CT引导下不同路径经皮肺穿刺活检诊断胸膜下结节

CT-guided different pathways percutaneous lung biopsy for diagnosis of subpleural pulmonary nodules

目的探讨CT引导下不同路径经皮肺穿刺活检(PTNB)诊断胸膜下结节的价值。方法147例胸膜下结节患者接受CT引导下PTNB,根据穿刺针与胸膜角度分为长路径组(穿刺针与胸膜角度≤50°,83例)与短路径组(穿刺针与胸膜角度>50°,64例),比较两组诊断准确率、单次穿刺成功率及术后出血、气胸等并发症,分析两组中直径≤10 mm、10~20 mm、≥20 mm结节之间调针次数、穿刺时间、患者气胸及出血发生率的差异。结果2组诊断准确率、单次穿刺成功率及气胸、出血发生率差异均无统计学意义(P均>0.05)。长路径组对于直径≤10 mm及10~20 mm结节的调针次数及穿刺时间均短于短路径组(P均<0.05)。结论CT引导下不同路径PTNB对胸膜下结节均具有较高诊断准确率。对直径<20 mm胸膜下结节建议长路径穿刺。

Objective To investigate the value of CT-guided percutaneous transthoracic needle biopsy(PTNB)in diagnosis of subpleural nodules.Methods CT-guided PTNB was performed in 147 patients with subpleural nodules.According to the angle of needle and pleura,the patients were divided into long path group(the angle of the needle and pleura≤50°,n=83)and short path group(the angle of the needle and pleura>50°,n=64).The accuracy rate of diagnosis,success rate of single puncturing,pneumothorax and hemorrhage after operation were compared between the two groups.The number of needle adjustments,puncture time,pneumothorax and hemorrhage in patients with nodular diameter≤10 mm,10—20 mm and≥20 mm were compared,respectively.Results There was no significant difference in accuracy rate of diagnosis,success rate of single puncturing,pneumothorax nor hemorrhage after operation between the two groups(all P>0.05).The number of needle adjustments and puncture time of lesions with nodular diameter≤10 mm and 10—20 mm in long path group were all shorter than those in short path group(all P<0.05).Conclusion CT-guided PTNB has high accuracy for subpleural nodules.For subpleural pulmonary nodule diameter<20 mm,long path puncture is the preferred approach.