改良CT和激光双引导经皮肺穿刺活检在肺癌精确诊断中应用

Application of modified CT and laser dual-guided standardized percutaneous cutting needle lung biopsy in the accurate diagnosis of lung cancer

目的传统经皮肺穿刺活检术在易操作性、精确性和安全性方面尚存在局限性。本研究探讨了改良的CT和激光双引导下标准化经皮肺穿刺活检流程在肺癌精确诊断中的应用价值。方法回顾性分析2013-01-15-2016-12-28南京大学医学院附属鼓楼医院肿瘤中心,采用改良的CT和激光双引导下标准化经皮肺穿刺活检流程患者159例。研究穿刺活检成功率、气胸及肺出血的发生率,及年轻医生掌握该改良标准化流程的平均时间。结果 159例患者穿刺活检成功率为100%,病理诊断阳性率为98.7%。气胸17.61%(28/159),其中轻度气胸13.84%(22/159),中度气胸2.52%(4/159),重度气胸1.26%(2/159)。肺出血20.75%(33/159),其中1级16.35%(26/159),2级4.40%(7/159),无≥3级肺出血;其中8.18%(13/159)伴有痰中带血丝,2.52%(4/159)伴有咯血。年轻医生熟练掌握改良的标准化肺穿刺活检流程的中位时间为2.5个月。结论改良的激光和CT双引导下标准化经皮肺穿刺活检流程,与以往研究相比,降低了肺穿刺活检难度,提高了肺穿刺活检的精确性、安全性,扩大了肺穿刺活检的适应症。

OBJECTIVE The procedure of traditional percutaneous lung biopsy has some limitations in operability,accuracy and safety.The aim of our study was to investigate the value of modified CT and laser dual-guided standardized percutaneous cutting needle lung biopsy in the accurate diagnosis of lung cancer.METHODS A retrospective review was made in 159 patients underwent modified CT and laser dual-guided standardized percutaneous cutting needle lung biopsy between January 15 th 2013 and December 28 th 2016.The success rate of lung biopsy,the incidence rate of pneumothorax and pulmonary hemorrhage,and the average time for young doctors to master the modified standardized lung biopsy process were studied,respectively.RESULTS 159 cases of patients,the success rate of lung biopsy was 100%.The positive rate of pathological diagnosis was 98.7%.28 cases of pneumothorax occurred（17.61%）,including 22 cases of mild pneumothorax（13.84%）,4 cases of moderate pneumothorax（2.52%）,and 2 cases of severe pneumothorax（1.26%）.At the same time,pulmonary hemorrhage occurred in 33 patients（20.75%）,of which 26 cases for level 1（16.35%）,7 cases of grade 2（4.40%）.There was no level 3 and above pulmonary hemorrhage.13 cases（8.18%）with blood tinged sputum and 4 cases（2.52%）with hemoptysis were noted among them.CONCLUSION The process of modified CT and laser dual-guided standardized percutaneous cutting needle lung biopsy,compared with historical controls,reduces the difficulty of lung biopsy,improves the accuracy and safety of lung biopsy,and expands the indications of lung biopsy.