'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

摘要

Objective To investigate the value of "stereotactic thrcc-point-onc-linc optimal puncturc"in ultrasound-guided thyroid nodule minimally invasive biopsy surgery. Methods Take clinical data of 921 cascs(1030 nodules) from September 2009 to April 2002 applying "stereotactic thrcc-point-onc-linc optimal puncture " minimally invasive biopsy into analysis. Results Operation time were 6 ~26 minutes in all cases, with an average of 13 minutes. Nodule diameter ranged in 0. 3 ~ 2. 3 cm, with an average of 0. 92 cm. In 165 cases,nodule diameter were lower than 0. 5cm,accounting for 17. 9%. In 135 cases,nodules tightly close to cervical vessels,nerves,trachea and esophagus (as the "danger zone") accounting for 14. 6%. All of 921 patients accepted puncture biopsy with success rate of 100% (921/921). Biopsy diagnosed 269 cases of thyroid carcinoma, 652 cases of benign lesions. 385 cases underwent surgical treatment after biopsy, and pathological coincidence rate reached to 98. 4%. Six cases confirmed false negatives (thyroid cancer misdiagnoscd as benign disease) , with false-negative rate of 1. 6% (6/385). No false positive cases. Afte biopsies patients showed no obvious discomfort,no obvious hematoma formation,although 34 cases occurred little effusion on the gland surface or in-termusclc without special treatment,and finally self-absorbed within an average of one month. Conclusion "Stereotactic three-point-on-line optimal puncture" is simple, accurate, shortening the operation time. Additionally, the method improve the pathological detection rate and success rate of surgery,and reduce the risk of surgery.%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～ 2.3 cm,平均0.92 cm.结节直径<0.5 cm 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.