1. Application of percutaneous puncture technology in the diagnosis of lung diseases
(1) Simulator-guided percutaneous lung biopsy for qualitative diagnosis of lung lesions
Percutaneous biopsy of thoracic lesions under fluoroscopic guidance has a history of more than 100 years. The technology is quite mature, safe and reliable, and the biopsy accuracy is between 64% and 97%. This method refers to using an X-ray simulator to perform central positioning to determine the needle insertion direction and depth of lung lesions, and then perform puncture biopsy. For pulmonary masses that can be clearly displayed in both anteroposterior and lateral views and are at a certain distance from the hilar blood vessels, simulator guidance is appropriate. The simulator can perform needle cutting in real time under fluoroscopy, and can also use a combination of cutting and needle aspiration to increase the positive rate of diagnosis. The main complication is pneumothorax, and data reports that the incidence rate of postoperative pneumothorax is about 10%. Of course, fluoroscopic guidance cannot accurately reflect the relationship between the lesion and surrounding structures. It is difficult to biopsy small lesions and deep lesions, and the diagnostic accuracy is low.
(2) CT-guided percutaneous lung biopsy to diagnose lung diseases
CT-guided puncture has a wide range of applications and has the most clinical applications. CT cross-sectional scanning has good spatial resolution and density resolution, and can accurately display the size, location and internal conditions of the lesion, as well as the anatomical relationship with blood vessels and other surrounding structures. It is especially suitable for difficult-to-locate lesions in the hilus and mediastinum. Those nearby. When a mass is mixed with atelectasis or obstructive pneumonia, enhanced scanning is sometimes required to determine the actual size of the mass. The method refers to first conducting a CT scan to determine the puncture point of the lesion, the depth and angle of the needle insertion, and then performing a puncture biopsy. The needle insertion status cannot be directly observed under conventional CT. The depth and direction of the needle insertion must be estimated after the needle insertion point is determined. After the needle insertion, another scan is performed for confirmation before needle biopsy can be performed.
The puncture accuracy under CT guidance is high, and lesions of 0.5 to 1 cm can also be successfully biopsied under CT guidance. Therefore, for pulmonary nodular lesions, cavitary lesions, diffuse lesions in both lungs, and mediastinal and hilar space-occupying lesions that cannot be diagnosed by conventional methods, CT-guided lung puncture aspiration and cutting needle biopsy can achieve satisfactory results. In particular, biopsy of pulmonary nodules with a diameter of ≤2cm has high accuracy and low complications. It can be used as the first choice method for qualitative diagnosis of solitary small nodules in the lungs. The operation is simple, safe and reliable.
The correct diagnosis rate of biopsy of intrapulmonary lesions under CT guidance is relatively high. At present, domestic and foreign literature reports that the overall accurate diagnosis rate of benign and malignant lesions ranges from 64% to 97%, with a boundary of 2cm and a diameter of 2cm. The correct diagnosis rate of the above large nodules is higher than that of small nodules. Tsukada applied cutting biopsy to 138 cases of chest lesions, and its diagnostic accuracy for lesions with a diameter of 5cm were 66.7%, 78.9%, 86.7%, 93.3% and 100% respectively.
(3) B-ultrasound in The value of B-ultrasound in the diagnosis of pulmonary diseases
The value of B-ultrasound in the diagnosis of thoracic diseases and in guiding thoracentesis has attracted increasing attention. If the lesion is close to the chest wall, it can be clearly displayed under B-ultrasound. B-ultrasound guides needle insertion and incision in real time, which can reduce the needle insertion time and can sometimes differentiate between masses, atelectasis and inflammation, and is low-cost. However, because ultrasound cannot penetrate gas, it is suitable for tumors that are close to the chest wall. Although there are reports of using ultrasound guidance to perform puncture biopsy of central lung cancer, there are still certain difficulties in confirming the mass [3].
(4) Indications and complications of percutaneous puncture technology
The indications and method choices for percutaneous biopsy are: ① Pulmonary nodules, especially those with negative sputum cytology. For lesions >2cm in diameter, a simulator can be used, which is simpler, cheaper, and more convenient than CT. For lesions ≤2cm in diameter, CT positioning can be used, which is more accurate than a simulator. ② For extratubular central lung lesions, CT is better for locating, because CT can more accurately locate lesions, especially for lesions in special locations such as the back of the heart, paraspinal, paraaortic, and hilar areas. The puncture point can be selected. Reduce complications. ③Less with lower density can be better localized by CT, because CT has higher resolution and can avoid necrotic areas. Areas with diagnostic value can be selected for sampling to improve the diagnostic rate. ④ Diffuse lesions can be diagnosed by using a simulator to locate them.
Complications of chest biopsy include pneumothorax, pulmonary hemorrhage, hemoptysis, pleural hemorrhage, tumor implantation and gas embolism in other organs. In fact, the latter two conditions are very rare.
Postoperative complications reported consistently at home and abroad are mainly pneumothorax and intrapulmonary hemorrhage; pneumothorax is the most common complication, and the literature reports that its incidence rate is 9% to 44%, mostly around 10%, most of which are small pneumothorax and do not require Treatment can be absorbed by itself, and only 1.6% to 14.3% of patients need closed chest drainage; intrapulmonary bleeding can be absorbed by itself in 1 to 3 days, and a few patients have blood in their sputum; the incidence of massive hemoptysis and pleural hemorrhage is low . The occurrence of complications is related to factors such as the operator's proficiency, the number of needle insertions, the sharp angle between the puncture needle and the pleura tangent line at the puncture point, and emphysema.
2. Percutaneous puncture treatment of pulmonary diseases
(1) Percutaneous puncture technology for the treatment of benign pulmonary diseases
Percutaneous pulmonary puncture treatment of benign pulmonary diseases The main disease is tuberculosis. Director Yang Shuhua of our hospital and others performed percutaneous pulmonary puncture intervention on 107 patients with single cavities of pulmonary tuberculosis who still excreted bacteria after medical treatment for more than 6 months. They injected isoniazid, amikacin and systemic anti-tuberculosis treatment into the cavities. Within a month, more than 80 cases of phlegm bacteria turned negative, with a negative conversion rate of 80%, a cavity closure rate of about 70%, and many cases of cavities shrinking. No serious complications occurred with this method. Therefore, percutaneous lung puncture interventional therapy is another effective treatment method after surgery to solve the problem of failed retreatment or recurrence of cavitary tuberculosis.
(2) Percutaneous puncture technology to treat lung cancer
1. Percutaneous puncture multi-electrode radiofrequency ablation or microwave treatment of lung cancer
Percutaneous puncture multi-electrode radiofrequency Ablation or microwave therapy is a rapidly developing thermal damage technology and a method of tumor hyperthermia. In recent years, the radiotherapy department of our hospital has also successively used it in the treatment of lung tumors, and the effect is very obvious. The treatment principle is to insert electrodes percutaneously under the guidance of CT, ultrasound, and magnetic resonance imaging, confirm that the electrodes are located in the target area, and start the radiofrequency machine. Radiofrequency waves are introduced into the surrounding tissue through the electrode. The electrolyte will be polarized when exposed to the external electric field, consuming a large amount of electric field energy, which is converted into heat energy. On the other hand, when the current passes through the tissue, heat energy will be generated due to the loss of resistance. The cytotoxic effect of high temperature is mainly to destroy the membrane structure of cells, followed by proteins and DNA, causing cell damage. Dual electrodes, phase array arrangement of multi-electrodes and cold electrodes can be used to increase the scope of tissue necrosis and achieve better results [18]. Liu Jun et al. reported 62 cases, including 56 cases of primary lung cancer and 6 cases of metastatic lung cancer, with one-time positioning The rate reached 94%. There were no significant changes in blood pressure, pulse and peripheral blood oxygen saturation in 62 patients during treatment. Postoperative complications included 10 cases of traumatic pneumothorax, 3 cases of skin burns, and 1 case of high fever and respiratory alkalosis. This treatment method has no side effects and complications. Percutaneous lung puncture radiofrequency ablation or microwave treatment of lung tumors is a safe, minimally invasive, and effective method. It will be a promising treatment method for the treatment of metastatic lung tumors.
2. Inject sustained-release chemotherapy drugs or radioactive particles into the tumor through percutaneous puncture
Use the tumor cell nuclear monoclonal antibody (131ICH-TNT) of Shanghai Mein Pharmaceutical for intratumoral injection. Systemic chemotherapy has unique efficacy in treating long-term advanced lung cancer, shrinking tumors and improving symptoms, significantly prolonging patients’ survival and improving their quality of life.