CT引导下经皮肺穿刺活检在肺部疾病诊断中的应用

摘要

目的 探讨CT引导下经皮肺穿刺活检术的临床应用价值.方法 连续收集105例肺部病变患者,分为局灶结节组(直径≤3 cm)、局灶团块组(直径＞3 cm)及弥漫性病变组.在CT引导下行活检针穿刺活检,穿刺活检病理结果与手术病理或临床随访结果对照.结果 对101例患者完成活检,穿刺活检成功率为96.19％(101/105)；其中局灶结节组33例,局灶团块组59例,弥漫性病变组9例.与手术病理或临床随访结果对照,总诊断符合率为92.08％ (93/101),3组的诊断符合率分别为87.88％(29/33),93.22％(55/59)及100％(9/9),各组间诊断符合率差异均无统计学意义(P均＞0.05)；总并发症发生率为12.38％(13/105).Logistic回归分析显示,病灶大小是出血的影响因素(x2=7.77,P =0.005),病灶大小和病灶周围有无肺气肿是气胸的影响因素(P＜0.001).结论 CT引导下经皮肺穿刺成功率及诊断符合率较高,并发症少,是一种具有较高实用性和安全性的活检取材方法.病灶直径≤3 cm及病灶周围广泛肺气肿可增大并发症风险.%Objective To observe the clinical value of CT-guided percutaneous needle aspiration biopsy for pulmonary diseases. Methods Totally 105 patients were enrolled and divided into 3 groups according to the image feature: Focal nodular group (diameter ≤3 cm), focal clumps group (diameter >3 cm) and diffuse lesions group. All patients underwent CT-guided needle lung biopsy, and the results were compared with that of surgical pathology or clinical follow-up. Results A total of 101 patients completed biopsy, and the success rate was 96. 19% (101/105). There were 33 patients in focal nodular group* 59 in focal clumps group, and 9 in diffuse lesions group. Compared with surgical pathology or clinical follow-up, the total diagnostic coincidence rate was 92.08% (93/101),and diagnostic coincidence rate was 87. 88% (29/33) in focal nodular group, 93. 22% (55/59) in focal clumps group, and 100% (9/9) in diffuse lesions group. There was no statistical difference among three groups (all P>0, 05). The complication rate was 12. 38% (13/105), According to Logistic regression analysis, the size of lesion was impact factor of bleeding (x2 =7, 77, P=0. 005) , and the size of lesion and emphysema around the lesion were impact factors of pneumothorax (P<0. 001). Conclusion CT-guided percutaneous needle lung biopsy is a practical and safe method, which has high success rate and high diagnostic coincidence rate and fewer complications. The risk of complications will increase when the size of lesions less than or equal to 3 cm and when there are extensive emphysema around the lesion.