肝脏恶性病变经皮穿刺不同活检方式比较

Percutaneous Puncturing Needle Biopsy of Liver Malignant Lesions:Comparison of Different Biopsy Methods

目的探讨不同活检方式对肝脏恶性病变穿刺活检的价值。方法 105例肝脏恶性病变患者行B超或CT引导下肝脏病变穿刺活检术113次,其中57次行切割活检,40次行负压抽吸活检,16次应用同轴活检枪系统行切割加抽吸活检,分析不同穿刺活检方式的敏感性。不同穿刺活检方式与病理诊断敏感性之间的关系采用SPSS17.0软件进行χ2检验分析,P<0.05为有统计学意义。结果所有病例一次穿刺成功率100%。无严重并发症发生。105例中穿刺诊断恶性病变88例,敏感性83.8%(88/105)。切割穿刺活检敏感性82.5%(47/57),抽吸穿刺活检敏感性70.0%(28/40),切割加抽吸活检敏感性81.3%(13/16)。本组病例切割取材与抽吸取材敏感性比较P=0.149;切割加抽吸取材与抽吸取材敏感性比较P=0.390;切割取材与切割加抽吸取材敏感性比较P=0.911。不同穿刺活检方式与病理诊断敏感性之间统计学无显著性差异(P>0.05)。结论不同活检方式对肝脏恶性病变穿刺活检的敏感性虽有差异,但差异无统计学意义,均有效可行。

Objective To discuss the clinical value of different biopsy methods in percutaneous puncturing needle biop- sy of liver malignant lesions. Methods A total of 113 times of ultrasound-gnided or CT-gnided percutaneous puncturing needle biopsy of liver lesion were performed in 105 patients with hepatic malignant disease. Three different biopsy methods were employed, including tru-eut （n = 57）, fine needle aspiration with negative pressure （n = 40） and tru-eut plus aspiration with co-axial biopsy gun （ n = 16）. The diagnostic sensitivities of different biopsy methods were analyzed. The correlation between the biopsy method and the pathological sensitivity was evaluated with ehi-square test using software SPSS 17. 0 ; and P 〈 0.05 was considered to be statistically significant. Results The procedure was successfully accomplished by single puncturing in all patients, with a success rate of 100%. No severe complications occurred. Of the 105 patients, biopsy confirmed malignant lesion in 88 with a diagnostic sensitivity of 83.8% （88/105）. The diagnostic sensitivity of trucut biopsy was 82.5% （47/57） ; the diagnostic sensitivity of fine needle aspiration was 70.0% （28/40） ; and the diagnostic sensitivity of tru-cut plus aspiration was 81.3% （13/16）. Statistic analysis with ehi-square test indicated that the difference in diagnostic sensitivities between tru-cut biopsy and fine needle aspiration, between fine needle aspiration and tru-cut plus aspiration, and between tru-cut biopsy and tru-cut plus aspiration were P = 0. 149, P = 0. 390 and P = 0.911 respectively. The differences among the three methods were not statistically significant （ P 〉 0.05 in all）. Conclusion In percutaneous puncturing needle biopsy of liver malignant lesions, the diagnostic sensitivities of three biopsy methods have no statistically significant differences. Clinically, all the three kinds of biopsy methods are effective and feasible.