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华西医学  2015 

穿刺方法对甲状腺结节超声引导细针穿刺抽吸活体组织检查结果的影响

DOI: 10.7507/1002-0179.20150592, PP. 2094-2097

Keywords: 甲状腺结节,细针穿刺抽吸活体组织检查,超声检查,技术

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Abstract:

目的?评估短轴穿刺和长轴穿刺两种方法对甲状腺结节超声引导细针穿刺抽吸活体组织检查(US-FNAB)结果的影响。方法?回顾性分析2011年3月―2014年11月行US-FNAB的甲状腺结节患者共2686例的临床资料。US-FNAB由5名初学者(Dr1~Dr5)进行操作,其中Dr1~Dr4每名初学者穿刺结节均为571例,Dr5为402例。根据Bethesda分类标准将细胞学结果分为穿刺有效和穿刺无效两类。Dr2是短轴穿刺,Dr1、Dr3~Dr5是长轴穿刺。按照甲状腺结节穿刺时间的先后顺序,分别比较Dr2与Dr1、Dr3~Dr5间第1个200例(F200)及最后1个200例(L200)穿刺无效率的差异(检验水准α=0.05),再分别进行Dr1、Dr3~Dr5间F200及L200穿刺无效率的两两比较(检验水准α’=0.008)。结果?在F200例的比较中Dr2的穿刺无效率高于Dr1、Dr3~Dr5,且差异均有统计学意义(P值分别为0.036、<0.001、0.007及<0.001);Dr1、Dr3~Dr5穿刺无效率的两两比较差异均无统计学意义(P值分别为0.033、0.551、0.011、0.122、0.672、0.050)。在L200的比较中Dr2的穿刺无效率低于Dr4,而高于Dr5,差异有统计意义学(P=0.027,0.003);Dr1、Dr3~Dr5穿刺无效率的两两比较,仅Dr3和Dr5、Dr4和Dr5间差异有统计学意义(P值分别为0.005,<0.001)。结论?对初学者而言,长轴穿刺方法优于短轴穿刺方法,建议初学者学习长轴穿刺方法。穿刺病例量达到200例后,长轴和短轴两种穿刺方法对穿刺结果的影响不明显,穿刺操作者可根据病变情况和个人爱好等选择穿刺方法。

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