多层CT导向下经皮肺穿刺活检术的临床应用

Clinical application of multi layer CT guided percutaneous lung biopsy

目的探讨多层CT导向下经皮肺穿刺活检术在肺部疾病中的应用价值及安全性。方法抽取2014年2月至2016年3月首都医科大学宣武医院接收的符合研究选取标准的41例肺部结节患者,所有患者均于多层CT导向下经皮肺穿刺活检。分析穿刺成功率、病理结果,并统计并发症发生情况。结果 41例患者共进行44次穿刺,其中38例患者一次成功、3例患者分别重复进行1次穿刺,一次性成功率为92.68%(38/41),二次成功率为7.32%(3/41),且所有患者均成功获取组织标本送至病理学检查,穿刺总成功率100.0%(41/41);38例患者成功取材并得到病理学诊断结果,与临床诊治或术后病理结果相符合,阳性率为92.68%(38/41),其中良性结节9例(结核5例,曲霉菌2例,错构瘤1例,炎性假瘤1例),恶性结节29例(腺癌18例,鳞癌4例,肺泡癌3例,转移癌2例,小细胞肺癌2例);穿刺结束后共出现6例气胸、5例轻微咳血,并发症总发生率为26.83%(11/41)。结论多层CT导向下经皮肺穿刺活检术可对肺结节进行有效诊断,操作简捷、诊断结果准确度高,且并发症发生率较低,具有一定安全性,可将其作为肺结节常规诊断手段。

Objective To investigate the value and safety of multi layer CT guided percutaneous lung biopsy in patients with pulmonary nodules.Method41 patients with pulmonary nodules were selected in our hospital from February 2014 to March 2016, all patients were subjected to multiple CT guided percutaneous lung biopsy. The success rate of puncture, pathological results and incidence of complications were analyzed.Result41 cases underwent a total of 44 times of puncture, including 38 cases with one-time successful puncture, 3 patients were repeated puncture, the one-time success rate was 92.68% （38/41）, the second-time success rate was 7.32% （3/41） and all patients were successfully obtained tissue samples sent to pathological examination, puncture success rate was 100.0% （41/41）. Pathological diagnosis were obtained in 38 cases, coincident with clinical diagnosis or postoperative pathological results, the positive rate was 92.68% （38/41）; There were 9 cases with benign nodules （tuberculosis 5 cases,aspergillosis 2 cases, hamartoma 1 case, inflammatory pseudotumor 1 case） and 29 cases with malignant nodules （adenocarcinoma 18 cases, squamous cell carcinoma 4 cases, alveolar cell carcinoma 3 cases, metastatic cancer 2 cases, small cell lung cancer 2 cases）; There were 6 cases of pneumothorax and 5 cases of mild hemoptysis after the puncture, the complication rate was 26.83% （11/41）.ConclusionMulti layer CT guided percutaneous lung biopsy can be effective in the diagnosis of pulmonary nodules meanwhile with a low rate of complications incidence. It can be performed as a routine diagnostic method in pulmonary nodules.