超声引导下经皮肺外周型病变穿刺活检病理诊断的影响因素探讨

FACTORS INFLUENCINGPATHOLOGICAL DIAGNOSIS IN ULTRASOUND-GUIDED PERCUTANEOUS PUNCTURE BIOPSY OF PERIPHERAL PULMONARY LESIONS

目的:探讨超声引导下经皮肺外周型病变穿刺活检病理诊断阳性率的影响因素。方法:回顾性分析216例接受超声引导下穿刺活检术的肺外周型病变患者的穿刺病理结果,将其分为成功组(病理诊断阳性)和失败组(病理诊断阴性)。分析性别、年龄、病灶位置、病灶内部回声、病灶大小,进针角度、进针次数等因素对穿刺成功的影响。结果:超声引导下经皮肺外周型病变216例穿刺活检的一次穿刺病理诊断阳性率为79.2%(171/216),二次穿刺病理诊断阳性率为85.2%(184/216);成功组和失败组病灶的平均前后径分别为:(3.35±0.14)cm和(2.43±0.26)cm,两者比较差异有统计学意义(P=0.012)。病灶前后径为0.4～1.0cm、1.1～2.0cm、2.1～3.0cm、3.1～5.0cm和>5.0cm的病理诊断阳性率分别为:68.8%,79.7%,85.7%,89.7%和94.1%。结论:病灶的大小是影响超声引导下经皮肺外周型病变穿刺活检病理诊断阳性率的一个重要因素,病理诊断阳性率随着病灶前后径的减小而降低。

Objective： To explore the factors influencing positive rate of pathological diagnosis in ultrasoundguided percutaneous puncture biopsy of peripheral pulmonary lesions. Methods： Retrospective analysis of 216 patients with peripheral pulmonary lesions who underwent ultrasound-guided pereutaneous lung biopsy. We classified the cases into a success group （pathological diagnosis was posive） and a failure group （pathological diagnosis was negative） to evaluate the factors affecting positive rate of pathological diagnosis in ultrasound-guided percutaneous puncture biopsy of the lungs. Sex, patient age, lesion location, lesion echo type, lesion size, number of needle passes and needle angle were analyzed. Results： The positive rate of pathological diagnosis was 79.6% （171/216）in the first biopsy, 85.2% （184/216） in second biopsies. Mean anteroposterior diameter of lesions （±s） in the success and failure groups were （3.35±0.14） cm and （2.43±0.26） cm, respectively, the difference was significant （ P =0. 012）. For lesions 0. 441.0 em, 1.1 -2.0 cm, 2.1-3.0 cm, 3.1-5.0 cm and 〉 5.0 cm in anteroposterior diameter, the positive rate of path- ological diagnosis was 68.8%, 79.7%, 85.7%, 89.7% and 94.1%, respectively. Conclusion： Lesion size is a determining factor in positive rate of pathological diagnosis. The positive rate of pathological diagnosis decreased in proportion to the decrease in the lesion anteroposterior diameter.