目的 讨论多窗技术+凝血酶封闭在CT导向下经皮肺穿刺活检中的应用价值。 方法 2009年6月－2010年3月收集分析由同一工作组连续完成的CT导向下肺穿刺活检患者共128例，其中A组58例，采用双窗技术+注射生理盐水；B组70例，采用多窗技术+注射凝血酶）。比较两组患者的诊断阳性率、气胸及肺出血发生率的差异。 结果 128例均穿刺成功，A组的穿刺诊断阳性率、气胸发生率及肺出血发生率分别为87.9%、13.8%、17.5%。B组的穿刺诊断阳性率为92.9%，气胸发生率为8.6%，肺出血发生率为5.7%。两组穿刺诊断阳性率和气胸发生率的差异无统计学意义（P＞0.05）；B组肺出血的发生率均明显低于A组，两组间肺内出血的发生率差异有统计学意义（P＜0.05）。 结论 多窗技术+凝血酶针道封闭技术能有助于减少气胸、肺出血等肺穿刺活术的并发症，具有重要的临床应用价值。
Objective To summarize some problems about the management of acute pancreatic pseuclocyst (PPC) by CT guided percutaneous drainage (PCD).Methods The recent domestic and foreign literatures were reviewed in order to explore the research advancement, such as indication, applied time, technique skill, complication and curative effect by CT guided PCD. Results This operation could be early performed in patients with acute PPC, preventing and decreasing the incidence of possible complications resulted from the traditional long-term observation and waiting. The technique skill of operation was easy with low incidence of complications and the effect was good. Combined use of somatostatin might shorten the treatment time. Some patients could be postoperatively managed in out-patient, thus the expense could be cut down. Conclusions CT guided PCD is a minimally invasive operation and is easy to perform with high effective rate and low incidence of complications and low cost. Reasonable selection of the indications and improvement of equipments and operation techniques may be helpful to improve the curative effect. The extended application of this operation is advised.
Objective To explore the value of CT guided percutaneous puncture, aspiration and drainage on diagnosis and treatment of local complications of severe acute pancreatitis (SAP). Methods Forty-three cases of SAP combined with pancreatic necrosis, peripancreatic hydrops, pseudocyst and abscess were analyzed, all of them underwent CT guided percutaneous puncture, aspiration and drainage. Results The punctures were performed on 43 SAP patients for sixty-four times, the success rate was 100%, and in 24 cases of them puncture were performed for diagnosis, the positive rate of fluid absorption by puncture was 100%. Forty-one of 43 cases (95%) received puncture and tube drainage, open operation was performed in one patient, one patient was automatically discharged. The remission rate of abdominal distension was 93% (40/43) and 16 of 43 cases (37%) were turned to open operation. The effective rate of drainage was 61% (25/41). Conclusion The puncture, aspiration and drainage guided by CT is an effective method in diagnosis and treatment of local complications in part of SAP cases.
ObjectiveTo evaluate the diagnostic value of computer tomography (CT)-guided percutaneous lung biopsy and tissue culture in pulmonary diseases. MethodsAfter the preoperative evaluation, 48 patients underwent CT-guided percutaneous lung biopsy were analyzed, and 16 patients accepted tissue culture. The clinical significance of combined diagnostic rate of histopathology and tissue culture was investigated. ResultsAll patients were punctured successfully. The pathological diagnosis confirmed 26 (54.2%) cases with malignant lesions and 16 (33.3%) cases with benign lesions. Six cases could not be pathological diagnosed. The pathological diagnostic rate was 87.5%. Sixteen patients accepted tissue culture. Among them 3 cases with benign lesions were cultured. The positive rate of tissue culture was 18.8%, and improved to 30.0% in the patients with benign lesion. The combined diagnostic rate of histopathology and tissue culture was 89.6%. In addition, the accuracy rate of pathological diagnosis in the group of lung nodules was 95.0%, higher than the others. The accuracy rate of pathological diagnosis in lung nodules of 2cm~3cm in diameter was 100.0%, and the positive rate of tissue culture in lung lump of 3cm~5cm in diameter was 25.0%. The incidence of pneumothorax and hemorrhage was 14.6%. ConclusionsCT-guided percutaneous lung biopsy is a safe and effective diagnostic method. For pulmonary infectious diseases, combination of CT-guided percutaneous lung biopsy and tissue culture can improve the early diagnostic rate.
Objective To investigate the effect of CT-guided percutaneous lung puncture biopsy and nursing of postoperative complications. Methods We retrospectively analyzed the clinical data of 522 patients who underwent CT-guided percutaneous lung biopsy between May and August 2014 in the Department of Lung Cancer Center. Effect of the puncture biopsy, postoperative complications and nursing measures were summarized. Results After surgery, 507 cases of diagnosis were confirmed, 10 were not confirmed, and 5 cases of puncture were unsuccessful. There were 203 cases of complications, including 122 cases of pneumothorax (23.4%), 56 of hemoptysis 56 (10.7%), 20 of pleural effusion (3.8%), 4 of pleural reaction (0.8%), and 1 of mediastinal emphysema (0.2%). All the above complications were cured after positive symptomatic treatment and nursing care. There were no such complications as severe hemopneumothorax, severe hemoptysis or needle tract metastasis. Conclusions CT-guided percutaneous lung puncture biopsy is a safe and reliable method, but there are some patients with complications. Observation and postoperative care are particularly important. Timely detection and positive care will achieve satisfactory results.
Objective To explore the diagnostic value and safety of CT-guided percutaneous lung biopsy (CT-PLB) for pulmonary nodules. Methods A total of 438 patients with pulmonary nodules underwent CT-PLB for further diagnosis. Results The CT-PLB was performed successfully in all 438 patients. The positive biopsy rate at the first puncture was 94.9%, and 100.0% at the second puncture. The pathology results revealed 379 (86.5%) cases of malignant lesions, 37 cases of benign lesions, and 22 cases with uncertainty. The sensitivity, specificity and accuracy of CT-PLB were 97.9% (376/384), 94.4% (51/54), and 97.4% (427/438), respectively. The first puncture induced complications included pneumothorax in 33 (7.5%) cases, blood in phlegm in 62 (14.2%) cases, pleural reaction in 7 (1.6%) cases, and bleeding at the site of puncture in 6 (1.4%) cases. There was no occurrence of neoplasm needle track implantation. The second puncture induced complications included pneumothorax in 7 (46.6%) cases and blood in phlegm in 11 (73.3%) cases. The incidences of pneumothorax and blood in phlegm were significantly higher in the patients with chronic obstructive pulmonary disease (COPD), with pulmonary lesion size＜3 cm, or with penetration depth ≥5 cm (P＜0.05). Conclusions CT-PLB is a safe method with a relatively small trauma and has good diagnostic value for pulmonary nodules. The incidence of complications increases in patients with smaller pulmonary lesions, deeper puncture, or COPD.
ObjectiveTo systematically evaluate the application effect of CT-guided Hook-wire localization and CT-guided microcoil localization in pulmonary nodules surgery. MethodsThe literatures on the comparison between CT-guided Hook-wire localization and CT-guided microcoil localization for pulmonary nodules were searched in PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP and CNKI databases from the inception to October 2021. Review Manager (version 5.4) software was used for meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of studies.ResultsA total of 10 retrospective cohort studies were included, with 1 117 patients including 473 patients in the CT-guided Hook-wire localization group and 644 patients in the CT-guided microcoil localization group. The quality of the studies was high with NOS scores>6 points. The result of meta-analysis showed that the difference in the localization operation time (MD=0.14, 95%CI −3.43 to 3.71, P=0.940) between the two groups was not statistically significant. However, the localization success rate of the Hook-wire group was superior to the microcoil group (OR=0.35, 95%CI 0.17 to 0.72, P=0.005). In addition, in comparison with Hook-wire localization, the microcoil localization could reduce the dislocation rate (OR=4.33, 95%CI 2.07 to 9.08, P<0.001), the incidence of pneumothorax (OR=1.62, 95%CI 1.12 to 2.33, P=0.010) and pulmonary hemorrhage (OR=1.64, 95%CI 1.07 to 2.51, P=0.020). ConclusionAlthough Hook-wire localization is slightly better than microcoil localization in the aspect of the success rate of pulmonary nodule localization, microcoil localization has an obvious advantage compared with Hook-wire localization in terms of controlling the incidence of dislocation, pneumothorax and pulmonary hemorrhage. Therefore, from a comprehensive perspective, this study believes that CT-guided microcoil localization is a preoperative localization method worthy of further promotion.
ObjectiveTo compare the imaging characteristics and surgical methods of pulmonary nodules in the external 1/3 group and internal 2/3 group. MethodsA retrospective analysis of clinical data from patients who underwent thoracoscopic preoperative CT-guided lung nodule localization at the Department of Radiology, the First Affiliated Hospital of Xiamen University from September 2020 to April 2022 was conducted. ResultsA total of 215 patients were enrolled (247 pulmonary nodules), including 70 males and 145 females, with a median age of 48.0 years. Based on the location of the nodules under CT guidance, those located in the external 1/3 area of the lung were classified into an external 1/3 group, while those located in the middle 1/3 and inner 1/3 areas were classified into an internal 2/3 group. There was no statistical difference between the two groups in terms of general clinical data, nature of pulmonary nodules, distribution of pulmonary nodules in lobes, localization time, and localization complications (P>0.05). However, there were statistical differences in the distance of pulmonary nodules from the pleura [0.6 (0.0-1.9) cm vs. 1.8 (0.0-4.5) cm, P<0.001], size of pulmonary nodules [0.7 (0.2-1.8) cm vs. 1.0 (0.2-2.0) cm, P<0.001], and surgical methods (P=0.002). In the external 1/3 group, 92.1% of nodules underwent thoracoscopic wedge resection, while fewer patients underwent other procedures; in the internal 2/3 group, 77.1% of nodules underwent thoracoscopic wedge resection, and 19.3% underwent segmentectomy. ConclusionThe diameter of pulmonary nodules, the distance of pulmonary nodules from the pleura, and surgical methods differ between the external 1/3 group and internal 2/3 group. Thoracic surgeons can develop more precise surgical plans based on the location and size of pulmonary nodules.
ObjectiveTo explore the influencing factors for Hook-wire precise positioning under CT guidance, determine the best positioning management strategy, and develop Nomogram prediction model. Methods Patients who underwent CT-guided Hook-wire puncture positioning in our hospital from July 2018 to November 2022 were selected. They were randomly divided into a training set and a validation set with a ratio of 7 : 3. Clinical data of the patients were analyzed, and the logistic analysis was used to screen out the risk factors that affected CT-guided Hook-wire precise positioning for the training set. The Nomogram prediction model was constructed according to the risk factors, and the goodness of fit test and clinical decision curve analysis were performed. ResultsA total of 199 patients with CT-guided Hook-wire puncture were included in this study, including 72 males and 127 females, aged 25-83 years. There were 139 patients in the training set and 60 patients in the validation set. In the training set, 70 patients were accurately located, with an incidence of 50.36%. Logistic regression analysis showed that height [OR=3.46, 95%CI (1.44, 8.35), P=0.006], locating needle perpendicular to the horizontal plane [OR=3.40, 95%CI (1.37, 8.43), P=0.008], locating needle perpendicular to the tangent line of skin surface [OR=6.01, 95%CI (2.38, 15.20), P＜0.001], CT scanning times [OR=3.03, 95%CI (1.25, 7.33), P=0.014], occlusion [OR=10.56, 95%CI (1.98, 56.48), P=0.006] were independent risk factors for CT-guided Hook-wire precise localization. The verification results of the Nomogram prediction model based on these independent risk factors showed that the area under the receiver operating characteristic curve (AUC) was 0.843 [95%CI (0.776, 0.910)], and the predicted value of the correction curve was basically consistent with the measured value. The AUC of the model in the validation set was 0.854 [95%CI (0.759, 0.950)]. The decision curves showed that when the threshold probability was within the range of 8%-85% in the training set and 18%-99% in the validation set, there was a high net benefit value. Conclusion Height, the locating needle perpendicular to the horizontal plane, the locating needle perpendicular to the tangent line of skin surface, number of CT scans, and occlusion are independent risk factors for CT-guided Hook-wire accurate localization. The Nomogram model established based on the above risk factors can accurately assess and quantify the risk of CT-guided Hook-wire accurate localization.