CT引导下经皮肺穿刺活检对肺部小病灶(≤3cm)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≤3 cm结节定性诊断的价值,探讨并发症发生的原因。方法收集本院CT引导下经皮肺穿刺活检的肺部占位性病变病例,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36例,取得有效标本34例,总的穿刺成功率为94.44%,其中1次穿刺成功32例(成功率为88.89%),2次穿刺成功2例。31例获得准确诊断,包括原发性肺癌27例、结核1例、炎性假瘤1例、淋巴瘤1例、转移瘤1例,总的诊断正确率86.11%。并发气胸4例(11.11%),出血14例(38.89%),出血并气胸同时发生2例(5.56%)。气胸、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 percutancous transthoracic pulmonary lesions（≤3 cm）biopsy using CT guidance and discuss the reasons of complications. Methods CT- guided percutaneous transthoracic incision biopsy was performed in 36 patients with pulmonary masses, 20 were male and 16 were female. The diagnostic accuracy, the major complications and their influence factors were reviewed. Results The effective specimen was gotten in 34 cases （ the achievement ratio 94.44% ）. The final diagnose was made in 31 cases （The diagnostic accuracy 86.11% ）, including 27 cases of primary pulmonary carcinoma,one case of tuberculosis and inflammatory pseudotumors respectively, 1 case of lymphadenoma and metastatic respectively. The major complications included pneumothorax （ 11.11% ） and pulmonary hemorrhage （38.89%）. 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.