机器人三维靶向定位系统在CT引导下肺穿刺活检术中的应用
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摘要
目的探讨MAXIOTM机器人三维靶向定位系统在CT引导下肺穿刺活检术中的应用。方法选择2017-08至09 40例经评估适合行肺穿刺活检术患者,随机分为试验组和对照组,每组20例。试验组采用MAXIOTM机器人三维靶向定位系统在CT引导下行肺穿刺活检术,对照组采用传统格栅定位器行CT引导下穿刺活检。比较试验组与对照组平均操作时间、一次性穿刺成功率、扫描次数、并发症发生率、活检病理诊断阳性率。结果试验组和对照组肺穿刺平均操作时间分别为(24.0±3.9)min和(27.3±4.1)min,两组比较差异无统计学意义(t=-1.91,P>0.05);试验组和对照组一次性穿刺成功率分别为75%(15/20)和25%(5/20),两组比较差异有统计学意义(χ~2=8.10,P<0.05);试验组和对照组平均扫描次数分别为(4.1±0.5)次和(6.0±1.3)次,两组比较差异有统计学意义(t=-4.65,P<0.05);试验组和对照组并发症发生率分别为10%(2/20)和40%(8/20),两组比较差异有统计学意义(χ~2=4.68,P<0.05);试验组和对照组活检病理诊断阳性率分别为100%(20/20)和90%(18/20),两组比较差异无统计学意义(χ~2=2.05,P>0.05)。结论 MAXIOTM机器人三维靶向定位系统在CT引导下肺穿刺活检术前较为精确地规划了穿刺路径,机械臂实时立体引导操作,一次性穿刺成功率提高,扫描次数减少,辐射剂量降低,并发症发生率低,具有较高的临床应用价值。
Objective To explore the clinical value of MAXIOTM robotic three-dimensional targeting system in lung puncture biopsy guided by CT. Methods Between August and September 2017,40 patients were randomly divided into the experimental group and control group. The experimental group adopted the MAXIOTM robotic three-dimensional targeting positioning system in the CT guided descending pulmonary puncture biopsy,while the control group was guided by the traditional grid locator to conduct the puncture biopsy. The average length of operation,one-time puncture success rate,scanning frequency,complication rate and biopsy pathological diagnosis rate were compared between the two groups. Results The average length of operation of lung puncture in the experimental group and control group was( 24. 0 ± 3. 9) min and( 27. 3 ± 4. 1) min respectively,so the difference between the two groups was not statistically significant( t =-1. 91,P > 0. 05). The one-time puncture success rate of the experimental group and control group was75%( 15/20) and 25%( 5/20) respectively,suggesting that the difference between the two groups was statistically significant( χ~2=8. 10,P < 0. 05). The average scanning times of the experimental group and the control group were( 4. 1 ± 0. 5) times and( 6. 0 ±1. 3) times respectively,and the difference between the two groups was statistically significant( t =-4. 65,P < 0. 05). The incidence of complications was 10%( 2/20) and 40%( 8/20) respectively in the experimental group and the control group so that the difference between the two groups was statistically significant( χ~2= 4. 68,P < 0. 05). The positive rate of test in the experimental group and the control group was 100%( 20/20) and 90%( 18/20) respectively,so the difference between the two groups was not statistically significant( χ~2= 2. 05,P > 0. 05). Conclusions The MAXIOTM robotic3 D targeting system can accurately plan the puncture path before CTguided lung biopsy. The real-time stereotactic operation of the robot arm can improve the success rate of disposable puncture,thus reducing the times of scans,radiation dose and complications.
Objective To explore the clinical value of MAXIOTM robotic three-dimensional targeting system in lung puncture biopsy guided by CT. Methods Between August and September 2017,40 patients were randomly divided into the experimental group and control group. The experimental group adopted the MAXIOTM robotic three-dimensional targeting positioning system in the CT guided descending pulmonary puncture biopsy,while the control group was guided by the traditional grid locator to conduct the puncture biopsy. The average length of operation,one-time puncture success rate,scanning frequency,complication rate and biopsy pathological diagnosis rate were compared between the two groups. Results The average length of operation of lung puncture in the experimental group and control group was( 24. 0 ± 3. 9) min and( 27. 3 ± 4. 1) min respectively,so the difference between the two groups was not statistically significant( t =-1. 91,P > 0. 05). The one-time puncture success rate of the experimental group and control group was75%( 15/20) and 25%( 5/20) respectively,suggesting that the difference between the two groups was statistically significant( χ~2=8. 10,P < 0. 05). The average scanning times of the experimental group and the control group were( 4. 1 ± 0. 5) times and( 6. 0 ±1. 3) times respectively,and the difference between the two groups was statistically significant( t =-4. 65,P < 0. 05). The incidence of complications was 10%( 2/20) and 40%( 8/20) respectively in the experimental group and the control group so that the difference between the two groups was statistically significant( χ~2= 4. 68,P < 0. 05). The positive rate of test in the experimental group and the control group was 100%( 20/20) and 90%( 18/20) respectively,so the difference between the two groups was not statistically significant( χ~2= 2. 05,P > 0. 05). Conclusions The MAXIOTM robotic3 D targeting system can accurately plan the puncture path before CTguided lung biopsy. The real-time stereotactic operation of the robot arm can improve the success rate of disposable puncture,thus reducing the times of scans,radiation dose and complications.
引文
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[12]Yoshimatsu R,Yamagami T,Kato T,et al.Percutaneous needle biopsy of lung nodules under CT fluoroscopic guidance with use of the“I-I device”[J].Br Radiol,2008,81(962):107-112.
[13]Lee S M,Park C M,Lee K H,et al,C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules:clinical experience in 1108 patients[J].Radiology,2013,271(1):291-300.
[14]杨清杰,胡蒙,郭明.新型三维穿刺定位引导器在经皮肺穿刺活检术中的应用[J].中华微创外科杂志,2016,16(11):1019-1022.
[2]金玉晶.低剂量螺旋CT肺癌筛查检出肺结节的处理及进展[J].癌症进展,2017,1(4):349-353.
[3]李家开,于淼,肖越勇,等.CT透视引导下经皮放射性125I例子永久植入治疗肺恶性肿瘤[J].中国医学影像技术,2012,28(9):1664-1669.
[4]胡佳寿,张立安,孙金凤,等.自动活检枪与CT-pinpoint三维激光定位导引系统的临床应用[J].中国医学影像学杂志,2006,14(3):184-188.
[5]杨杰,肖越勇,张肖,等.电磁导航系统在CT引导下经皮穿刺肺活检术中的应用[J].中国介入影像与治疗学,2012,9(3):172-177.
[6]Krucker J,Xu S,Venkatesan A,et al.Clinical utility of resl-time fusion guidance for biopsy and ablation[J].J Vasc Interv Radiol,2011,22(4):515-520.
[7]任伟,李茹恬,闫婧,等.改良CT和激光双引导经皮肺穿刺活检在肺癌精确诊断中的应用[J].中华肿瘤防治杂志,2017,24(19):1373-1377.
[8]金雪云,嵇爱平,刘国平,等,CT引导下经皮肺穿刺活检在肺外周病变中的诊断价值[J].当代医学,2014,10(28):72-73.
[9]Nakatani M,Tanigawa N,Kariya S,et al.Analysis of factors influencing accuracy and complications in CTguided lung biopsy[J].Minim Invasive Ther Allied Technol,2012,21(6):415-422.
[10]Wu C C,Macher M M,Shepard J A.Complications of CT guided percutaneous needle biopsy of the chest:prevention and management[J].AJR Am J Roentgenol,2011,196(6):W678-682.
[11]Wang Y,Jiang F,Tan X,et al.CT-guided percutaneous transthoracic needle biopsy for paramediastinal and nonparamediasinal lung lesion:diagnostic yield and complications in 1848 patients[J].Medicine,2016,95(31):e4460.
[12]Yoshimatsu R,Yamagami T,Kato T,et al.Percutaneous needle biopsy of lung nodules under CT fluoroscopic guidance with use of the“I-I device”[J].Br Radiol,2008,81(962):107-112.
[13]Lee S M,Park C M,Lee K H,et al,C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules:clinical experience in 1108 patients[J].Radiology,2013,271(1):291-300.
[14]杨清杰,胡蒙,郭明.新型三维穿刺定位引导器在经皮肺穿刺活检术中的应用[J].中华微创外科杂志,2016,16(11):1019-1022.