多层螺旋CT引导下经皮肺穿刺活检术的临床应用及并发症影响因素分析

Clinical application of multislice computed tomography-guided percutaneous transthoracic needle biopsy and influencing factors of its complications

目的探讨多层螺旋CT(multislice computed tomography,MSCT)引导下经皮肺穿刺活检术(percutaneous transthoracic needle biopsy,PTNB)的临床价值和并发症因素分析。方法回顾川北医学院附属医院和重庆市垫江县人民医院2013年1月—2016年12月行MSCT引导下PTNB的179例肺部周围性结节患者,分析并发症的发生率及影响因素,总结穿刺活检结果及诊断准确率。结果 179例患者中,MSCT引导下PTNB检出129例恶性肿瘤,与手术切除病灶后的病理结果及临床保守治疗随访结果对照比较,总体诊断正确率93.30%,恶性肿瘤诊断正确率92.14%,主要并发症为气胸、肺出血、呼吸困难、咯血。并发症主要危险因素为病灶大小≤2 cm、距离膈面短径≤5 cm、穿刺深度>5 cm、穿刺胸膜角度>50°、穿刺次数≥2次、穿刺时间≥20 min、患者年龄>60岁、合并肺部疾病(P<0.05)。结论 MSCT引导下PTNB临床应用价值高,穿刺技术熟练、选择合适的穿刺方案有利于减少穿刺活检的并发症。

Objective To investigate the clinical value and complication factors of percutaneous transthoracic needle biopsy （PTNB） guided by multislice computed tomography （MSCT）. Methods From January 2013 to December 2016, 179 patients treated with MSCT-guided lung biopsy in the Affiliated Hospital of North Sichuan Medical College and Dianjiang People＇s Hospital were reviewed. Occurrence rate and the influencing factors of complications were analyzed. Meanwhile, biopsy findings and diagnostic accuracy rate were summarized. Results A total of 129 cases of lung cancer were detected under MSCT-guided percutaneous biopsy in 179 patients with a diagnostic accuracy of 93.30%. The correct rate of malignant tumor diagnosis was 92.14%. The main complications were pneumothorax, pulmonary hemorrhage, dyspnea and hemoptysis. Major risk factors of MSCT-guided PTNB complications included lesion size ,〈 2 cm, the shortest distance to the diaphragm ,〈 5 cm, puncture depth 〉 5 cm, pleural puncture angle 〉 50°, the puncture times ≥ 2, puncture time≥ 20 minutes, age of patients 〉 60 years, and existence of pulmonary disease （P〈0.05）. Conclusions The clinical application value of MSCT-guided PTNB is high. Skilled puncture technique and appropriate puncture procedure are helpful to reduce complications.