CT联合电子水平仪技术在穿刺活检诊断肺微小结节的应用价值  

The value of CT combined electronic level guided percutaneous transthoracic needle biopsy in diagnosis of small pulmonary nodules

作　　者：王国栋[1] 邓燕云[1] 黄东宁[1] 彭勇[2] 

机构地区：[1]柳州市工人医院肿瘤科,广西柳州545005 [2]第四军医大学西京医院放射科,陕西西安710032

出　　处：《实用放射学杂志》2017年第6期614-616,620,共4页Journal of Practical Radiology

摘　　要：目的 探讨CT联合电子水平仪引导经皮肺穿刺活检，对诊断肺部微小结节的临床价值。 方法 对44例肺微小结节行CT联合电子水平仪引导下穿刺活检，术后组织送病理学检查。结节根据直径大小不同分为2组，直径为0.5-1.0 cm为A组（10例），直径为1.1-2.0 cm为B组（34例），以切除术后病理及临床诊疗后随访12月以上的诊断结果为最终结果。对比分析其敏感度、特异性、准确性及并发症，并将2组结节的诊断准确性、敏感性、特异度应用配对χ2检验进行比较,P〈0.05有显著性差异。 结果 （1）44例病灶中，穿刺靶点到位率100%；总穿刺敏感度为90.9%，特异性为100%，准确性为88.6%，阳性预测值为97.5%，阴性预测值为100%。其中A组的敏感度为77.8%，特异性为100%，准确性为70.0%；B组的敏感度为94.1%，特异性为100%，准确性为94.1%；A组的敏感度、准确性均高于B组（P＜0.05）,特异性无差异。（2）并发症：气胸发生率为9.1%，肺内出血发生率为11.4%，血胸发生率为2.3%，总并发症发生率为22.7%，经处理后均治愈。病灶周围有肺气肿是气胸及肺内出血的危险因素（χ^2=11.2、10.2,P＜0.05）,而病灶部位、大小及深度均与上述并发症无关（P＞0.05）。 结论 对肺部微小结节病变，CT联合电子水平仪引导下经皮经肺穿刺活检是一种安全、有效、准确性高的诊断方法。Objective To discuss the clinical value of （3T combined electronic level guided percutaneous transthoracic needle biopsy in diagnosis of small pulmonary nodules.Methods 44 cases of lung mini-nodule underwent CT combined electronic level guided percutaneous transthoracic needle biopsy. After operation the tissue was sent for pathologic examination. The nodules were divided into two groups, including Group A （diameter 0.5-1.0 cm, N 10） and Group B （diameter 1.1-2.0 cm, N= 34） , according to the different sizes of diameter. The excision of postoperative pathological and diagnosis result of clinical diagnosis and treatment of more than 12 months follow up were taken as the final result. The sensitivity, specificity, veracity and complications were compared and analyzed using paired χ^2-test, taking P〈 0.05 as significant difference.Results （1）The arrival rate of target puncture were 100% in 44 cases, with the sensitivity rate of 90.9%, specificity rate of 100%, veracity rate of 88.6%, positive predictive value of 97.5%, and negative predictive value of 100%. The sensitivity, specificity and veracity of Group A were 77.8%, 100% and 70.0% respectively. And the sensitivity, specificity and veracity of Group B were 94.1%, 100% and 94.1% respectively. The sensitivity, veracity of Group A was higher than Group B （P〈0.05）, while there was no difference in specificity. （2 }Complication： the incidence rate of pneumothorax, pulmonary bleeding symptoms and hemothorax were 9.1%, 11.4%, 2.3%, respectively. The incidence rate of total complication was 22.7%, and all be cured after the treatment. The lesions with emphysema around is a risk factor for pneumothorax and pulmonary bleeding symptoms （χ^2=11.2, 10.2, P〈0.05）. However, the position, size and deepness was not correlated with the complications mentioned above （P〉0.05）. Conclusion CT combined electronic level guided percutaneous transthoracic needle biopsy is a safe, effective and accurate diagnostic method for lung mini-nodule lesion.

关 键 词：肺微小结节 活检 电子水平仪 计算机体层成像 

分 类 号：R563[医药卫生—呼吸系统] R446.8[医药卫生—内科学]