探讨负压抽吸活检针在肝困难病灶活检中的应用价值及可行性。

回顾性分析2022年3月至2022年9月于中山大学附属第三医院行超声引导下肝肿物消融并穿刺活检术的81例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男66例，女15例；年龄30～73岁，中位年龄58岁。患者采用超声引导下Sonopsy-C1型18 G负压抽吸活检针穿过同轴针以不同角度来回抽吸取材，取材1～4次，获得满意组织，累计组织长度大于20 mm，10%福尔马林液固定，送病理学检查。再将微波或射频针通过同轴针消融病灶及烧灼针道，防止针道出血。根据病灶的大小和位置特征，将病灶分为困难组和非困难组。比较两组的基线情况和结局指标。两组标本长度等比较采用Wilcoxon符号秩和检验。并发症发生率等比较采用χ²检验或Fisher确切概率法。

81例患者90个病灶，其中困难组59例，64个病灶；非困难组24例，26个病灶。困难组邻近重要部位距离为0（0，2）mm，明显小于非困难组的11（9，15）mm（Z=-7.767，P<0.05）。两组活检成功率和病理诊断率均为100%，均未见严重并发症。两组病灶最大径、病灶邻近部位、活检次数、标本最大长度和病理结果差异均无统计学意义（P>0.05）。

对于肝内小病灶或紧邻危险部位的困难病灶，超声引导下使用负压抽吸活检针手动取材，既可在不增加取材次数的情况下取得足够行病理诊断的组织，又不增加并发症发生风险。

To evaluate the application value and feasibility of negative pressure aspiration biopsy needle in the biopsy of complicated liver lesions.

Clinical data of 81 patients who underwent ultrasound-guided liver tumor ablation and biopsy in the Third Affiliated Hospital ofSun Yat-sen University from March 2022 to September 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 66 patients were male and 15 female, aged from 30 to 73 years, with a median age of 58 years. Ultrasound-guided Sonopsy-C1 18 G negative pressure aspiration biopsy needle was used to obtain the samples from different angles through the coaxial needle for 1-4 times. Satisfactory tissues were obtained. The accumulated tissue length was >20 mm, fixed in 10% formalin solution, and transferred for pathological examination. Then, microwave or radiofrequency needle was utilized to ablate the lesions and cauterize the needle track through the coaxial needle to prevent the bleeding from needle track. According to the size and location characteristics of the lesions, all lesions were divided into the complicated group and non-complicated group. Baseline data and outcome indexes were compared between two groups. The length of tissues between two groups was compared by Wilcoxon signed rank-sum test. The incidence of complications was compared by Chi-square test or Fisher's exact test.

90 lesions were detected from 81 patients, including 59 cases and 64 lesions in the complicated group, and 24 cases and 26 lesions in the non-complicated group. In the complicated group, the distance from vital organs was 0 (0,2) mm, significantly less than 11 (9,15) mm in the non-complicated group (Z=-7.767, P<0.05). The success rate of biopsy and pathological diagnosis rate were 100% in two groups. No serious complications occurred in two groups. There were no significant differences in the maximum diameter of the lesions, adjacent organs of the lesions, the number of biopsy, the maximum length of the specimens and pathological results between two groups (P>0.05).

For small liver lesions or complicated lesions adjacent to vital sites, manual sampling with negative pressure aspiration biopsy needle under ultrasound guidance can obtain sufficient tissues for pathological diagnosis without increasing the number of sampling or sacrificing the risk of complications.