributes to a safer and easier procedure, but also minimizes the chance of complications and improves diagnostic accuracy.

並列關鍵字

computed tomography, guidance ； thorax, biopsy