CT引导下经皮肺穿刺活检在老年孤立性肺结节中的应用  

CT-guided percutaneous lung biopsy for the elderly solitary pulmonary nodules

作　　者：杨雯[1,2] 李倩[1,2] 孙文逵[1,2] 曾俊莉[1,2] 梁文君[1,2] 宋勇[1,2] 

机构地区：[1]南京大学医学院临床学院 [2]南京军区南京总医院呼吸内科,南京210002

出　　处：《临床肿瘤学杂志》2014年第11期1015-1018,共4页Chinese Clinical Oncology

基　　金：江苏省自然科学基金资助项目(BK2011658)

摘　　要：目的探讨CT引导下经皮肺穿刺活检对老年孤立性肺结节的诊断价值及并发症。方法回顾性分析2008年1月至2014年1月行CT引导下经皮肺穿刺活检并经手术病理、临床治疗或随访观察证实的113例老年孤立性肺结节病例。根据CT扫描图像选择最佳穿刺层面及穿刺点获取标本。结果 113例孤立性肺结节全部取材成功,穿刺病理提示恶性肿瘤94例,良性病变19例。经手术病理、临床治疗或随访观察证实为恶性肿瘤96例(85.0%),良性病变17例(15.0%),诊断准确率为96.5%,灵敏度为97.1%,特异度为90.0%。大结节组(>15mm且≤30mm,n=98)的诊断准确率为98.9%,显著高于小结节组(≤15mm,n=15)的80.0%(P=0.007)。全组并发症为气胸(n=22)和肺内自限性出血(n=15),症状均较轻;无致死性不良反应发生。气胸发生与穿刺次数(P=0.002)及肺内针道距离(P=0.06)有关。结论 CT引导下经皮肺穿刺活检是一种创伤小且实用的定性诊断方法,对老年孤立性肺结节具有较高的临床应用价值。Objective To evaluate the diagnostic value and complications of CT-guided percutaneous lung biopsy for the eld- erly solitary pulmonary nodules. Methods A total of 113 patients from January 2008 to January 2014 with solitary pulmonary nodules who were performed by percutaneous transthoracic needle biopsy by CT-guided were reviewed. All of the patients were confirmed by pa- thology or clinical course. The CT scan was used to choose the best targeted level and the puncture point. Results Specimens of 113 patients were obtained successfully. Ninety-four cases were proved to be malignancies and 19 cases of benign lesions by biopsy. Ninety- six cases （85.0%） of malignancies and 17 cases （15.0%） of benign lesions were proved by pathology and clinical course. The diag- nostic accuracy, sensitivity and specificity were 96. 5%, 97. 1% and 90. 0%, respectively. The diagnostic accuracy of large nodules group （ 〉15mm and ≤30mm,n=98） was 98.9%, higher than 80.0% of small nodules group （ ≤15mm, n= 15） with statistical sig- nificance （P=0. 007）. The main complications were phenmothorax （ 19. 5%） and self-limiting bleeding （13.3%） and both of them were mild. No death-related complications happened. The incidence of phenmothorax was related to puncture times （P= 0. 002） and the length of puncture needle in lung tissues （P=O. 06）. Conclusion CT-guided percutaneous lung biopsy for the elderly solitary pulmo- nary nodules is an efficient and safe diagnostic method with few complications.

关 键 词：肺穿刺活检 孤立性肺结节 老年 诊断 

分 类 号：R730.4[医药卫生—肿瘤]