肺部小病灶经皮穿刺活检41例分析

Analysis of Percutaneous Biopsy of 41 Small Lung Lesions

背景与目的近年来由于肺癌筛查工作的广泛开展,越来越多的肺部小病灶被发现,本研究旨在分析计算机断层扫描(computed tomography, CT)引导下经皮肺小病灶(直径<2 cm)穿刺活检结果及并发症、预后。方法选择2015年1月-2017年12月期间行CT引导下经皮肺穿刺活检术41例肺内周围型病灶,单发病灶39例多发病灶2例,病灶最大径5-20(13.1±5.2)mm。病灶距离肺表面深度1-45(16.5±13.7)mm,毛玻璃样成分(ground glass opacity, GGO)比例0%-100%(66.8%±35.2%)。结果 41例患者进行43次穿刺。43次穿刺均成功取得病理组织。手术证实其中非典型腺瘤样增生(atypical adenomatous hyperplasia, AAH)3例,鳞癌1例,腺癌37例(原位癌7例,微侵润癌5例,侵润性25例,有2例患者为双原发癌),炎性病变2例。除2例炎性病变正在随访中,活检与手术病理吻合度(特异性)为100%。气胸22例,发生率51.2%,需闭式引流2例,17例发生咯血,发生率39.5%,均为自限性。2例出现颅内空气栓塞经治疗痊愈,发生率4.6%。结论对于肺部小病灶CT引导经皮穿刺技术上可行。但对于肺部小病灶尤其是纯GGO的穿刺活检,目前还需要持谨慎态度。

Background and objective When lung cancer screening work extensively developed in recent years, more and more small lung lesions were found in clinic, The aim of this study is to analysis computed tomography （CT） guided percutaneous biopsy for lung small lesions （diameter〈2 cm） on results, complications and prognosis. Methods Choose CT guided percutaneous lung biopsy were performed in 41 cases of pulmonary peripheral lesions, single lesion in 39 cases, multi- ple lesions in 2 cases, 5-20 （13.1±5.2） mm in maximum diameter, depth from lung surface 1-45 （16.5±13.7） mm, ground-glass opacity （GGO） components 0%-100% （66.8%±35.2%）. Results 41 patients and 43 biopsies successfully obtained pathologi- cal tissue. Atypical adenomatous hyperplasia in 3 cases, squamous carcinoma in i case, adenocarcinoma in 37 cases（ carcinoma in situ in 7 cases, micro-invasive carcinoma in 5 cases, invasive adenocarcinoma in 25 cases, double primary lung cancer in 2 cases）, inflammatory lesions in 2 cases. Except 2 cases of inflammatory lesions are in follow-up, biopsy and surgical pathology alignment （specificity） was 100%. 41 patients occurred complications related to percutaneous biopsy. Pneumothorax were in 22 cases, drainage required in 2 cases. There were 17 cases with hemoptysis, accounting for 39.5% incidence are self-limited. Intracranial air embolism occurred in 2 cases by 4.6% incidence. They were fully recovered. Conclusion For small lung lesions, CT guided percutaneous biopsy is technically feasible. However, for small lung lesions especially pure GGO biopsy, it is still need to be cautious.