CT引导下肺穿刺活检诊断肺部局灶性磨玻璃密度结节失败因素分析  

Failure factor analysis of CT guided PTNB for f GGN in diagnosis

作　　者：严高武 杨国庆[1] 付泉水 陈洪[1] 曾浩[1] 范晓萍 胡纳[1] 沈小程 徐晓雪[2] 杨汉丰[2] 杜勇[2] 

机构地区：[1]遂宁市中心医院放射科,四川遂宁629000 [2]川北医学院附属医院放射科,四川南充637000

出　　处：《川北医学院学报》2017年第5期684-687,共4页Journal of North Sichuan Medical College

基　　金：国家自然科学基金(81141067);遂宁市中心医院科研项目(2016S05)

摘　　要：目的:分析CT引导下肺穿刺活检(percutaneous transthoracic needle biopsy,PTNB)诊断肺部局灶性磨玻璃密度结节(focal ground-glass nodule,fGGN)失败及引起并发症的影响因素。方法:回顾性分析80例CT引导下PTNB诊断fGGN的相关资料,记录其诊断失败(取材不成功、假阳性及假阴性)的病例、并发症发生情况并分析其影响因素。结果:诊断失败病例均为假阴性(n=9),12例发生气胸,16例发生少量出血。多因素Logistic回归分析显示:病变大小≤10 mm、GGO百分比>90%、针道距离>9 cm为诊断失败的独立危险因素;病变大小≤10 mm、病变位于下叶、GGO百分比>90%、针道距离>9cm、穿过胸膜的次数>2次、沿针道存在肺气肿为气胸发生的独立危险因素;病变大小≤10 mm、病变位于下叶、GGO百分比>90%、针道距离>9 cm为出血发生的独立危险因素。结论:CT引导下PTNB可作为fGGN重要的临床诊断方法之一,但需警惕诊断失败、并发症及其影响因素。Objective：To evaluate the diagnosis failure,complications and influencing factors of CT-guided percutaneous lung biopsy （PTNB） for focal ground-glass nodule （fGGN） in the lung.Methods：80 subjects with fGGN were retrospectively investigated for diagnosis failure cases （defined as nondiagnostic,false positive,and false negative results）,complications and influencing factors.Results：There were 9 false negative results identified as diagnostic failure cases,with 12 subjects each had a pneumothorax,and mild bleeding occurred in 16 subjects.Multivariate logistic regression analysis revealed that lesion size ≤10 mm,GGO percentage 90%and needle distance〉 9 cm were significant independent risk factors for failure diagnosis.Lesion size ≤10 mm,lesions in the lower lobe,GGO percentage〉 90%,needle distance〉 9 cm,pleural passages 〉2 times and emphysema along the needle pathway were significant independent risk factors for emphysema pneumothorax.Lesion size ≤10 mm,lesions in the lower lobe,GGO percentage 90%,and needle distance 〉9 cm were significant independent risk factors for hemorrhage.Conclusion：CT-guided PTNB can be used as an important clinical diagnostic method for fGGN,but it should be alert to diagnosis failure,complications and its influencing factors.

关 键 词：肺 活组织检查 局灶性磨玻璃密度结节 体层摄影术 X线计算机 

分 类 号：R657.4[医药卫生—外科学]