CT与超声引导下经皮肺或胸膜病变穿刺活检的有效性和安全性比较

Comparison of the efficacy and safety of percutaneous needle biopsy of pulmonary or pleural lesions guided by CT and ultrasound

目的比较CT与超声引导下经皮肺或胸膜病变穿刺活检的有效性和安全性。方法回顾性分析2017年2月至2020年10月在湖北医药学院附属十堰市人民医院接受CT或超声引导下经皮穿刺的病灶靠近胸膜的193例肺占位患者的临床资料。根据穿刺方式将患者分为CT引导组(n=115)和超声引导组(n=78)。比较两组患者的一般临床资料、病理检查结果及穿刺成功率、并发症发生率。采用logistic回归进行单因素、多因素分析。结果CT引导组恶性肿瘤检出率(60.00%,69/115)高于超声引导组(50.00%,39/78),但差异无统计学意义(χ^(2)=1.89,P=0.170)。CT引导组穿刺成功率(88.70%,102/115)略低于超声引导组(93.59%,73/78),差异无统计学意义(χ^(2)=1.32,P=0.251)。CT引导组术后并发症发生率(18.26%,21/115)高于超声引导组(6.41%,5/78),差异有统计学意义(χ^(2)=5.60,P=0.018);CT引导组气胸发生率(13.04%,15/115)高于超声引导组(3.85%3/78),差异有统计学意义(χ^(2)=4.65,P=0.031);CT引导组出血发生率(5.22%,6/115)高于超声引导组(2.56%,2/78),差异无统计学意义(χ^(2)=0.82,P=0.364)。CT引导组中有1例(0.87%)患者出现严重出血需要手术治疗,5例(4.35%)需要胸腔闭式引流进行治疗,超声引导组中未出现气胸或出血需要进行引流或手术治疗患者。单因素分析发现穿刺方法为影响病变-胸膜接触弧长(LPCAL)≥38mm的患者穿刺成功率的独立危险因素(OR=7.82,95%CI为1.57~35.50,P=0.039);多因素分析显示穿刺方法为影响LPCAL≥38mm患者穿刺成功率的独立危险因素(OR=7.75,95%CI为1.44~41.36,P=0.042)。LPCAL≥38mm患者中,CT和超声引导穿刺成功率分别为84.38%(54/64)、98.00%(49/50),CT引导穿刺成功率低于超声引导,差异具有统计学意义(χ^(2)=4.52,P=0.034);LPCAL<38mm患者中,CT和超声引导穿刺成功率分别为94.12%(48/51)、85.71%(24/28),CT引导的穿刺成功率高于超声引导,但差异无统计学意义(χ^(2)=0.71,P=0.399)。结论超声引导下经皮肺或胸膜病变穿刺活检具有诊断正确率高、并发症少等优点,其与CT引导下穿刺活检均为胸壁病变穿刺的可行方法。当LPCAL≥38mm时,超声引导下穿刺活检可能更具优势。

Objective To compare the efficacy and safety of CT and ultrasound-guided percutaneous biopsy of lung or pleural lesions.MethodsThe clinical data of 193 patients with lung space occupying lesions near the pleura who underwent CT or ultrasound-guided percutaneous puncture in Shiyan People's Hospital Affiliated to Hubei University of Medicine from February 2017 to October 2020 were analyzed retrospectively.According to the puncture mode,the patients were divided into CT-guided group(n=115)and ultrasoundguided group(n=78).The general clinical data,pathological examination results,puncture success rate and complication rate were compared between the two groups.Logistic regression was used for univariate and multivariate regression analysis.Results The detection rate of malignant tumors in the CT-guided group(60.00%,69/115)was higher than that in the ultrasound-guided group(50.00%,39/78),with no statistically significant difference(χ^(2)=1.89,P=0.170).The puncture success rate in the CT-guided group(88.70%,102/115)was slightly lower than that in the ultrasound-guided group(93.59%,73/78),with no statistically significant dfference(χ^(2)=1.32,P=0.251).The incidence of postoperative complications in the CT-guided group(18.26%,21/115)was higher than that in the ultrasound-guided group(6.41%,5/78),with a statistically significant difference(χ^(2)=5.60,P=0.018).The incidence of pneumothorax in the CT-guided group(13.04%,15/115)was higher than that in the ultrasound-guided group(3.85%,3/78),with a statistically significant difference(χ^(2)=4.65,P=0.031).The incidence rate of bleeding in the CT-guided group(5.22%,6/115)was higher than that in the ultrasound-guided group(2.56%,2/78),with no statistically significant difference(χ^(2)=0.82,P=0.364).In the CT-guided group,1 patient(0.87%)had severe bleeding requiring surgical treatment,5 patients(4.35%)required closed thoracic drainage for treatment.In the ultrasoundguided group,no patients had pneumothorax or bleeding requiring drainage or surgery.Univariate analysis showed that the puncture method was an independent risk factor for the puncture success rate in patients with lesion-pleura contact arc length(LPCAL)≥38 mm(OR=7.82,95%CI:1.57-35.50,P=0.039).Multivariate analysis showed that puncture method is an independent risk factor affecting the puncture success rate in patients with LPCAL≥38 mm(OR=7.75,95%CI:1.44-41.36,P=0.042).Among patients with LPCAL≥38 mm,the puncture success rates of CT-and ultrasound-guided puncture were 84.38%(54/64)and 98.00%(49/50),respectively,and the puncture success rate of CT-guided puncture was lower than that of ultrasoundguided puncture,with a statistically significant difference(χ^(2)=4.52,P=0.034).In LPCAL<38 mm patients,the puncture success rates of CT-and ultrasound-guided puncture were 94.12%(48/51)and 85.71%(24/28),respectively,and the CT-guided puncture success rate was higher than that of the ultrasound-guided puncture,with a statistically significant difference(χ^(2)=0.71,P=0.399).Conclusion Ultrasound-guided percutaneous puncture biopsy of lung or pleural lesions has the advantages of high diagnostic rate and few complications.Both ultrasound-guided and CT-guided puncture biopsy are feasible methods for puncture of chest wall lesions.When LPCAL≥38 mm,ultrasound-guided puncture biopsy may have more advantages.