基于“PET”原则的CT引导下经皮肺穿刺活检术的临床应用

Linical application of CT-guided percutaneous transthoracic needle biopsy based on PET

目的:探讨基于"PET"原则的CT引导下经皮肺穿刺活检术(PTNB)(PET-CT-PTNB)的诊断效果及并发症,并对并发症的危险因素行进一步分析。方法:2015年1月至2017年1月间前瞻性入组肺部病变需行CT引导下PTNB的患者220例,其中112例患者行PET-CT-PTNB,108例患者行常规CT引导下PTNB(CT-PTNB)。分析两组的临床资料,比较两组的诊断率、气胸发生率和胸腔闭式引流率,并探讨气胸发生的危险因素。结果:两组的诊断率无统计学差异(94.6%vs 92.6%,P>0.05);PET-CT-PTNB组气胸发生率低于CT-PTNB组(8.9%vs 19.4%,P<0.05);两组胸腔闭式引流率无统计学差异(1.8%vs 3.7%,P>0.05);在PET-CT-PTNB组中,翻转时间<15 s亚组气胸发生率低于翻转时间>15 s亚组(5.3%vs 16.7%,P<0.05),且前者胸腔闭式引流率亦低于后者(0%vs 5.6%,P<0.05)。多因素分析显示在CT-PTNB组中,病灶大小<3 cm、病灶深度>5 cm、穿刺次数>3次、合并COPD均是危险因素,但只有病灶深度>5 cm、合并COPD有统计学意义(OR值>1,P<0.05);在PET-CT-PTNB组中,病灶大小<3 cm、病灶深度>5 cm、穿刺次数>3次、合并COPD均是危险因素,但所有因素均无统计学意义(OR值>1,P>0.05);在危险因素中,病灶深度>5 cm、合并慢阻肺在PET-CT-PTNB组明显减弱。结论:在对患者行CT引导下肺穿刺活检时,选择PET-CT-PTNB法可在不影响诊断效果的情况下有效减少气胸并发症的出现,尤其对于合并多个危险因素的患者。

Objective： To investigate the diagnostic efficacy and complications of CT-guided percutaneous transthoracic needle biopsy（ PTNB） based on PET（ PET-CT-PTNB）,and to further analyze the risk factors of complications. Methods： Two hundred and twenty patients with lung lesions having a demand for CT-guided PTNB between January 2015 and January 2017 were prospectively analyzed. Among them,112 patients were subjected to PET-CT-PTNB,and 108 underwent routine CT-guided PTNB（ CT-PTNB）. Clinical data of the 2 groups were analyzed; diagnostic rate,the incidence of pneumothorax and the rate of closed thoracic drainage were compared; and the risk factors of pneumothorax were explored. Results： There was no statistical difference in the diagnostic rate between the two groups（ 94. 6% vs. 92. 6%,P 0. 05）. The incidence of pneumothorax in the PET-CT-PTNB group was lower as compared with the CT-PTNB group（ 8. 9% vs. 19. 4%,P 0. 05）. There was no statistical difference in the rate of closed thoracic drainage between the two groups（ 1. 8% vs. 3. 7%,P 0. 05）. In the PET-CT-PTNB group,the incidence of pneumothorax and the rate of closed thoracic drainage were lower in both subgroups of turnover time 15 s and 15 s（ 5. 3% vs. 16. 7%,P 0. 05; 0% vs. 5. 6%,P 0. 05）. Multivariate analysis demonstrated that in the CT-PTNB group,the size of lesion 3 cm,the depth of lesion 5 cm,the number of puncture 3,and combined COPD were all risk factors,with only the depth of lesion 5 cm and combined COPD presenting statistical significance（ OR 1,P 0. 05）. In the PET-CT-PTNB group,the size of lesion 3 cm,the depth of lesion 5 cm,the number of puncture 3,and combined COPD were all risk factors,showing no statistical significance（ OR 1,P 0. 05）. Among these risk factors,the depth of lesion 5 cm and combined COPD were obviously weakened in the PET-CT-PTNB group. Conclusion： When patients undergo CTguided needle biopsy of the lung,PET-CT-PTNB is suggested to effectively reduce the incidence of pneumothorax without influencing the incidence of pneumothorax,especially for patients combined with multiple risk factors.