超声引导下周围型肺病变穿刺活检术的诊断价值及影响因素

Analysis on diagnostic value and related influencing factors of ultrasound-guided biopsy of peripheral lung lesions

目的探讨超声引导下周围型肺病变穿刺活检的诊断价值及相关影响因素,总结提高确诊率的方法和技巧。方法分析2018年1月至2019年1月因周围型肺病变在广州医科大学附属第一医院住院,行超声引导下肺穿刺活检术且具有穿刺病理结果的病例共311例。通过单因素分析以及多因素Logistic回归分析的统计学方法,分别分析患者的性别、年龄、病变位置、病变大小、病变与胸膜接触面直径、病变内有无坏死以及进针次数是否为超声引导下周围型肺病变穿刺活检术确诊率的影响因素。结果311例超声引导下周围型肺病变穿刺活检的病例整体确诊率为86.2%(268/311),总并发症发生率为10.3%(32/311),其中气胸发生率为2.3%(7/311),咯血发生率为6.1%(19/311),胸腔积液发生率为1.0%(3/311),胸膜反应发生率为1.0%(3/311)。单因素分析发现:病变大小、病变与胸膜接触面直径、病变内有无坏死是超声引导下周围型肺病变穿刺活检确诊率的影响因素(P<0.05);但患者性别、年龄、病变位置及进针次数与确诊率无关(P>0.05)。多因素Logistic回归分析发现:病变大小并非超声引导下周围型肺病变穿刺活检确诊率的独立影响因素(P>0.05);而病变与胸膜接触面直径是确诊率的保护因子(P<0.05,β=1.059,OR=2.882)、病变内有无坏死是确诊率的危险因子(P<0.05,β=-0.895,OR=0.409)。结论病变与胸膜接触面直径、病变内有无坏死是影响超声引导下周围型肺病变穿刺活检确诊率的重要因素。所以,掌握病变与胸膜接触面较小的病变的穿刺技巧以及避开病变的坏死区域能更好地提高超声引导下周围型肺病变穿刺活检的确诊率。

Objective Explore the diagnostic value and related influencing factors of ultrasound-guided biopsy of peripheral lung lesions,and summarize the methods and techniques to improve the diagnosis rate.Methods Analysis 311 patients were hospitalized in the First Affiliated Hospital of Guangzhou Medical University due to peripheral lung lesions and underwent ultrasound-guided lung biopsy with puncture pathological results from January 2018 to January 2019.Through single factor analysis and multivariate logistic regression analysis,whether the gender,age,lesion location,lesion size,diameter of the contact surface between the lesion and the pleura,whether there is necrosis in the lesion,and the number of needle insertions are factors affecting the diagnosis rate of ultrasound-guided biopsy of peripheral lung lesions.Results The overall diagnosis rate of 311 cases of ultrasound-guided biopsy of peripheral lung lesions was 86.2%(268/311),the total complication rate was 10.3%(32/311),and the incidence rate of pneumothorax was 2.3%(7/311)),the incidence of hemoptysis was 6.1%(19/311),the incidence of pleural effusion was 1.0%(3/311),and the incidence of pleural reaction was 1.0%(3/311).Univariate analysis found that:the size of the lesion,the diameter of the contact surface between the lesion and the pleura,and the presence or absence of necrosis in the lesion affected the diagnosis rate of ultrasound-guided peripheral lung lesion biopsy(P<0.05);but the patient′s gender,age,lesion location and The number of needle insertions was not related to the diagnosis rate(P>0.05).Multivariate logistic regression analysis found that the size of the lesion is not an independent influencing factor for the diagnosis rate of biopsy of peripheral lung lesions guided by ultrasound(P>0.05);and the diameter of the contact surface between the lesion and the pleura is a protective factor for the diagnosis rate(P<0.05,β=1.059,OR=2.882).The presence or absence of necrosis in the lesion is a risk factor for the diagnosis rate(P<0.05,β=-0.895,OR=0.409).Conclusion The diameter of the contact surface between the lesion and the pleura,and whether there is necrosis in the lesion are important factors that affect the diagnosis rate of biopsy of peripheral lung lesions guided by ultrasound.Therefore,mastering the puncture skills of the lesion with a small contact surface between the lesion and the pleura and avoiding the necrotic area of the lesion can better improve the diagnosis rate of ultrasound-guided puncture biopsy of peripheral lung lesions.