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目的探讨儿童实体肿瘤在完全快速镇静镇痛术下CT引导立体定位穿刺活检的可行性。方法穿刺前先予芬太尼后异丙酚静脉注射,待进入睡眠状态、肌肉松弛、睫毛反射消失后开始穿刺,术中若患儿躁动酌情追加异丙酚至镇静满意。活检针用同轴穿刺针(弹簧内芯切割针),根据CT显示屏上所确立的定位点,标记出进针穿刺点。待患儿呼吸平稳后,按预定的进针角度方向及深度穿刺到所要求的部位。根据取材效果,切割1～3次,100 mL.L-1甲醛10 mL固定后,送病理检查。结果芬太尼联合异丙酚静脉注射给药能达到较好的镇静、镇痛状态,整个操作过程能控制在较好的无躁动状态。病理结果:肾母细胞瘤9例,肝母细胞瘤5例,神经母细胞瘤3例,病理难以确诊1例。结论异丙酚联合小剂量芬太尼应用于儿童实体肿瘤穿刺活检的镇静镇痛,效果满意,起效快,清醒快,非麻醉专业医师也容易掌握其用法用量。
Objective To investigate the feasibility of CT-guided stereotactic biopsy in children with solid tumors under complete rapid sedation and analgesia. Methods Venous fentanyl before propofol intravenous injection, to be asleep, muscle relaxation, eyelashes disappear after the start of puncture, intraoperative if the child restless propofol appendiculate appropriate to calm satisfaction. Biopsy needle with coaxial needle (spring core cutting needle), according to the CT screen established by the anchor point, marked needle puncture point. Children to be stable breathing, according to the predetermined direction and depth of the needle into the required position. According to the material effect, cut 1 to 3 times, 100 mL.L-1 formaldehyde 10 mL fixed, sent pathological examination. The results of fentanyl and propofol intravenous injection can achieve better sedation, analgesic state, the entire operation can be controlled in the better state of restlessness. Pathological findings: 9 cases of nephroblastoma, 5 cases of hepatoblastoma, 3 cases of neuroblastoma, pathological diagnosis is difficult to diagnose in 1 case. Conclusion Propofol combined with low-dose fentanyl for sedation and analgesia of solid tumor biopsy in children with satisfactory results, rapid onset, fast awake, non anesthesia physicians are easy to grasp the amount of usage.