PET-CT与常规CT引导经皮肺穿刺活检的安全性及有效性对比研究

COMPARETHE SAFETY AND EFFICACY BETWEEN18 F-FDG PET-CT AND ROUTINE CT IN AIDING CT-GUIDED PERCUTANEOUS LUNG BIOPSY

目的探讨PET-CT及常规CT引导下经皮肺穿刺活检的安全性及有效性。方法回顾性分析2015年7月—2019年12月厦门大学附属中山医院呼吸与危重症医学科行经皮肺穿刺活检病例191例,将其分为PET-CT引导组(甲组)和常规CT引导组(乙组),对比分析二组的穿刺成功率与准确率,并分析二组并发症的发生,及其与性别、年龄、吸烟指数、病灶大小、与胸壁距离、病灶形态、病灶多寡、肺部基础病等的关系。结果 191例中,男132例,女59例,年龄20~86岁,平均(59.73±9.14)岁,其中甲组76例,乙组115例,均穿刺成功,穿刺中及穿刺后最常见的并发症为气胸(18.85%)、出血(17.28%)及穿刺部位疼痛(4.19%),2例患者术后出现发热,抗感染后好转,1例合并颈部、胸壁皮下气肿,1例患者穿刺17天后因原发病情加重抢救无效死亡。分层分析发现,二组患者的穿刺相关并发症的发生差异并无统计学意义,气胸的发生与病灶大小及穿刺次数有关,出血与穿刺次数有关,与年龄、性别、肺部基础病、吸烟史、病灶部位、病灶多少、病灶大小、病灶形态等无明确相关性。病理结果分析提示,PET-CT患者的诊断成功率97.37%(74/76),诊断准确率85.53%(65/76),常规CT组诊断成功率89.57%(103/115),诊断准确率68.7%(79/115)(P<0.05)。结论 PET-CT或常规CT引导下经皮肺穿刺活检的并发症无区别,多数并发症轻微,经及时处理均可痊愈;与常规CT对比,PET-CT定位下穿刺诊断成功率和准确率高。

Objective Compare the safety and efficacy between 18 F-FDG PET-CT and routine CT in aiding CT-guided percutaneous lung biopsy.Methods The retrospective data were analyzed including one hundred and ninety-one patients who underwent CT-guided percutaneous lung biopsy after a PET-CT scan or a conventional CT scan from the Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Xiamen University from July 2015 to Dec 2019.After statistic analysis, analyze the postoperative complications of pneumothorax, bleeding with age、sex、smoking history、the size of lesions、chest wall distance、focal form, also the numbers of lesions and pulmonary history disease as risk factors, and compare with the diagnose results, then judge.Results Among 191 cases, 132 were males and 59 were females, aged 20-86 years old, average was(59.73±9.14) years old, 76 cases underwent PET-CT scan while 115 cases underwent lung biopsy after conventional CT.All patients were successfully punctured.The most common complications were pneumothorax(18.85%), bleeding(17.28%) and pain at the puncture site(4.19%),2 cases got a fever after biopsy and were recovered after anti-infective therapy, 1 case had neck and chest subcutaneous emphysema, 1 case died after 17 days because of the primary condition aggravated.Statistical analysis found that the occurrence rate of the complications between the two groups has no statistical difference, pneumothorax happened with the lesion size and puncture times.Bleeding was significantly related to puncture times, but had nothing to do with age, sex, smoking history, the size of the lesions, chest wall distance, focal form, also the numbers of lesions and pulmonary history disease.Pathological analysis showed that the success rate and accuracy rate of PET-CT patients were 97.37%(74/76) and 85.53%(65/76),while the success rate and accuracy rate of conventionalCT group were 89.57%(103/115) and 68.70%(79/115),the results were statistically different(P<0.05).Conclusion Complications of PET-CT or conventional CT-guided percutaneous lung biopsy were mainly pneumothorax, bleeding, pain at the puncture site, etc.Most of the complications were slight and could be cured after timely treatment.Compared with conventional CT,the success rate and accuracy of puncture diagnosis under PET-CT localization were higher.