CT引导下中心型肺癌肺段支气管病变穿刺针吸活检

CT-guided Needle Aspiration Biopsy in Segmental Bronchial Lesions of Central Lung Cancer

目的探讨CT引导下中心型肺癌肺段支气管病变穿刺针吸活检的价值,为制订治疗方案提供可靠的依据。资料与方法 55例疑似中心型肺癌肺段支气管病变患者行CT引导下穿刺针吸活检术采集病理组织标本,观察穿刺并发症情况,以及不同体位和穿刺针方向对并发症的影响。结果 55例患者均一次穿刺成功,并采集满意的组织活检标本,病理组织学明确诊断50例,确诊率为90.91%;其中手术病理或穿刺术后随访证实中心型肺癌肺段支气管病变阳性40例(72.73%),经穿刺术后随访证实中心型肺癌肺段支气管病变阴性10例(18.18%)。穿刺并发症:19例(34.55%)发生针道渗血,4例(7.27%)少量气胸,两者差异有统计学意义(χ2=6.03,P<0.01)。俯卧位与仰卧位穿刺的并发症发生率差异无统计学意义(P>0.05);垂直穿刺、水平穿刺、45°穿刺的并发症发生率依次降低(χ2=3.68,P<0.05)。结论 CT引导下穿刺针吸活检在中心型肺癌肺段支气管病变中的病理诊断准确度较高,且无明显严重并发症,值得临床推广应用。

PurposeTo investigate CT-guided needle aspiration biopsy in segmental bronchial lesions of central lung cancer., and to provide basis for developing therapeutic schedule.Materials and Methods Fifty-five cases of suspected central lung cancer with segmental bronchial lesions were selected. All patients underwent CT-guided needle aspiration biopsy. The puncture complications and the effect of different position and direction of the puncture needle on complications were observed.Results All 55 patients were punctured successfully in one time. Satisfactory biopsy specimens were collected in all patients. Pathological diagnosis rate was 90.91% （50/55）. Operative pathology or post-puncture follow-up confirmed the central lung cancer with segmental bronchial lesions in 40 cases with positive rate of 72.73% （40/55）, and the negative rate was 18.18% （10/55）. As for puncture complications, the needle tract bleeding was seen in 19 cases （34.55%）, and some pneumothorax in 4 cases （7.27%）. There was statistic difference between the two complications （χ^2=6.03,P〈0.01）. The complications of prone and supine position had no statistical difference （P〉0.05）. Incidence of complications decreased with performance angle by the order of vertical puncture, horizontal puncture, and 45 degrees puncture. There was statistic difference （χ^2=3.68,P〈0.05）.Conclusion CT-guided percutaneous needle aspiration biopsy is accurate in diagnosis of central lung cancer with segmental bronchial lesions. It has no serious complication and is worthy of general clinical application.