超声引导下肺周围型病变穿刺活检成功率的影响因素分析

Ultrasound-guided Percutaneous Biopsy of Peripheral Pulmonary Lesions:Factors Influencing Success Rate

目的 分析超声引导下肺周围型病变穿刺活检成功率的影响因素,总结提高穿刺活检成功率的技巧.资料与方法 回顾性分析410例行超声引导下经皮穿刺活检术的肺周围型病变患者的临床及病理资料,分析患者性别、年龄、病灶部位、病灶大小、病灶内部有无坏死、进针角度和进针次数对穿刺成功率的影响.结果 410例患者中,恶性病变144例,良性病变206例,穿刺成功率为85.4％ （350/410）.病灶最大径≤2.0cm、2.1～6.0cm、＞6.0 cm者穿刺成功率分别为78.6％、91.7％和80.3％,差异有统计学意义（x2=13.011,P＜0.05）；病灶内部有坏死和无坏死者穿刺成功率分别为74.6％和87.2％,差异有统计学意义（x2=6.422,P＜0.05）.大病灶（最大径＞6.0 cm）坏死率为36.4％,显著高于病灶最大径≤ 6.0 cm者的10.2％,差异有统计学意义（x2=30.830,P＜0.05）.患者性别、年龄、病灶部位、进针角度、进针次数对穿刺成功率均无显著影响（x2=0.057、1.717、1.140、0.372、0.094,P＞0.05）.结论 病灶大小和病灶内部有无坏死是影响超声引导下肺周围型病变穿刺活检成功率的主要因素,掌握小病灶的穿刺技巧和大病灶穿刺过程中避开坏死灶是提高穿刺活检成功率的关键.

PurposeTo analyze the factors influencing the success rate of ultrasoundguidedpercutaneous biopsy in peripheral pulmonary lesions, and to summarize the skillsto raise the success rate. Materials and Methods The clinical and pathological data of410 patients who had undergone ultrasound-guided percutaneous biopsy in peripheralpulmonary lesions were collected and analyzed according to some factors which mightinfluent the success rate such as gender, age, lesion location, lesion size, central necrosis oflesion, number of needle passes and needle angel. Results Among 410 cases, 144 lesionswere diagnosed as malignant and 206 lesions as benign. The success rate of ultrasoundguidedpercutaneous biopsy was 85.4% （350/410）. For the largest lesion diameter ≤ 2.0cm, 2.1-6.0 cm and 〉6.0 cm, the success rate was 78.6%, 91.7% and 80.3%, respectively（differences with statistic significance, χ2=13.011, P〈0.05）. The success rate of lesionswith or without central necrosis was 74.6% and 87.2%, respectively （differences withstatistic significance, χ2=6.422, P〈0.05）. The incidence rate of necrosis in large lesions （thelargest diameter 〉6.0 cm） was 36.4%, significantly higher than that of other lesions withlargest diameter ≤ 6.0 cm （incidence rate 10.2%） （χ2=30.830, P〈0.05）. Other factors suchas gender, age, lesion location, needle angle and number of needle passes had no impacton the success rate （differences without statistic significance, χ2=0.057, 1.717, 1.140, 0.372,0.094; P〉0.05）. Conclusion Lesion size and central necrosis of lesion are the importantfactors influencing success rate of ultrasound-guided percutaneous biopsy, thereforeimproving percutaneous skills in small lesions and avoiding necrosis in large lesions canimprove the success rate.