超声造影引导胸膜穿刺在胸腔积液查因的研究

Application of contrast-enhanced ultrasound guided pleural puncture in etiology of pleural effusion

目的探讨常规超声和超声造影对胸腔积液查因患者的胸膜评估情况以及超声造影引导胸膜穿刺活检的应用价值。方法回顾分析54例胸腔积液查因患者胸膜的常规超声、超声造影以及超声引导穿刺活检的结果。对比良恶性胸膜病变的超声表现,对比常规超声和超声造影以及造影增强不同区域的穿刺阳性率,从而评估超声造影引导胸膜穿刺的价值。结果良恶性胸膜病变与常规超声所提示胸膜的增厚类型(未增厚、弥漫性增厚、结节样增厚、团块样增厚及不均匀增厚)(P=0.48)及胸膜的超声造影增强类型(均匀增强、不均匀增强及不增强)(P=0.16)均无相关性。但是超声造影引导的胸膜穿刺阳性率高于常规超声(P=0.02)。尤其超声造影能够区分病灶的增强区和不增强区,在增强区的穿刺阳性率高于不增强区(P=0.00)。结论超声造影能够指引穿刺者避开病灶内坏死区域,从而有效的提高穿刺活检的阳性率,有助于判断胸腔积液病因,具有一定的临床应用价值。

Objective To investigate the value of routine ultrasound and contrast-enhanced ultrasound in the pleural assessment and the guidance of pleural puncture biopsy of patients with pleural effusion by contrast-enhanced ultrasound.Methods The results of routine ultrasound contrast-enhanced ultrasound and ultrasound-guided puncture biopsy of pleura in 54 patients with pleural effusion were analyzed retrospectively.The ultrasonic findings of benign and malignant pleural lesions were compared.The value of contrast-enhanced ultrasound guided pleural puncture was evaluated by comparing the positive rate of puncture of routine ultrasound,contrast-enhanced ultrasound and contrast enhancement of different areas.Results There was no significant correlation between benign and malignant pleural lesions and the types of pleural thickening indicated by routine ultrasound(no thickening,diffuse thickening,nodular thickening,lumpy thickening and uneven thickening)(P=0.48)and the types of pleural contrast-enhanced ultrasound(uniform enhancement,non-uniform enhancement and non-enhancement)(P=0.16).However,the positive rate of pleural puncture under contrast-enhanced ultrasound guidance was higher than that of routine ultrasound(P=0.02).In particular,contrast-enhanced ultrasound could distinguish the enhanced area from the non-enhanced area,and the positive rate of puncture in the enhanced area was higher than that in the non-enhanced area(P=0.00).Conclusion Contrast-enhanced ultrasound may guide the puncture doctor to avoid the necrotic area in the lesion,thus effectively improve the positive rate of puncture biopsy.It is helpful to determine the etiology of pleural effusion and has certain clinical application value.