CT引导下经皮肺穿刺活检术在肺肿瘤定性诊断中的应用

Application of CT-guided percutaneous transthoracic biopsy in the qualitative diagnosis of lung tumor

目的探讨CT引导下经皮肺穿刺活检术在肺肿瘤定性诊断中的应用价值。方法选取山东省青岛市骨伤科医院2009年1月～2011年12月诊治的肺部病变患者137例,均行CT引导下经皮肺穿刺活检术,对活检取材行细胞学检查和病理组织诊断,分析其在肺肿瘤定性诊断中的准确性。结果患者的病灶直径为1.3～10.2cm,平均(3.9±0.5)cm,其中直径为3～5 cm的患者居多,其次为超过5 cm和不足3 cm。病灶分布于右下叶的患者最多,其次为右上叶、左上叶、左下叶、右中叶。胸膜穿刺次数1～4次,平均(2.1±0.6)次,其中胸膜穿刺2次的患者居多,其次为1、3、4次。恶性肿瘤中,确诊99例,诊断准确率为92.5%,其中腺癌最多,其次为鳞癌、小细胞癌、细支气管肺泡癌、转移癌,8例未见恶性细胞后经术后病理确诊,为假阴性,假阴性率为7.5%。良性病变中,炎性假瘤居多,其次为结核、错构瘤、硬化性血管瘤。其他疾病中,纤维组织增生居多,其次为坏死血管。经统计学分析,差异均有统计学意义(均P<0.05)。气胸患者15例,发生率为10.9%,其中13例为少量气胸未经处理于1周后吸收,2例患者气胸量超过30%经胸腔闭式引流治愈。病灶及针道周围出现实质性出血患者13例,发生率为9.5%,经静卧、止血、补液处理后治愈。结论 CT引导下经皮肺穿刺活检术是一种安全有效、准确性高、并发症少的诊断方法,在肺肿瘤定性诊断中具有重要的临床价值。

Objective To explore the application value of CT-guided percutaneous transthoraeic biopsy in the qualitative diagnosis of lung tumor. Methods 137 patients with lung disease in Qingdao Orthopedics Hospital in Shandong Province from January 2009 to December 2011 were selected. CT-guided pereutaneous transthoracie biopsy was used in all cases. The cytological detection and histopathologie biopsy were applied on materials in order to analyze the accuracy in the qualitative diagnosis of lung tumor. Results The lesion diameters were from 1.3 to 10.2 em and was the average of （3.9±0.5）cm. The patients with 3-5 cm diameter lesion were in the majority, followed by ones with that of more than 5 cm and less than 3 em. The patients with lesion on right lower lobe were in the majority, followed by right upper lobe, left upper lobe, left lower lobe and right middle lobe. The times of chest tapping was from 1 to 4 and the average times was （2.1±0.6）. The patients with twice chest tapping were in the majority, followed by once, three and four times. Among malignant tumor, 99 cases were made a definite diagnosis with 92.5% in accuracy rate. The glandular type was the most prominent, followed by squamous carcinoma, small cell carcinoma, bronehioloalveolar carcinoma and metastatic carcinoma. 8 cases were diagnosed as false negatives by pathologic detection after operation with 7.5% false negative rate. The inflammatory pseudotumor was the most of the benign lesions, followed by tuberculosis, hamar- toma and sclerosing hemangioma. The fibroplastic proliferation was in the majority, followed by angionecrosis in other diseases. It had statistical significance （all P 〈 0.05）. The pneumothorax occurred in 15 patients with occurrence of 10.9%. It was absorbed untreatedly in 13 cases after a week with 9.5% occurrence rate and they all cured by inactivity, hemostasis and transfusion. Conclusion CT-guided pereutaneous transthoracie biopsy is a safe, efficient and high accuracy diagnosis method. It has a significantly clinical diagnosis value on long tumor.