CT引导下立体定向脑内病灶活检术14例报告

目的 探讨CT引导下立体定向脑内病灶活检术的可行性。方法使用CT、立体定向仪及手术软件系统进行脑内病灶活检手术14例，计算机辅助软件自动计算靶点。结果病检确诊肿瘤8例，局灶性炎症增生3例，脑脓肿2例，1例未能确诊。结论CT引导下立体定向脑内病灶活检术是获得定性诊断可行的方法，具有损伤小、费用低、安全及病检准确率高等优点。     

CT立体定向脑组织活检90例分析

目的：采用CT引导立体定向术对脑内病变进行活检，为诊断与治疗及其预后的评估提供组织学依据。材料与方法：使用CJF-I型脑立体定向系统和SOMATOMCR或SOMATOMPlus-4CT机，对90例脑肿瘤和非肿瘤性病变实施立体定向脑活检。结果：82例获得明确的病理诊断，占91．1％，无严重手术并发症和死亡。结论：CT立体定向脑活检术是安全的，具有很高的确诊价值。作者就手术操作技巧进行了详细探讨。     

左侧大脑顶叶胶质母细胞瘤合并左侧脑干、丘脑多发性脑梗死1例并文献复习

目的:探讨胶质母细胞瘤合并脑梗死病例的影像学特征及病理表现。方法:报道我院1例同侧(左侧)胶质母细胞瘤合并脑梗死病例,利用立体定向脑活检术进行病理诊断,并结合文献进行分析。结果:该例患者经立体定向脑活检术确诊左侧大脑顶叶病灶为胶质母细胞瘤,左侧脑干、丘脑为多发性脑梗死。文献检索收集符合的病例15例,女性8例,男性7例;平均年龄60岁;所有病例均发生在大脑半球内;MRI提示病灶典型强化7例,提示脑梗死4例,提示血管堵塞并缺血病灶4例;进行病理活检12例,全部明确诊断为胶质母细胞瘤。结论:脑胶质瘤和脑梗死临床及影像学表现相似,容易相互误诊,在临床工作中应予以重视,必要时可行立体定向脑活检术确诊。     

39例CT引导立体定向脑活检术快速病理诊断和常规病理诊断比较分析

目的评价CT引导立体定向脑活检快速病理检查在外科病理诊断中的价值。方法39例CT引导立体定向脑活检术的标本,将其快速石蜡切片与其随后的常规切片或／和手术切除标本进行对比观察。结果39例中36例(占92％)快速病理结果具有临床指导价值。其中27例肿瘤病例中,19例能明确诊断,5例有提示意义。结论CT引导立体定向脑活检快速病理检查对颅内大多数病变能作出正确诊断。靶点选择的典型性和靶点邻近部位多次取材可提高诊断阳性率。     

CT引导脑立体定向活检的评价

本文报告24例CT引导脑立体定向活检病例。具体介绍了手术方法;指出CT引导的脑立体定向活检是一种准确、安全、简便的方法,而且并发症少。本法既可用于脑深部实性病灶,也可用于囊性病灶抽液。本文并讨论活检取材部位及术后出血处理等。     

CT引导立体定向切除颅内占位性病变的护理

ＣＴ引导立体定向手术是将立体定向仪通过结合器与ＣＴ连接测出靶点的三维坐标 ,准确定位后将手术器械导入靶点实施手术的方法。此手术方法免除了传统开颅及脑室造影定位给患者带来的痛苦 ,降低了手术创伤和并发症 ,缩短了治疗时间。我们在ＣＴ引导下为 2 4例颅内占位病变患者行立体定向手术 ,疗效明显 ,现将护理体会介绍如下。1　临床资料1 1　一般资料　本组 2 4例中男 14例 ,女 10例 ,9～ 70岁。其中转移瘤3例 ,炎性肉芽肿 2例 ,脑囊虫病 6例 ,行立体定向活检术 2例 ,病理证实为胶质瘤后行肿瘤切除术。临床表现 :2 4例中癫痫 10例 ,头痛 …     

39例CT引导立体定向脑活检术快速病理诊断和常规病理诊断 …

评价ＣＴ引导立体定向脑活检快速病理检查在外科病理诊断中的价值。方法３９例ＣＴ导立体定向脑活检术的标本,将其快速石蜡切片与其随后的常规切片或／和手切除标本进行对比观察。结果３９例中３６例快速病理结果具有临床指导价值。其中２７例肿瘤病例中,１９例能明确诊断,５例有提示意义。     

脑炎误诊为胶质瘤4例分析

目的：分析脑炎误诊为脑胶质瘤的原因。方法：回顾性分析4例脑炎误诊为脑胶质瘤患者临床资料。结果：4例均行手术治疗,术后病理检查证实为脑炎。结论：脑炎有多种类型,可以多种表现形式首发,临床医师要综合考虑、全面分析,及时行脑脊液、脑电图及颅脑影像学检查,必要时进行立体定向活检,以利于减少手术风险。     

CT引导下脑内病变立体定向治疗28例分析

ＣＴ引导下脑内立体定向技术使手术器械能精确地到达大脑内任意一点[1] ,可应用于脑内血肿清除、脑深部病灶定向活检、肿瘤、脑血管畸形、脑脓肿、脑积水、脑内囊性病变立体定位治疗及置管引流等。1　资料与方法2 0 0 0年 10月～ 2 0 0 2年 5月我们开展ＣＴ立体定向治疗2 8例 ,男 2 0例 ,女 8例 ,年龄 4 5～ 73岁。其中脑深部病灶定向活检 2例 ,脑脓肿立体定位治疗 3例 ,脑血肿立体定向清除术 2 3例。全部病变均一次准确定位。本组病例先行ＣＴ扫描确诊为颅内病变 ,3例为脑脓肿 ,2例未确诊 ,2 3例为颅内血肿。患者在局麻下安装国产ＡＳＡ - …     

导航下微侵袭立体定向脑肿瘤活检的手术配合

随着近年来神经外科技术的飞速发展和微侵袭神经外科理念和技术的广泛而深入的应用,将微侵袭观念引入立体定向活检手术中并探讨其在确定脑深部或主要功能区病变的病理组织学诊断中的作用。因为病灶位置的特殊性,常规开颅手术切除时常伴随较大的风险和后遗症。对于不宜手术切除的深部或多发病灶（如淋巴瘤,脱髓鞘病变）,除非需要手术缓解急性期占位症状,否则切除病灶往往效果不甚理想。立体定向活检技术的发展为脑内病灶的活检与诊断提供了便利。通过微侵袭技术以最小的损伤明确诊断,从而为进一步治疗提供依据。目前相对成熟的无框架立体定向技术摆脱了以往定向仪框架的安装、调节等繁琐步骤,配合功能磁共振导航对病灶进行实时、精确定位。利用细针穿刺活检病变组织,根据术中标本冰冻病理结果决定手术方案,相对传统开颅手术更加快捷,创伤更小。     

超声引导下麦默通旋切系统在触诊阴性乳腺病灶诊断中的应用

目的探讨超声引导下麦默通旋切系统对触诊阴性乳腺病灶的诊断优势及意义。方法2014年1月~2015年9月我院所收治经超声诊断而临床触诊阴性病灶的341例患者采用超声引导下麦默通旋切系统旋切并对其中164例患者进行了BARD活检针穿刺活检,回顾分析了相应患者的临床资料,分析了麦默通旋切系统较BARD活检穿刺针的诊治优势,同时对常见并发症进行探讨。结果341例麦默通旋切患者穿刺成功率为100%,164例BARD活检穿刺针患者穿刺成功率为82.19%,麦默通旋切组标本病检阳性率为100%,而BARD活检穿刺针组阳性率仅为76.1%。341例患者中仅5例患者出现轻微皮下瘀斑,3例患者出现术后血肿。结论针对触诊阴性的乳腺病灶,在超声引导下行麦默通旋切活检术具有微创、安全、成功率高、并发症少的优势,对触诊阴性乳腺病灶的诊治具有重要意义。       

“立体定向三点一线择优穿刺法”在甲状腺结节微创组织病理活检术中的应用价值

目的探讨“立体定向三点一线择优穿刺法”在超声引导甲状腺结节微创组织病理活检术中的应用价值。方法总结分析2009年9月—2012年4月我科应用“立体定向三点一线择优穿刺法”完成甲状腺结节微创组织病理活检921例（共1030个结节）的临床资料。结果 921例穿刺术用时6～26分钟,平均13分钟。结节直径0.3～2.3cm,平均0.92cm。结节直径〈0.5cm 165例,占17.9%。结节紧邻颈部大血管、神经、气管及食道（“危险区”）135例,占14.6%。921例患者活检取材,穿刺成功率为100%（921/921）。活检诊断为甲状腺癌的269例,良性病变652例。活检后行手术治疗385例,病理符合率98.4%。假阴性（甲状腺癌误诊为良性疾病）6例,假阴性率1.6%（6/385）。无假阳性。活检后患者均未出现明显不适,发生腺体表面及肌间少许渗出34例,无明显血肿形成,未经特殊处置,平均1个月后自行吸收。结论 “立体定向三点一线择优穿刺法”应用简便、准确,缩短了手术时间,同时提高了病理的检出率,降低了手术风险。提高了手术的成功率。     

超声在乳腺疾病微创诊疗中的应用

目的使用Mammotome乳腺微创旋切技术对乳腺病灶进行组织学活检和切除，评价超声在此微创诊疗中的作用。方法36例女性患者36处乳腺病灶在超声引导下行微创旋切术，超声动态实时监测切除全过程，所有切除组织均送病理学检查。结果36例36处病灶中，临床诊断33例良性病灶均被Mammotome微创旋切切除，疑为乳腺癌的3例仅行部分切除活检，所有操作无一例失败，均获得明确诊断。除3例疑为乳腺癌患者外，其余病灶在切除后1周、1个月和3个月行超声检查和临床触诊均未在原手术病灶区发现异常。结论超声引导下乳腺病灶微创旋切术是一项简便、安全、有效的技术，具有良好的临床应用前景。     

彩色超声多普勒在乳腺触诊阴性病变微创诊断中的应用

目的彩色超声多普勒引导下用微创方法对乳腺触诊阴性的病变进行活检,良性病变完全切除,评价彩超在此微创诊疗中的应用。方法30处临床触诊阴性的乳腺病变均经超声清晰显示,疑为恶性病变7处,其中4处含微钙化,良性病变23处。30处病变均行Mammotome微创旋切术活检,整个过程彩超动态实时监测,评价其诊疗效果。结果23处良性病变完全切除,其中纤维腺瘤15处,乳腺腺病6处,非典型增生2处;疑为恶性的7处病变仅行部分切除活检,其中6处为恶性肿瘤,1处为乳腺囊性增生,疑为恶性的病灶后均经手术切除并复送病理证实。所有病例术后1周、1个月、3个月行临床及彩超复查,未发现复发迹象。结论Mammotome微创旋切术是目前诊断乳腺病变的理想方法,彩超在该微创诊疗中具有重要的作用。     

Stereotactic Breast Biopsy: The Nurse's Role

Over the past 3 decades many efforts have been made to educate women about the importance of early detection in the fight against breast cancer. Increased participation in mammography screening, along with improved systemic therapy, is said to be responsible not only for the most recent increase in breast cancer survival but for the increased detection of abnormal mammogram lesions and the estimated 1.4 million biopsies done each year. In the past, all these biopsies were performed in the operating room as an open, wire localization, surgical biopsy. Because only 20% of these biopsies result in a cancer diagnosis, there has been an increase in image-guided breast biopsies, of which a large proportion is with stereotactic imaging. These breast biopsies are performed to diagnose and, or remove these breast lesions which has kept many women out of the operating room. The women with benign diagnosis are followed appropriately and those with a cancer diagnosis proceed to the operating room for definitive surgery. The biopsy tools have progressed from fine-needle aspiration through vacuum-assisted devices, some designed to give a diagnosis and others designed to remove a benign lesion. With the arrival of newer biopsy tools that allow for large and complete samples, we may soon see patients with small cancers being diagnosed and treated in one setting with an image-guided breast biopsy. Despite their minimally invasive nature, these newer diagnostic techniques are still biopsies with the anxiety associated with a potential diagnosis of breast cancer. The nurse's role in pre- and postprocedural education is crucial to the success of any stereotactic breast biopsy program. As the potential for these devices moves toward therapy the nurse's role will expand.     

Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses.

OBJECTIVE: Large-core needle biopsy of the breast can be performed with stereotactic or ultrasonographic guidance. However, ultrasonographically guided large-core needle biopsy has notable advantages, including the absence of ionizing radiation, increased patient comfort, and greater cost-effectiveness. The purpose of this study was to evaluate the accuracy of ultrasonographically guided large-core needle biopsy for the diagnosis of breast cancer in palpable and nonpalpable breast masses. METHODS: The study was a retrospective review of consecutive ultrasonographically guided large-core needle biopsies for indeterminate breast masses. A total 424 ultrasonographically guided core biopsies were performed in 367 patients with 1 or more breast masses. Ultrasonographically guided core biopsy was performed with a 14-gauge spring-loaded needle and a freehand technique. Correlation of ultrasonographically guided core biopsy pathologic findings with subsequent surgical pathologic findings or long-term imaging follow-up was performed. RESULTS: Of 424 indeterminate breast lesions for which histopathologic findings were obtained by ultrasonographically guided core biopsy, 234 cancers were diagnosed. Twenty-eight additional lesions had either questionable but not definitively malignant pathologic features (n = 11) or radiologic-pathologic discordance (n = 17) and were surgically excised. Of these, 8 additional cancers were diagnosed. Patients or surgeons chose excision of 41 additional lesions that were benign on ultrasonographically guided core biopsy No cancer was found in these surgical specimens. One additional cancer was diagnosed at a 6-month imaging follow-up because of interval growth. On the basis of surgical and long-term imaging follow-up, the sensitivity of ultrasonographically guided core biopsy for the diagnosis of breast carcinoma was 99.2% (95% confidence interval, 95.6%-99.9%) in 173 palpable breast masses and 93.2% (95% confidence interval, 87.1%-97%) in 251 nonpalpable masses. In cancers diagnosed on the basis of immediate surgical excision as a result of ultrasonographically guided core biopsy that showed either questionable pathologic features or radiologic-pathologic discordance, the sensitivity of ultrasonographically guided core biopsy for the diagnosis of breast cancer was 99.2%. CONCLUSIONS: Ultrasonographically guided large-core needle biopsy is a sensitive percutaneous biopsy method for the diagnosis of breast cancer in palpable and nonpalpable breast masses.     

Preferential use of sonographically guided biopsy to minimize patient discomfort and procedure time in a percutaneous image-guided breast biopsy program.

OBJECTIVE: To determine whether preferential use of sonographic guidance for percutaneous biopsy of breast masses results in a subset of patients with a shorter procedure time and less discomfort compared with patients undergoing stereotactic biopsy. METHODS: A prospective observational study was performed on 193 women undergoing percutaneous image-guided breast biopsy between 1997 and 1999. Data were collected on room time, physician time, and patient comfort levels for 122 stereotactic and 71 sonographically guided biopsies. Differences between stereotactic and sonographically guided biopsy for all lesions and for masses were analyzed for statistical significance. RESULTS: Mean room times were 62.2 minutes for stereotactic biopsy and 39.4 minutes for sonographically guided biopsy (P < .0001). Mean physician times were 23.0 minutes for stereotactic biopsy and 15.8 minutes for sonographically guided biopsy (P < .0001). When we limited our analyses to women undergoing biopsy for masses, the difference in physician time largely disappeared, but the difference in room time remained (P < .0001). Women undergoing stereotactic biopsy were more likely to report discomfort due to body positioning than were women undergoing sonographically guided biopsy (P < .001). These differences existed whether we included all lesions or restricted our analyses to masses. CONCLUSIONS: Preferential use of sonographically guided breast biopsy for masses results in shorter procedure times and less patient discomfort compared with prone stereotactic biopsy.     

超声引导及重复活检在CT/MR LR-4/5类肝局灶性小病变穿刺活检的应用价值

目的探讨超声引导及重复活检在CT/MR LR-4/5类肝局灶性小病变穿刺活检中的应用价值。方法收集<2 cm且CT/MR LR-4/5类的251个病灶行超声引导下肝局灶性病变活检,共241例患者。分为US和CEUS引导下穿刺活检,每次活检穿1~2针。恶性病变经活检或手术切除后病理确诊。良性病变的最终诊断是依靠重复活检或至少6个月的影像学检查无变化。结果超声引导下穿刺活检成功率100%;218个灶病变最终确诊为恶性。CT/MR LR-4/5类与超声引导下穿刺活检的定性诊断率为86.85%和98.01%。US组及CEUS组引导下首次活检定性诊断率为78.10%和90.35%;40个灶首次活检病理未明确病变性质的病变经重复活检后定性诊断率100%;重复穿刺后,两组穿刺活检定性诊断率为96.35%和100%。首次活检及重复活检的定性诊断率为83.67%和100%。结论超声引导下穿刺活检能提高CT/MR LR-4/5对肝内局灶性小病变的诊断效能,重复活检能提高常规超声引导下穿刺活检定性诊断率的临床价值。     

CT引导下经皮骨骼肌肉系统疾病穿刺活检42例体会

目的:探讨CT引导下经皮骨骼肌肉系统疾病穿刺活检术的技术要点。方法:回顾分析我院2006年6月至2007年11月42例行CT引导下骨骼肌肉系统疾病患者的活检资料、手术及术后病理及穿刺并发症情况。结果:36例经穿刺得到确切病理结果,成功率85.7%(36/42),其中良性病变15例,恶性病变21例,36例中19例行手术治疗,术后病理与活检病理结果符合率94.7%(18/19),3例穿刺取得的病理组织不足,未能获得明确的病理诊断,占7.1%(3/42),3例活检失败,占7.1%(3/42),所有病例均未发生严重并发症。结论:CT引导下经皮穿刺活检术对骨骼肌肉系统疾病的诊断具有准确性高、创伤小、并发症少等特点,在活检时病变骨组织与周围软组织肿块采用不同的活检器材分别取材,可提高活检的成功率。     

超声导向下Mammotome切除乳腺纤维腺瘤的应用

目的 探讨在超声导向下，应用Mammotome活检及旋切系统切除乳腺纤维腺瘤。方法 在超声导向下，利用Mammotome对乳腺纤维腺瘤进行活检和切除，对出现的并发症进行及时处理，术后对治疗效果进行随访观察。结果 86例患者的175个纤维腺瘤被切除，患者的并发症少，并发症包括出血、血肿和胸大肌损伤等，经及时处理后恢复。术后不影响乳房外观，部分患者手术区域有不同程度的瘢痕形成。结论 在超声导向下，应用Mammotome切除乳腺纤维腺瘤，不但有助于诊断，而且可以达到切除肿块的目的，是一种创伤小、并发症少的微创手术。