1、Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time BioPince活检枪CT引导下经同轴套管针肺部病变穿刺活检术Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time CT导引肺穿刺活检术特点 肺组织损伤小，安全可靠 CT定位精确、准确率高 CT图像清晰，清楚显示体内不同密
2、度的组织结构和病灶，无重叠影响 对纤支镜不能达到部位或肺内多发病灶是肺穿刺的优势 安全、快捷、准确安全、快捷、准确Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 适应症 肺内结节、纵隔肿块 胸壁或胸膜的肿块 肺局灶、或多发的肺内实变，需取得局部感染细菌学诊断以确定治疗计划 放、化疗前取得细胞组织学诊断Our greatest weakness lies in giving up.The most certain way to s
3、ucceed is always to try just one more time 禁忌症 血管瘤、血管性病变、凝血障碍性病变、包虫病 严重肺气肿、肺纤维化、肺动脉高压；肺内或胸腔内化脓性病变；动静脉畸形、动脉瘤；严重出血倾向；穿刺行径有肺大疱、或肺囊肿 严重恶病质不能配合Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 我院开展穿刺活检的历史、1994年，X线电视引导穿刺活检；、1996年，普通CT扫描引导穿刺活检；、2000
4、年，螺旋CT透视引导穿刺活检。Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 术前准备 常规检查出凝血时间、血小板计数等 完善CT检查，评估手术风险等 术前禁食46h，以防术中呕吐 术前谈话、签字，并向病人及家属详细说明手术过程 训练病人在平静呼吸下屏气，以便在术中很好配合 Our greatest weakness lies in giving up.The most certain way to succeed is alw
5、ays to try just one more time 术 前 器 材 准 备、活检针（枪）；、与活检针相匹配的同轴套管针；、玻璃片、固定标本用盛酒精乙醚液和 盛福尔马林用的玻片容器；、栓塞止血备用：明胶海绵、同轴套管、平头针芯；、气胸引流备用：18G穿刺针、导丝、9扩张管、8猪尾多侧孔引流管。Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 活检针 抽吸针 切割针 环钻针Our greatest weakness lies
6、in giving up.The most certain way to succeed is always to try just one more time 抽吸针：口径较细的斜切面针，只能获得细胞学标本，如千叶针活检针Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 活检针 切割针：口径较粗，具有不同形状的针尖，可获得组织芯或组织块，如沟槽针Our greatest weakness lies in giving up.Th
7、e most certain way to succeed is always to try just one more time 常见凹槽式活检枪常见凹槽式活检枪Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 环钻针：介于抽吸或切割活检针之间活检针Our greatest weakness lies in giving up.The most certain way to succeed is always to try ju
8、st one more time 全球唯一圆柱切割型 多59%的组织样本Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 2022-12-2714BioPince一次性全自动活检针 全球唯一圆柱切割型 多59%的组织样本ConventionalSide-NotchBioPinceOur greatest weakness lies in giving up.The most certain way to succeed is al
9、ways to try just one more time 2001-8-11江苏大学附属武进医院校15132333套套芯芯自动自动活检长度可调活检长度可调同轴套管针同轴套管针Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time Biopince针头部与组织针头部与组织Our greatest weakness lies in giving up.The most certain way to succeed is always t
10、o try just one more time Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 2022-12-2718BioPince 取样原理独特的三重套管设计Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 2022-12-2719BioPince三种活检深
11、度调节13mm 取 9mm 组织样本23mm 取 19mm 组织样本33mm 取 29mm 组织样本Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 同轴套管针 15G和17G 分别16G与18G穿刺针匹配 10cm、15cm、20cm三种规格 操作方便灵活 穿刺成功后经工作套管进行活检 一次穿刺多次活检Our greatest weakness lies in giving up.The most certain way to
12、succeed is always to try just one more time 手术过程 体位选择 CT扫描病灶 进针位置、深度及角度选择 消毒、铺单、局麻 进针到位CT扫描确认位置 活检取组织Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 体位选择 上叶、肺门仰卧位 中叶仰卧位侧方入路 下叶基底段、背段俯卧位原则：医师方便操作 患者能够耐受 Our greatest weakness lies in giving up
13、.The most certain way to succeed is always to try just one more time CT扫描 观察病变位置、大小、形态、与周围组织关系 选择最佳层面和穿刺点，光标测出进针方向、角度和深度 在己选定层面体表相应部位放置金属标记，做3-5层局部扫描 检查床固定在选定层面位置，打开定位灯以其光标为横坐标，固定的标记物为纵坐标，确定皮肤穿刺点，记号笔标记Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one m
14、ore time 穿刺选择原则 穿刺点 皮肤至病变最短距离处 穿刺层面 显示病灶最大层面处 Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 穿刺前准备 常规消毒铺单，穿手术衣，局部普鲁卡因或利多卡因麻醉 穿刺针置于皮下穿刺点准备进针 训练患者平静呼吸下屏气Our greatest weakness lies in giving up.The most certain way to succeed is always to try
15、 just one more time 穿刺扫描 嘱病入平静呼吸下屏气，按预定角度、深度快速进针达病变部位 再行CT扫描确认针尖己到达病变理想位置Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 肺穿准确影响因素 操作者的熟练程度 病理细胞学医师的诊断水平 穿刺部位、穿刺点定位不准 穿刺针选择不当 标本处理不当 标本检查项目不全Our greatest weakness lies in giving up.The most cer
16、tain way to succeed is always to try just one more time 气胸：2.2%10.6%。一般超过50%的气胸给予临床处理 咯血：较少见，一般可自愈，若量大，可对症治疗 空气栓塞：极少见 瘤细胞种植：罕见并发症Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time（）选定（）选定CT穿刺最佳层面穿刺最佳层面、认清、认清CT图像上图像上“断面位置数据断面位置数据”；、确定穿刺点。、确定穿刺点
17、。、标注出坐标网格线；、标注出坐标网格线；、测量穿刺点到达纵坐标或横坐标的距离、测量穿刺点到达纵坐标或横坐标的距离。、测量穿刺针进、出病灶的深度、角度。、测量穿刺针进、出病灶的深度、角度。Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one
18、more time 纵坐标纵坐标横坐标横坐标CT扫描横断面扫描横断面CT扫描孔内激光定位线扫描孔内激光定位线Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 纵坐标纵坐标纵坐标纵坐标CT扫描横断面扫描横断面CT图像、网格线与激光定位线的关系图像、网格线与激光定位线的关系Our greatest weakness lies in giving up.The most certain way to succeed is always
19、to try just one more time 纵坐标纵坐标横坐标横坐标断面位置数据断面位置数据Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 横坐标横坐标纵坐标纵坐标穿刺点穿刺点Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time（4）标注体表穿刺点）标注体表穿刺
20、点、移动床面，使扫描架上显示的位置数据与、移动床面，使扫描架上显示的位置数据与CT图像上图像上“断面位置数据断面位置数据”完全一致；完全一致；、打开激光定灯，此时病人体表：、打开激光定灯，此时病人体表：横行线横行线为为最佳穿刺层面最佳穿刺层面；纵行线纵行线分别是分别是CT图像上网格线图像上网格线中的中的横坐标横坐标和和纵坐标纵坐标；、根据、根据CT图像的测量数据，把穿刺点翻录到图像的测量数据，把穿刺点翻录到病人体表，用龙胆紫标注病人体表，用龙胆紫标注“”、碘酒固定之、碘酒固定之。Our greatest weakness lies in giving up.The most certain w
21、ay to succeed is always to try just one more time 断面位置数据断面位置数据Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 取材与标本取材与标本、改变套管针的角度，摄取
22、病灶内不同、改变套管针的角度，摄取病灶内不同方向的组织条以上。方向的组织条以上。、把取得的组织条在玻片上滚滑，制取、把取得的组织条在玻片上滚滑，制取涂片，用以上酒精浸泡固定涂片。涂片，用以上酒精浸泡固定涂片。、把组织条放入福尔马林液中固定，备、把组织条放入福尔马林液中固定，备作病理切片检查。作病理切片检查。武进医院放射科武进医院放射科Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 圆柱形组织条自动吐在玻片上、并可滚圆柱形组织条自
23、动吐在玻片上、并可滚制成涂片，然后放入福尔马林液中固定。制成涂片，然后放入福尔马林液中固定。Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 福尔马林瓶中的圆柱形组织条福尔马林瓶中的圆柱形组织条Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例1术前CTOur g
24、reatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例1术中CTOur greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例1术中穿刺Our greatest weakness lies in giving up.The most certain way to succeed is
25、always to try just one more time 病例1病理Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例2术前CTOur greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例2 濮术中Our greatest weakness lies in gi
26、ving up.The most certain way to succeed is always to try just one more time 病例2病理Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例3术前CTOur greatest weakness lies in giving up.The most certain way to succeed is always to try just one more t
27、ime 病例3 陆术中Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例3病理Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例4 周术前C TOur greatest weakness lies in giving up.The most certain w
28、ay to succeed is always to try just one more time 病例4术中Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例4病理Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例5 沈术前CTOur greatest we
29、akness lies in giving up.The most certain way to succeed is always to try just one more time 病例5术中Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例5病理Our greatest weakness lies in giving up.The most certain way to succeed is always to try
30、just one more time 病例6 郑术前CTOur greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例6术中Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time 病例6病理Our greatest weakness lies in giving up.The most certain way to succeed is always to try just one more time BioPinceBioPince活检枪优点活检枪优点、有相匹配的同轴套管穿刺针，避免反复穿刺、有相匹配的同轴套管穿刺针，避免反复穿刺造成损伤。造成损伤。、组织的活检长度可调，为：、组织的活检长度可调，为：13mm13mm、23mm23mm、33mm33mm。适合于不同大小的病灶。适合于不同大小的病灶。、系中空枪式活检针，取出的组织为圆柱形，、系中空枪式活检针，取出的组织为圆柱形，摄取组织量更多。摄取组织量更多。、可把针内组织能自动吐出。、可把针内组织能自动吐出。总结总结
