周围型肺部肿块经皮穿刺活检超声及CT引导方法的比较分析

COMPARISON AND ANALYSIS OF ULTRASOUND AND CT GUIDED PERCUTANEOUS LUNG BIOPSY IN DIAGNOSING PERIPHERAL PULMONARY MASSES

目的 分析比较超声与CT引导下经皮肺穿刺活检在周围型肺部肿块的诊断明确率、并发症发生率并探讨其相关影响因素。方法 回顾性分析2013年1月—2015年1月首都医科大学附属北京朝阳医院呼吸内科收治的,经痰脱落细胞、纤维支气管镜检查未能定性,胸部CT显示周围型肺部肿块的成年患者118例。根据其经皮肺活检方法不同分为超声引导组和CT引导组,其中超声引导组57例,CT引导组61例,观察比较二组患者在诊断明确率、并发症发生率的差异并试分析其原因。结果 超声引导组穿刺活检诊断明确率93.0%高于CT引导组的88.5%,二组比较差异无统计学意义（χ~2=0.69,P〉0.05）;二组均未出现血胸、针道转移、呼吸衰竭等严重并发症,超声引导组并发症发生率8.8%低于CT引导组的19.7%,二组比较差异无统计学意义（χ~2=2.84,P〉0.05）;但超声引导组气胸发生率1.8%低于CT引导组的14.8%,二组比较差异有统计学意义（χ~2=4.86,P〈0.05）。结论 超声引导经皮肺穿刺活检是一种安全、有效的临床诊断方法,对于周围性肺部肿块,建议首选超声引导穿刺活检。

Objective To compare the detection rate and complication between ultrasound and CT guided percutaneous lung biopsy in the diagnosis of peripheral pulmonary masses and to analyze its influence fac‐tors .Methods Data were collected from 118 patients who underwent percutaneous lung biopsy for suspec‐ted lung cancer during the period from January 2013 to January 2015 in respiration medicine ,Beijing Chaoy‐ang Hospital .All of these patients were failed with bronchofiberscopy diagnosing but confirmed to be pul ‐monary masses with CT .The cases were allocated to ultrasound - or CT - guided confirmation group by the means of biopsy ,of which 57 cases were confirmed by ultrasound - guided approach and 61 ,by CT . The detection rate ,complications were compared between the two groups and the influence factors were tried to be analyzed .Results The detection rate of ultrasound guided group （93 .0% ） was higher than that of CT guided group（88 .5% ） ,the complications of ultrasound guided group（8 .8% ） was lower than that of CT guided group（19 .7% ） .The results showed no significant difference （χ2 = 0 .69 ,2 .84 ,both P〉0 .05） ;the frequency of pneumothorax in performing ultrasound guided percutaneous lung biopsy （1 .8% ） was lower than that in CT guided group （14 .8% ） .The result showed significant difference （χ2 = 4 .86 ,P〉0 .05） .Conclusion Ultrasound guided percutaneous lung biopsy is a safe and effective means for pulmonary mass ,and is preferable to the cases with pulmonary mass that can be confirmed by ultrasonoscopy .