CT引导下细针多方向经皮肺穿刺活检的临床应用

Clinical application of CT-guided percutaneous pulmonary biopsy with needle

目的:评价CT引导下经皮肺穿刺活检对周围性肿块的诊断价值,探讨并发症发生的原因。方法:CT引导下经皮肺穿刺活检的肺部占位性病变60例,均采用切割针和自动枪取材,分析诊断正确率、并发症发生率及影响因素。结果:本组60例全部取得有效标本,穿刺成功率为100%。58例获得准确诊断,包括原发性肺癌49例、结核3例、炎性假瘤2例、转移瘤2例、结节病1例、肺曲菌病1例,诊断正确率为96.6%。并发气胸8例,出血10例。气胸及出血的发生与穿刺针通过含气肺组织的长度均有明显关系(P<0.01),气胸的发生与患者肺气肿的存在无明显关系(P>0.05),位于肺野内带的病灶较外带病灶更易发生出血(P<0.01)。结论:CT引导下经皮肺穿刺活检操作简便、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 diagnostic significance of percutaneous pulmonary biopsy under CT guidance and to discuss the causes of complication. Methods ： CT-gnided percutaneous transthoracic incision biopsy was performed in 60 patients with pulmonary masses. The diagnostic accuracy, major complications and the influence factors were reviewed. Results： Aueffective specimens were obtained from the 60 cases（ achievement ratio 100% ）. Final diagnosis was made in 58 cases （diagnostic accuracy 96.6% ）, including 49 cases of primary pulmonary carcinoma,3 cases of tuberculosis ,2 cases of inflammatory pseudotumors,2 cases of metastasis, 1 case of sarcoid and 1 case of aspergillosis. The major complications included pneumothorax （ 13.3% ） and pulmonary hemorrhage （ 16.7% ）. Pneumothorax and pulmonary hemorrhage were obviously associated with the length of the needle cutting through the air lung （P 〈 0.01）. Pneumothorax was not associated with pneumonectasia or location of the lesions （P 〉 0. 05 ）. Conclusions： CT-guided pereutaneous transthoracic needle biopsy is a feasible and safe method in diagnosis of pulmonary lesions with high accuracy. Accurate location of the lesions and skillful manipulation are essential in decreasing complications.