CT引导下经皮肺穿刺切割活检对肺部病变的诊断价值

Clinical significance of percutaneous transthoracic pulmonary lesions biopsy using CT guidance

目的评价CT引导下经皮肺穿刺切割活检术对肺部实质性肿块定性诊断的价值,探讨并发症发生的原因。方法收集我院CT引导下经皮肺穿刺活检的肺部占位性病变91例,均采用切割针和自动枪取材,分析诊断正确率、并发症发生率及其影响因素。结果本组91例,取得有效标本88例,总的穿刺成功率为(96.70%),其中1次穿刺成功84例(成功率为92.30%),2次穿刺成功7例。85例获得准确诊断,包括原发性肺癌79例、结核2例、炎性假瘤2例、淋巴瘤1例、转移瘤1例、错构瘤1例、结节病1例,总的诊断正确率93.40%。本组并发气胸14例(15.38%),出血21例(23.08%),出血并气胸同时发生3例(3.30%)。气胸与出血的发生与穿刺针通过含气肺组织的长度成正相关,气胸的发生与患者肺气肿的存在和2次穿刺相关,位于肺野内带的病灶较中、外带病灶更易发生出血。结论CT引导下经皮肺穿刺切割活检操作简便、安全,诊断准确性高。术前准确定位,分步进针,熟练的技术操作可以减少并发症的发生。

Objective To evaluate the clinical significance of percutaneous transthoracic pulmonary lesions biopsy using CT guidance and discuss the reasons of complications. Methods CT-guided percutaneous transthoracic incision biopsy was performed in 91 patients with pulmonary masses, 56 were male and 35 were female. The diagnostic accuracy, the major complications and their influence factors were reviewed. Results The effective specimen was gotten in 88 cases （achievement ratio 96.70%）. The final diagnose was made in 85 cases （diagnostic accuracy 93.40%）, including primary pulmonary carcinoma 79 cases, tuberculosis and inflammatory pseudotumors 2 cases respectively, lymphadenoma, metastasis, harmatoma and sarcoid 1 case respectively. The major complications included pneumothorax （15.38%） and pulmonary hemorrhage （23.08%）. Pneumothorax and pulmonary hemorrhage were associated with the length of the needle cutting through the air lung. Pneumothorax was associated with pneumonectasia and location of the lesions. Conclusion CT-guided pereutaneous transthoracic needle biopsy was a feasible and accurate method for diagnosing pulmonary lesions. The key factors of decreasing the complications include accurate location of the lesions, the shortest pathway and skillful manipulation.