超声造影在周围型肺肿块穿刺活检中作用

Role of contrast-enhanced ultrasound in puncture biopsy of peripheral lung masses

目的观察周围型肺肿块患者行超声造影及常规超声引导下经皮肺肿块穿刺活检的成功率及并发症情况,探讨超声造影在周围型肺肿块穿刺活检中的应用价值。方法行超声引导下经皮肺肿块穿刺活检组织病理检查确诊的332例周围型肺肿块患者,其中超声造影引导者82例为造影组,常规超声引导者250例为非造影组,比较2组肿块直径、肿块位置、穿刺针数、肿块内液化坏死区显示率、坏死区最大径线、病灶内及路径上较大血管显示率、1次穿刺成功率、肿块恶性率及穿刺并发症发生情况。结果造影组肿块内液化坏死区显示率(61.4%)、坏死区最大径线[(33.2±13.8)mm]、病灶内及穿刺路径上较大血管显示率(65.1%)、1次穿刺成功率(94.0%)、肿块恶性率(66.3%)、穿刺2针比率(59.0%)均高于非造影组[19.2%、(13.6±11.4)mm、27.6%、85.6%、53.2%、43.6%](P<0.05),2组年龄、性别比例、肿块直径、肿块位置比较差异均无统计学意义(P>0.05)。造影组出血、总体并发症发生率(1.2%、4.8%)均低于非造影组(8.4%、13.2%)(χ^(2)=4.127,P=0.042;χ^(2)=4.431,P=0.035),少量气胸、进行性气胸、咳血、疼痛发生率(2.4%、0、1.2%、0)与非造影组(1.2%、0.4%、2.4%、0.8%)比较差异均无统计学意义(P>0.05)。结论与常规超声引导比较,超声造影引导下周围型肺肿块穿刺活检一次穿刺成功率较高、穿刺并发症少。

Objective To observe the success rate and complications of contrast-enhanced ultrasound(CEUS) versus conventional ultrasound guided percutaneous lung mass puncture biopsy in patients with peripheral lung masses(PLM), and to investigate the role of CEUS in the biopsy of PLM. Methods Totally 332 patients with PLM underwent ultrasound guided percutaneous lung mass puncture histopathological examination, among which, 82 patients underwent CEUS guided biopsy(contrast group), and 250 patients underwent conventional ultrasound guided biopsy(non-contrast group). The diameter of PLM, location and number of puncture, displaying rate of liquefied necrotic area in the mass, maximum diameter of necrotic area, displaying rate of larger blood vessels in the mass and path, success rate at the first attempt of puncture, malignant rate, and incidence of complications after puncture were compared between two groups. Results The displaying rate of liquefied necrotic area in PLM(61.4%), the maximum diameter of necrotic area [(33.2±13.8) mm], the displaying rate of larger blood vessels in the mass and path(65.1%), the success rate at the first attempt of puncture(94.0%), the malignant rate(66.3%) and the percentage of patients receiving twice puncture(59.0%) in contrast group were higher than those in non-contrast group [19.2%,(13.6±11.4) mm, 27.6%, 85.6%, 53.2%, 43.6%](P<0.05). There were no significant differences in the age, gender ratio, mass diameter, and mass location between two groups(P>0.05). The incidences of bleeding and overall complication were lower in contrast group(1.2%, 4.8%) than those in non-contrast group(8.4%, 13.2%)(χ^(2)=4.127, P=0.042;χ^(2)=4.431, P=0.035), and there were no significant differences in the incidences of complications such as a small amount of pneumothorax, progressive pneumothorax, hemoptysis, and pain between contrast group(2.4%, 0, 1.2%, 0) and non-contrast group(1.2%, 0.4%, 2.4%, 0.8%)(P>0.05). Conclusion Compared with conventional ultrasound guided puncture biopsy, CEUS guided puncture biopsy of PLM has higher success rate at the first attempt of puncture and less complications.