螺旋CT引导下经皮肺穿刺活检对不同大小肺结节及良恶性诊断的效能分析

Diagnostic performance of spiral CT-guided percutaneous lung biopsy for benign and malignant pulmonary nodules in different sizes

目的探究螺旋CT引导下经皮肺穿刺活检对不同大小肺结节良恶性的诊断价值及效能。方法选取2018年1月至2020年12月本院收治的82例肺结节患者作为研究对象,所有患者均行螺旋CT引导下经皮肺穿刺活检,以病理检查结果为金标准,分析所有患者螺旋CT引导下经皮肺穿刺活检及病理检查结果。结果82例患者中,有79例为一次性穿刺成功。病理结果显示,结节直径>10~15 mm者22例,结节直径>15~20 mm共计21例,结节直径>20~25 mm者17例,>25~30 mm者22例;结节直径>10~15 mm者螺旋CT引导下经皮肺穿刺活检检查符合率为90.91%、结节直径>15~20 mm者穿刺符合率为85.71%、结节直径>20~25 mm者穿刺符合率为88.24%、>25~30 mm者穿刺符合率为95.45%。82例患者螺旋CT引导下经皮肺穿刺活检恶性结节总诊断精确率为82.61%,其中结节直径>10~15 mm者恶性结节诊断精确率显著低于结节直径>15~20 mm者、结节直径>20~25 mm者、>25~30 mm者,差异有统计学意义(P<0.05);结节直径>10~15 mm者气胸并发症发生率高于结节直径>15~20 mm者、结节直径>20~25 mm者、>25~30 mm者,但差异无统计学意义;结节直径>10~15 mm者出血并发症发生率高于结节直径>15~20 mm者、结节直径>20~25 mm者、>25~30 mm者,差异有统计学意义(P<0.05)。结论螺旋CT引导下经皮肺穿刺活检对不同直径肺结节良恶性均具有一定诊断效能,但结节大小会影响诊断精确度及并发症发生率,肺小结节患者的诊断精确率较低,且并发症发生率较高;螺旋CT引导手术视野较清晰,可降低并发症发生率,值得临床推广应用。

Objective To investigate the diagnostic value and efficacy of spiral CT-guided percutaneous lung biopsy on benign and malignant pulmonary nodules of different sizes.Methods A total of 82 patients with pulmonary nodules admitted to our hospital from January 2018 to December 2020 were enrolled as research subjects,and all patients underwent percutaneous lung biopsy guided by spiral CT,and the results of percutaneous lung biopsy and pathological examination under spiral CT guidance were statistically analyzed with the results of pathological examination as the gold standard.Results Among the 82 patients,79 had a successful one-time puncture.The pathological results showed that there were 22 cases with nodule diameter>10-15 mm,21 cases with nodule diameter>15-20 mm,17 cases with nodule diameter>20-25 mm,and 22 cases with nodule diameter>25-30 mm,the compliance rate of percutaneous lung biopsy under the guidance of spiral CT was 90.91%for those with nodule diameter>10-15 mm,85.71%for those with nodule diameter>15-20 mm,88.24%for those with nodule diameter>20-25 mm,and 95.45%for those with nodule diameter>25-30 mm.The total diagnostic accuracy of malignant nodules in percutaneous lung biopsy under spiral CT guidance was 82.61%,among which the diagnostic accuracy of malignant nodules with nodule diameter>10-15 mm was significantly lower than that of nodule diameter>15-20 mm,nodule diameter>20-25 mm,and>25-30 mm.The difference was statistically significant(P<0.05),and the complication rate of pneumothorax in nodule diameter was higher than that in nodule diameter>15-20 mm,nodule diameter>20-25 mm,and>25-30 mm,but the difference was not statistically significant.The incidence of bleeding complications in nodule diameter>10-15 mm was higher than that in nodule diameter>15-20 mm,nodule diameter>20-25 mm,and>25-30 mm,the difference was statistically significant(P<0.05).Conclusion Percutaneous lung biopsy guided by spiral CT has certain diagnostic efficacy for benign and malignant pulmonary nodules of different diameters,but nodule size will affect the diagnostic accuracy and complication rate,and the diagnostic accuracy of patients with small pulmonary nodules is low and the complication rate is high.Helical CT-guided surgery has a clear field of view,which can reduce the incidence of complications and is worthy of clinical promotion and application.