目的：探讨立体定向活检术在颅内多发病变诊断中的临床价值，研究手术方法、技术要点及降低手术并发症的方法．方法回顾性总结2009年1月至2013年6月间昆明医科大学第一附属医院神经外二科收住院并行立体定向活检术的23例病例，患者年龄11～73岁（平均34.6岁），其中男性患者12例，女性患者11例；手术采用螺旋CT薄层扫描、ASA-602S和Leksell-Frame-G高精度脑立体定向仪、Sedan侧方开口的活检针、Backlund活检针、STORZ神经内窥镜；活检标本术后行常规病理学检查，必要时行免疫组化检查．结果病理诊断阳性率91.3%（21例），其中炎性肉芽肿1例，感染性病变1例，钙化1例，胶质增生6例，星形细胞瘤WHOⅠ～Ⅱ级1例，星形细胞瘤WHOⅡ级2例，星形细胞瘤WHOⅡ～Ⅲ级1例，混合型少突-星形细胞瘤WHOⅠ～Ⅱ级1例，多形性胶质母细胞瘤WHOⅣ级3例，生殖细胞瘤1例，转移瘤1例，弥漫性大B细胞淋巴瘤1例，颅内肉芽肿性动脉炎1例，阴性2例．无术后昏迷、偏瘫、感染、颅内出血等严重并发症．结论立体定向活检术是颅内多发病变诊断的重要方法之一，定位精确、创伤小、安全可靠、有效减少并发症的发生、值得推广．%Objective To investigate the clinical value of stereotactic biopsy in the diagnosis of the multiple intracranial lesions, and explore the operation methods, technical points and clinical experiences to reduce surgical complications. Methods Twenty-three patients in the first affiliated hospital of Kunming Medical University underwent stereotactic biopsy from January 2009 to June 2013 were analyzed retrospectively. The patients were aged between 11 and 73 years (the mean age of 34.6 years) . There were 12 males and 11 females. Operations were performed by thin thickness of spiral CT scan, ASA-602S and Leksell-Frame-G stereotactic frame, Sedan side-cutting needle, Backlund side-cutting needle and neuroendoscope of STORZ. Routine histopathological examinations of specimens were conducted. The immunohistochemical staining of the histopathological section of specimens was performed if necessary. Results The diagnostic yield was 91.3% (21 cases) . The result of pathological diagnosis was inflammatory granuloma in 1, inflammatory lesion in 1, calcification in 1, hyperplasia of colloid cells in 6, astrocytoma in 1 (WHOⅠ-Ⅱ), astrocytoma in 2 (WHOⅡ), astrocytoma in 1 (WHOⅡ-Ⅲ), mixed oligoastrocytoma in 1 (WHOⅠ-Ⅱ), glioblastoma multiforme in 3 (WHOⅣ), germinoma in 1, brain metastases in 1, diffuse large B-cell lymphoma in 1, intracranial granulomatousarteritis in 1 and negative in 2. There were no serious complications, such as coma, hemiparalysis, infection and intracranial hematoma. Conclusion Stereotactic biopsy is an important method in the diagnose of multiple intracranial lesions. It has the advantages of precise location, less damage, safe performance, and reducing the complication effectively. It is worth promoting.
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