低剂量CT引导下肺小结节穿刺活检术的临床应用

Clinical application of CT-guided percutaneous transthoracic core needle biopsy using low dose in pulmonary nodules

目的:探讨低剂量CT引导下穿刺活检术在肺小结节中的诊治价值。方法:回顾性分析2010年~2016年行CT引导下肺小结节活检穿刺术患者709例按CT成像参数分为低剂量组(Ⅰ组:100 kVp,50 mAs)286例及常规剂量组(Ⅱ组:120 kVp,100 mAs)423例,比较两组的穿刺成功率、诊断准确性、特异性、敏感性、并发症以及辐射剂量。结果:Ⅰ组、Ⅱ组穿刺成功率分别为98.6%和97.6%,肺部病变的诊断准确率分别为97.8和97.1%,差异均无统计学意义(P>0.05)。Ⅰ组、Ⅱ组气胸和咯血并发症发生率分别为18.1%、19.8%和2.5%、2.7%,两组差异无统计学意义(P>0.05)。Ⅰ组、Ⅱ组平均辐射剂量分别为(1.5±1.9)mSv和(0.7±0.3)mSv,差异有统计学意义(P<0.01)。结论:低剂量CT引导下肺小结节穿刺活检在辐射剂量明显降低的前提下仍能保持较高诊断准确性和安全性,值得临床广泛推广。

Objective To investigate the diagnostic and therapeuric value of low dose CT guided needle biopsy in small pulmonary nodules.Method A total of 709 patients who under went CT guided small pulmonary nodule biopsy from 2010 to 2016 were retrospectively analyzed.According to CT imaging parameters,they were divided into low-close group(groupⅠ:100 kvp,50 mas)286 cases and conventional dose group(GroupⅡ:120 kvp,100 mas)423 cases.The success rate,diagnostic accuracy,specificity,sensitivity,complications and radiation dose of the two groups were compared.Results The success rates of puncture in groupⅠand groupⅡwere 98.6%and 97.6%respectively,and the diagnostic accliracy rates of pulmonary lesions were 97.8%and 97.1%respectively,with no significant difference(P>0.05).The complication rates of pneumothorax and hemoptysis in groupⅠand groupⅡwere 18.1%,19.8%and 2.5%,2.7%respectively,and there was no significant difference between the two groups(P>0.05).The average radiation dose of groupⅠand groupⅡwere(1.5±1.9)mSv and(0.7±0.3)mSv,respectively,and the difference was statrsticaity sianificant(P<0.01).Conclusion Low dose CT guided needle biopsy of small pulmonary nodules can maintain high diagnositic accuracy and safety under the premiss of significantly reduced radiation dose which is worthy of wide clinical promotion.