CT引导经皮肺穿刺活检对纤维支气管镜阴性患者的临床应用价值

Clinical application value of CT guided percutaneous lung biopsy in patients with negative fiberoptic bronchoscopy

目的：评价CT引导经皮肺穿刺活检对纤维支气管镜检查阴性患者的临床应用价值。方法回顾性分析51例肺中央型病变患者的临床资料，患者均先行纤维支气管镜检查结果阴性后行CT引导下经皮穿刺活检。记录患者的穿刺次数、并发症、病理等。根据病灶大小将患者分为三组：2.5～4.5 cm组、4.6～6.5 cm组、＞6.5 cm或肿块已波及段以下支气管组。结果51例患者病灶直径2.5～10.8 cm，平均4.9 cm，共穿刺86次，43例（84.3%）获得明确病理诊断，其中肺小细胞癌14例，肺鳞癌11例，腺癌6例，神经内分泌癌1例，腺鳞癌4例，硬化性血管瘤2例，结核2例，炎性假瘤2例，大细胞癌1例。24例（47.1%）发生并发症，其中少量气胸10例，术中、术后咳血及痰中带血6例，中至大量气胸5例（3例行胸腔闭式引流），针道渗血2例，胸腔内出血合并胸壁血肿1例，无死亡病例。2.5～4.5 cm组22例、4.6～6.5 cm组17例、＞6.5 cm或肿块已波及段以下支气管组12例，三组明确诊断率比较差异无统计学意义[81.8%（18/22）、14/17、11/12，P＞0.05]，三组并发症发生率比较差异有统计学意义[63.6%（14/22）、7/17、2/12，P＜0.05]。结论对肺中央型病变常规首选纤维支气管镜检查，但由于病变的多样性，难免出现假阴性情况，对这些患者采用CT引导下经皮穿刺活检是可行、安全的，活检阳性率较高，相关风险较低。

Objective To evaluate the clinical application value of CT guided percutaneous lung biopsy in patients with negative fiberoptic bronchoscopy. Methods The clinical data of 51 patients with central type lung lesions were retrospectively analyzed and all patients had a negative result of fiberoptic bronchoscopy. Then they underwent the CT guided percutaneous lung biopsy. The number of paracentesis, complication and pathology were recorded. The patients were divided into 3 groups according to the tumor size：2.5-4.5 cm group, 4.6-6.5 cm group and〉6.5 cm or tumor reaching the segmental bronchus group. Results The tumor diameter of 51 patients was 2.5-10.8 cm, average 4.9 cm. The number of paracentesis was 86 times, and 43 cases （84.3%） obtained definite pathological diagnosis： small cell carcinoma of lung in 14 cases, lung squamous cell carcinoma in 11 cases, adenocarcinoma in 6 cases, neuroendocrine carcinoma in 1 case, adenosquamous carcinoma in 4 cases, sclerosing hemangioma in 2 cases, tuberculosis in 2 cases, inflammatory pseudotumor in 2 cases, and large cell carcinoma in 1 case. The incidence of complication was 47.1%（24/51）, among which the total slight pneumothorax occurred in 10 cases, intraoperative and postoperative hemoptysis, sputum with blood in 6 cases, greater amounts pneumothorax in 5 cases （3 cases underwent the closed drainage of pleural cavity）, puncture path errhysis in 2 cases, thoracic cavity hemorrhage and thoracic wall haematoma in 1 case. No patient died. The 2.5-4.5 cm group had 22 cases, 4.6-6.5 cm group had 17 cases and 〉6.5 cm or tumor reaching the segmental bronchus group had 12 cases, and there was no＆nbsp;statistical difference in the rate of definite pathological diagnosis among 3 groups：81.8%（18/22）, 14/17 and 11/12, P〉0.05;and there was statistical difference in the incidence of complication among 3 group：63.6% （14/22）, 7/17 and 2/12, P〈0.05. Conclusions The preferred examination of central type lung lesions patients is fiberoptic bronchoscopy, but because of diversity of disease, the CT guided percutaneous lung biopsy in the patients with negative fiberoptic bronchoscopy is feasible, safe, with high positive rate of biopsy and lower risk.