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超声内镜引导下Trucut胃周实质脏器活检
目的评估超声内镜引导下Trucut穿刺活检技术(EUS-TCB)对胃周实质器官穿刺活检的有效性及安全性.方法以三头30kg食用猪为研究对象,经静脉麻醉后行超声内镜检查及超声内镜引导下肝脏、胰腺及肾脏Trucut穿刺活检,穿刺获取的组织标本通过大体及组织学检查,观察获取组织条块的状态,测量组织条块的长度.检查结束后进行动物解剖并观察腹腔内出血状况.结果共对三头动物进行33次穿刺,其中肝脏穿刺11次,胰腺6次,肾脏16次.9次(81.8%)肝脏穿刺成功获得组织,获得的组织长度2～4mm,平均(3.00±0.66)mm;6次(100%)胰腺穿刺均获得组织,组织长度1.6～2.5mm,平均(2.0±0.3)mm;13次(81.25%)肾穿刺成功获得了肾脏组织,组织长度0.95～7.00mm,平均(3.64±1.73)mm;所有穿刺经组织病理学观察均能清晰判断出其组织来源;大体解剖观察腹腔内未见显著的出血现象.结论超声内镜引导下Trucut穿刺活检可以安全、有效地对胃周实质脏器进行穿刺,并获得满意的组织用于组织病理学观察.
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内镜超声引导下Trucut针活检
EUS is a sensitive method for staging gastrointestinal malignancies and pancreatic lesions. EUS FNA offers a diagnostic accuracy of about 60% - 90% for pancreatic tumors and more than 90% for lymph nodes.There are several limitations of EUS FNA including the need for on - site cytopathology review. In addition, accuracy of cytologic review is hampered by the presence of blood, benign epithelial cells, desmoplasia and well - differentiated tumors. Furthermore, the small biopsy sample and destruction of tissue architecture limits the diagnostic sensitivity for GISTs and lymphomas. Many of these problems can be overcomed with use of EUS trucut biopsy (TCB) needles. These large calibers , cutting needles, acquire larger tissue samples allowing preservation of tissue architecture and histologic examination. Our recently described experience with EUS TCB initially in swine and later humans demonstrated the safety for acquiring histologic tissue representative of the target organs sampled enabling accurate diagnosis. These studies suggested greater diagnostic accuracy of EUS TCB for submucosal mass lesions and lymphoma and potentially the need for fewer needles passes for solid pancreatic neoplasms. In this paper we reviewed the current TCB literature, device design and technique, help trouble shoot potential problems, and offerred opinion as to the utility and role of this new device.
