超声内镜引导下肝活检术与经皮肝活检术不同活检针在肝占位病变中的应用对比研究

Comparison on the application of different biopsy needles of EUS-LB and PLB in space occupying lesions of liver

目的:对比研究超声内镜引导下肝活检术(EUS-LB)使用22G活检针与经皮肝活检术(PLB)使用18G活检针在肝占位病变中应用的安全性及准确性。方法:选取医院行EUS-LB和(或)PLB的47例患者,依据穿刺方法不同将其分为EUS-LB组(20例)和PLB组(27例)。EUS-LB组使用22G活检针,PLB组使用18G活检针,比较EUS-LB与PLB的诊断率、标本充足性和并发症发生率等。结果:两组技术穿刺获取病灶组织成功率均为100%;PLB技术100%获取充足标本,EUS-LB技术85%获取充足标本,差异有统计学意义(χ^(2)=4.33,P<0.05),PLB技术诊断准确率为96%,EUS-LB技术诊断准确率为80%。EUS-LB与PLB对恶性肝脏占位诊断的灵敏度分别为88%和100%,两种方法诊断的特异度、阳性预测值及阴性预测值均为100%。活检后24 h内PLB中度以上疼痛发生率为52%,EUS-LB中度以上疼痛发生率为10%,差异有统计学意义(χ^(2)=8.96,P<0.05);PLB与EUS-LB疼痛视觉模拟评分(VAS)分别为(4.8±2.4)分和(1.7±1.9)分,差异有统计学意义(t=-4.78,P<0.05)。结论:EUS-LB与PLB技术均安全可行,PLB的诊断准确率及标本充足性高,可能与使用粗针穿刺相关,EUS-LB或可通过使用粗针来提高诊断准确率及标本充足性。

Objective:To compare the safety and accuracy of endoscopic ultrasound-guided liver biopsy(EUS-LB) with 22G biopsy needle and percutaneous liver biopsy(PLB) with 18G biopsy needle in space occupying lesions of liver.Methods:74 patients who underwent EUS-LB and/or PLB were selected.And they were divided into EUS-LB group(20 cases) and PLB group(27 cases) according to different biopsy methods.EUS-LB used 22G biopsy needle,and PLB used 18G biopsy needle.The diagnostic rate,the adequacy of specimen and incidence of complications between EUS-LB group and PLB group were compared.Results:The success rates of two groups were 100% in obtaining lesion tissue by puncture.PLB technique could obtain adequate specimen in 100% ability,while EUS-LB could obtain them in 85% ability,and the difference of that between two methods was significant(χ^(2)=4.33,P<0.05).The diagnostic accuracies of EUS-LB and PLB were 80% and 96%,respectively.The sensitivities of EUS-LB and PLB were 88% and 100% for the diagnosis of malignant space occupying lesion of liver,respectively.The diagnostic specificity,positive predictive value and negative predictive value both two methods were 100%.The incidences of pain above moderate degree of PLB and EUS-LB within 24 h post biopsy were 52% and 10%,respectively,and the differences of them between two methods were significant(χ^(2)=8.96,P<0.05).The scores of Visual Analogue Score(VAS) of PLB and EUS-LB were(4.8±2.4) and(1.7±1.9),and the difference of that between two methods was significant(t=-4.78,P<0.05).Conclusion:Both EUS-LB and PLB are safety and feasibility.And the diagnostic accuracy rate and the adequacy of specimen of PLB are high,which can be correlation with the puncture of using bodkin.EUS-LB might increase diagnostic accuracy rate and the adequacy of specimen through using bodkin.