对比CT引导下不同进针路径经皮肺穿刺活检效果

Comparison on different needle approaches of CT-guided percutaneous lung biopsy

目的对比观察不同进针路径CT引导下经皮肺穿刺活检效果。方法回顾性分析86例接受CT引导下经皮肺穿刺活检的肺部病变患者,根据规划进针路径是否与床面垂直分为垂直床面(PT)组与非垂直床面(NPT)组,是否与体表垂直分为垂直体表(PB)组与非垂直体表(NPB)组,测量各组实际进针路径与规划路径间的偏移角度、针尖偏移距离及进针深度,统计穿刺次数、穿刺时间及术后气胸、针道出血例数。结果86例中,83例(83/86,96.51%)获得、3例未获明确病理诊断。术后气胸发生率12.79%(11/86),针道出血发生率33.72%(29/86)。实际进针时,各组角度均有不同程度偏移,PT组偏移角度小于NPT、PB、NPB组,针尖偏移距离小于NPT及PB组(P均<0.05);各组穿刺时间、进针深度、穿刺次数及术后气胸、针道出血差异均无统计学意义(P均>0.05)。术后发生气胸与未发生气胸者之间,进针深度差异有统计学意义(P<0.05);术后针道出血与未出血者间进针深度、穿刺时间及穿刺次数差异均有统计学意义(P均<0.05)。偏移角度与进针深度呈负相关(r=-0.37,P<0.01),针尖偏移距离与进针深度呈正相关(r=0.45,P<0.01)。结论行CT引导下经皮肺穿刺活检时,使患者处于倾斜位,选择垂直于床面且进针较短的穿刺路径有助于减少偏移及并发症。

Objective To compare the different needle approaches of CT-guided percutaneous lung biopsy.Methods Data of 86 patients with lung lesions underwent CT-guided percutaneous lung biopsy were retrospectively analyzed.According to whether the planned needle path being perpendicular to the bed surface or not,the patients were divided into perpendicular to the table(PT)group and not perpendicular to the table(NPT)group;according to whether the planned path being perpendicular to the body surface or not,they were divided into perpendicular to the body surface(PB)group and non-perpendicular body surface(NPB)group.The offset angle,tip offset distance and needle depth between actual needle approach path and planned needle approach path were measured and compared among 4 groups.The times of needle insertion,puncture time and the postoperative pneumothorax and needle path bleeding cases were counted.Results Among 86 patients,clear pathologic diagnosis was obtained in 83 cases(83/86,96.51%),but failed in 3 cases.The incidence of postoperative pneumothorax was 12.79%(11/86),and of hemorrhage of puncture pathway was 33.72%(29/86).The actual needle insertions shifted to varying degrees in all 4 groups,but the offset angle of PT group was smaller than that of NPT,PB and NPB groups,and the needle tip offset distance was shorter than that of NPT and PB groups(all P<0.05).There was no statistically significant difference of times of needle insertion,needle depth,puncture time,postoperative pneumothorax nor needle tract bleeding among 4 groups(all P>0.05),whereas there were statistical differences of needle depth between patients with or without pneumothorax,also of needle depth,times of needle insertion and puncture time between those with or without needle hemorrhage after operation(all P<0.05).The offset angle was negatively correlated with needle depth(r=-0.37,P<0.01),and the needle tip offset distance was positively correlated with needle depth(r=0.45,P<0.01).Conclusion For CT-guided percutaneous lung biopsy,tilting the patient and choosing vertical bed surface and short puncture path as far as possible could effectively reduce the incidence of deviation and complications.