CT引导经皮肺穿刺及经电子支气管镜肺活检对肺周围型病变诊断价值

摘要

目的 通过比较CT引导下经皮肺穿刺(TNLB)及经电子支气管镜肺活检(TBLB)对肺周围型病变的确诊率及并发症的发生情况,探讨2种活检方式在临床诊断工作中的价值.方法 近5年广州市胸科医院经影像学诊断为肺周围型病变查因的患者249例,按照肺活检方式分为经皮肺穿刺肺活检组(TNLB组)153例和经支气管镜肺活检组(TBLB组)96例,比较比较2种活检方法确诊率及各种并发症发生率.结果 TNLB组确诊率(77.8％)明显高于TBLB组(45.8％);并发症方面:气胸发生率两组相似,肺出血发生率TBLB组(53.1％)明显高于TNLB组(7.2％),但在30 ml以上的出血,两组无统计学差异；TBLB组血氧饱和度下降及心动过速的发生率明显高于TNLB组.结论 2种活检方法都是创伤小、安全性较高的检查手段,在临床上的使用各有优劣,有些情况下能形成互补,结合起来有助于提高肺周围型病变确诊率.%Objective To explore the values of CT-guided transthoracic needle lung biopsy ( TNLB ) and transbronchoscopic lung biopsy ( TBLB )in the clinical diagnosis by comparing the identification rates of both procedrues for peripheral lung lesions and the incidence rates of procedure-related complications.Methods 249 patients with peripheral lung lesions on radiographic examinations were divided into TNLB group( 153 patients ) and TBLB group ( 96 patients ) based on the method for lung biosy.The rate of lesion identification and the incidence rate of complications were compared between the two groups.Results The rate of lesion identification was markedly higher in TNLB group than in TBLB group ( 77.8％ vs.45.8％ ).The incidence of pneumothorax was similar in the two groups.The incidence of pulmonary hemorrhage was significantly higher in TBLB group than in TNLB group ( 53.1％ vs.7.2％ ),but the rate of bleeding volume of 30 ml or more did not differ significantly between the two groups.The incidence rates of tachycardia and decreased SaO2 were evidently higher in TBLB group than in TNLB group.Conlusions Both biopsies is a less invasive,safer procudure and have their own advantages and disadvantages.Combination of the two procedures is beneficial for the improvement of the identification rate of peripheral lung lesions.