徒手穿刺Vs穿刺架引导下穿刺

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                    <p style="line-height: 2em;">1. 超声引导下“徒手”穿刺技术&nbsp;</p><p style="line-height: 2em;">超声引导下(无穿刺架)将穿刺针穿入皮下，然后穿刺针继续刺人病灶，此过程无穿刺架引导。这种技术穿刺针与超声探头分开，可以随意移动超声探头显示病灶，而且穿刺针可以任意角度进行穿刺，但不易显示穿刺针，需要较多的经验，而且精确性受限，因此该技术对浅表组织结构或者较大病灶的穿刺有一定作用。另外，对一些结构比较复杂的部位，例如甲状腺、狭小部位的关节腔、复杂部位的神经阻滞等，在进针过程中需要随时调整穿刺针的路径，这种情况下一般不建议使用固定路径的穿刺架，以免限制了对穿刺针的调整。如图26，为甲状腺的徒手穿刺方法。&nbsp;</p><p style="line-height: 21.3333px;"><br  /></p><p style="line-height: 2em;"><img data-s="300,640" data-type="png" src="http://mmbiz.qpic.cn/mmbiz_png/dx3KibwtDhvcE2dNZZsDGo0jwFuF60w0cZXkSDAPYKw64FHfFeGnicGEh1OLh1g8cQt7qhJXul32YrURQ9hYJ4PQ/0?wx_fmt=png" data-ratio="0.8738461538461538" data-w="325"  /><br  />2.穿刺架引导下的穿刺 （平面内穿刺架）</p><p style="line-height: 2em;">使用穿刺架配合显示器上的引导线进行穿刺操作，是目前经常采用的穿刺方法，也是最令人满意的超声技术并应作为介入性超声的首选方法。穿刺时将消毒后的穿刺架安装在探头上，该装置有针道以保证穿刺针能够穿过并在穿刺区内保持稳定，显示器上引导线可引导穿刺路径。这种技术使穿刺针沿引导线路径准确地穿入组织，并且能实时显示穿刺过程，使得穿刺能够规范化，安全性和效率都得到提高，同时对超声介入技术的推广起到比较大的帮助。如图27，经方医疗为Wisonic C5-1腹部探头开发的穿刺架。</p><p style="line-height: 21.3333px;"><br  /></p><p style="line-height: 2em;"><img data-s="300,640" data-type="png" src="http://mmbiz.qpic.cn/mmbiz_png/dx3KibwtDhvcE2dNZZsDGo0jwFuF60w0cjKB2zkuU6GSlC9Roz6JHyk7KibYgw5pN3W1ytLLoljUgVolHI4Aj4icQ/0?wx_fmt=png" data-ratio="0.6714579055441479" data-w="487"  /><br  /></p><p style="line-height: 2em;">3．半开放式或半徒手式穿刺技术 （任意角度平面内穿刺架）&nbsp;</p><p style="line-height: 2em;">介于徒手穿刺和穿刺架引导穿刺之间，即解决了徒手穿刺中新手比较难找到穿刺针针尖的问题，同时也解决了穿刺架的固定路径对穿刺针随时调整带来不便的问题。其设计思路是，把穿刺针限制在声学平面内，使得在整个进针过程中穿刺针一直能够清晰的显示，同时在声学平面内，穿刺针能够在0-90度直接任意调节。该方法不仅适用于浅表结节，对于深部的结节也能适用。下图为半开放式穿刺架，图28为Zonare C4-1腹部探头开发的半开放式穿刺架、图29为Alpinion L3-12x浅表探头开发的半开放式穿刺架。</p><p style="line-height: 21.3333px;"><br  /></p><p style="line-height: 2em;"><img data-s="300,640" data-type="png" src="http://mmbiz.qpic.cn/mmbiz_png/dx3KibwtDhvcE2dNZZsDGo0jwFuF60w0ccTBdGszzsQzOg54GZaHXdulteiaXBibACPIqibdib0iacFx9nQg0J7S8Wjg/0?wx_fmt=png" data-ratio="0.4264705882352941" data-w="680"  /></p><p><br  /></p><p style="max-width: 100%; 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