CT引导下经皮肺穿刺活检术对438例肺部肿块的临床诊断意义

CT-Guided Percutaneous Lung Biopsy in Diagnosis of Pulmonary Nodules: 438 Cases Analysis

目的探讨CT引导下经皮肺穿刺活检在肺部肿块诊断中的意义及并发症防治措施,分析产生并发症的原因及主要影响因素,以提高CT引导下经皮穿刺肺活检术穿刺成功率。方法对2015年1月至2016年6月住院且临床难以确诊的肺部肿物患者438例行CT引导下经皮肺穿刺活检术,并通过病理学确诊。结果 438例患者全部穿刺成功,穿刺成功率100.0%,一次穿刺阳性率94.9%,二次穿刺阳性率100.0%。438例病理诊断为恶性病变379例(86.5%),良性病变37例,不确定22例。经皮穿刺活检的敏感性、特异性、准确率分别为97.9%(376/384)、94.4%(51/54)、97.4%(427/438)。一次穿刺出现气胸33例(7.5%),痰中带血62例(14.2%),胸膜反应7例(1.6%),针道渗血6例(1.4%),未见针道种植。15例患者第二次穿刺出现气胸7例(46.6%),痰中带血1 1例(7 3.3%)。合并慢性阻塞性肺疾病(简称慢阻肺)、肺部病灶<3 c m或穿刺深度≥5 c m的患者气胸和痰中带血发生率更高,差异有统计学意义(P<0.05)。结论 CT引导下经皮肺穿刺活检术对肺部肿块具有良好的临床诊断价值,穿刺进针深、病灶小、有慢阻肺的患者穿刺并发症发生率越高。CT引导下经皮肺穿刺活检术是一种创伤相对小、确诊率高、安全性较好的方法。

Objective To explore the diagnostic value and safety of CT-guided percutaneous lung biopsy （CT-PLB）for pulmonary nodules. Methods A total of 438 patients with pulmonary nodules underwent CT-PLB for further diagnosis. Results The CT-PLB was performed successfully in all 438 patients. The positive biopsy rate at the firstpuncture was 94.9%, and 100.0% at the second puncture. The pathology results revealed 379 （86.5%） cases of malignant lesions, 37 cases of benign lesions, and 22 cases with uncertainty. The sensitivity, specificity and accuracy of CT-PLB were97.9% （376/384）, 94.4% （51/54）, and 97.4% （427/438）, respectively. The first puncture induced complications included pneumothorax in 33 （7.5%） cases, blood in phlegm in 62 （14.2%） cases, pleural reaction in 7 （1.6%） cases, and bleeding atthe site of puncture in 6 （1.4%） cases. There was no occurrence of neoplasm needle track implantation. The second puncture induced complications included pneumothorax in 7 （46.6%） cases and blood in phlegm in 11 （73.3%） cases. Theincidences of pneumothorax and blood in phlegm were significantly higher in the patients with chronic obstructive pulmonary disease （COPD）, with pulmonary lesion size 〈 3 cm, or with penetration depth ≥5 cm （P 〈 0.05）. Conclusions CT-PLB is a safe method with a relatively small trauma and has good diagnostic value for pulmonary nodules. The incidence of complications increases in patients with smaller pulmonary lesions, deeper puncture, or COPD.