金普乐, 田晓玲, 杜芸, 王平, 王敏. 胸腔前外侧壁层胸膜活检30例临床分析[J]. 中国肿瘤临床, 2008, 35(18): 1021-1023.
引用本文: 金普乐, 田晓玲, 杜芸, 王平, 王敏. 胸腔前外侧壁层胸膜活检30例临床分析[J]. 中国肿瘤临床, 2008, 35(18): 1021-1023.
JIN Pu-le, TIAN Xiao-ling, DU Yun, WANG Ping, WANG Min. Clinical Analysis of 30 Parietal Pleural Biopsies of the Anterolateral Thoracic Cavity[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2008, 35(18): 1021-1023.
Citation: JIN Pu-le, TIAN Xiao-ling, DU Yun, WANG Ping, WANG Min. Clinical Analysis of 30 Parietal Pleural Biopsies of the Anterolateral Thoracic Cavity[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2008, 35(18): 1021-1023.

胸腔前外侧壁层胸膜活检30例临床分析

Clinical Analysis of 30 Parietal Pleural Biopsies of the Anterolateral Thoracic Cavity

  • 摘要: 目的: 胸膜活检是明确胸膜疾病性质的重要手段。获得胸膜组织的主要方法有:Vim-silverman分叶针,Abrams针,Cope针,Tru-Cut针,电视胸腔镜,纤维支气管镜替代胸腔镜胸膜活检术等,这些方法在不同方面存在活检的组织小,操作复杂,技术要求高,创伤大等缺点。本文提出一种新的胸膜组织活检器械-钳式胸膜活检套管针,并探讨其对胸膜咬检的效果和安全性。 方法: 应用钳式胸膜活检套管针对30例胸腔积液患者进行胸膜腔腋前线壁层胸膜活检。沿胸壁垂直方向将套管针送入胸腔,拔出针芯,将活检钳插入套管针外套管内,一只手固定外套管,另一手用指尖捏住活检钳体部,沿外套管管腔来回做提插运动,同时向腋前线胸腔逐步、缓慢推送外套管,当出现阻力感时说明已经抵达壁层胸膜,此时张开活检钳,将外套管和活检钳前推,钳头轻轻施压壁层胸膜后,关闭钳头并退出外套管,取出组织块。 结果: 取材成功率96.6%(29/30),病理诊断阳性率为70.6%(21/30),第1次咬检明确诊断率76.2%(16/21),病理未见肌肉、脂肪组织。平均活检组织块2.1±1.3mm。发生气胸4例(13.3%),胸痛14例(46.6%),出血3例(10%)。 结论: 应用钳式胸膜活检套管针进行腋前线壁层胸膜活检是一种操作简单、安全和有效的胸膜活检方法。

     

    Abstract: Objective : Pleural biopsy plays an important role in the differential diagnosis of pleural disease. Thoughpleural biopsies using Vim-Silverman type needle, Abrams needle, Cope needle, Tru-Cut needle, video-assist-ed thoracoscope and bronchofibroscope are popular in obtaining pleural tissues, these methods have somedisadvantages. The tissue obtained is small, the procedures are complicated, and they may cause trauma.The aim of this study is to evaluate the feasibility and safety of using trocar forceps, a new technique for pleu-ral biopsy. Methods : Thirty patients with pleural effusion underwent parietal pleura biopsy at the anterior axil-lary line. We inserted the trocar into the pleural cavity perpendicularly, pulled off the core-needle, inserted thebiopsy forceps into the canula, and then held the canula with one hand and carefully pinched the body of thebiopsy forceps with the other hand. We then opened the biopsy forceps, gently pushing both the canula andthe biopsy forceps to increase pressure against the pleura and ultimately closed the forceps to pull off the tis-sue sample. Results : Pleural tissue was successfully obtained in 29 patients (96.6%), 21 (70.6%) of which con-firmed the pathological diagnosis of the first biopsy. In 16 patients (76.2%), a definitive diagnosis was madeon the basis of the first biopsy. Neither muscle nor fat was observed microscopically. The average size of tis-sue sample obtained using trocar forceps was 2.1±1.3mm. Pneumothorax occurred in 4 patients (13.3%).Fourteen (46.6%) patients had pleuralgia and 3 patients had hemorrhage (10%). Conclusion : Parietal pleuralbiopsy with trocar forceps is simple, safe and effective.

     

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