CT引导下切割针经皮肺活检在肺部片状、实变病变的诊断价值及安全性评价  

Clinical value and safety of CT-guided transthoracic cutting needle lung biopsy in the diagnosis of pulmonary flake or consolidation lesions

作　　者：李建东 郝淑玲 王斐 

机构地区：[1]陆军总医院呼吸科,北京100700

出　　处：《山西医科大学学报》2017年第10期1034-1038,共5页Journal of Shanxi Medical University

摘　　要：目的评价CT引导下切割针经皮活检对肺部片状、实变病灶的诊断价值及安全性。方法回顾性分析我院2013-01~2016-12 CT引导下切割针经皮肺活检肺部单发或多发性片状、实变病灶患者100例的102例次活检的临床、影像及病理资料。结果 100例患者,男64例,女36例,年龄在15-85岁,平均(56.3±12.1)岁。患者肺部单发片状、实变病灶均≥2.5 cm×2.5 cm,多发性片状病灶具有≥2.5 cm×2.5 cm的可穿刺病灶。96例穿刺成功,肺活检穿刺成功率94.1%(96/102)。获得病理诊断83例,82例明确诊断,诊断的准确率86.5%(83/96),正确诊断率82.0%(82/100)。肺活检气胸发生率4.9%(5/102),咯血11.8%(12/102),胸痛4.9%(5/102)。82例确诊患者中,肿瘤28例(34.1%),其中肺腺癌22例(78.6%),肺鳞癌4例(14.3%),小细胞肺癌及胸膜间皮瘤各1例(3.5%);非肿瘤病变54例(65.9%),其中机化性肺炎23例(42.6%),非特性炎症13例(24.1%),肺结核病9例(16.7%),化脓性肺炎4例(7.4%),隐球菌肺炎2例(3.7%),过敏性肺炎、非特异性间质性肺炎、脱屑性间质性肺炎各1例(1.9%)。结论 CT引导下切割针经皮肺活检对肺部单发或多发性片状、实变病灶具有较高的诊断价值,不良反应少,是安全的方法。对性质不明确的肺部片状、实变病灶,积极行经皮肺活检明确诊断。Objective To evaluate the value and safety of CT-guided transthoracic cutting needle lung biopsy in the diagnosis of pulmonary flake or consolidation lesions. Methods A total of 100 patients admitted in the department of respiration,PLA Army General Hospital from January 2013 to December 2016 underwent CT-guided transthoracic cutting needle lung biopsy. Clinical data,chest CT images,pathological results and complication of the patients were retrospectively analyzed. Results One hundred patients（64 males and 36 females,aged 15-85 years; mean 56. 3 ± 12. 1 years old） showed single（ ≥2. 5 cm × 2. 5 cm in vertical diameter） or multiple（at least one lesion≥2. 5 cm × 2. 5 cm in vertical diameter） flake or consolidation lesions in chest CT scan. Lung biopsy was successful in 96 of 102 cases（94. 1%）. Among 83 patients pathologically diagnosed by lung biopsy,82 patients were finally confirmed the diagnosis. The diagnostic accuracy was 86. 5%（83/96） and the correct diagnosis rate was 82. 0%（82/100）. Complication of transthoracic lung biopsy had pneumothorax（4. 9%,5/102）,hemoptysis（11. 8%,12/102） and chest pain（4. 9%,5/102）. In 82 patients confirmed diagnosis,tumor accounted for 34. 1%（28 patients）,including lung adenocarcinoma（78. 4%,22/28）,squamous cell carcinoma（14. 3%,4/28）,small cell lung carcinoma（3. 5%,1/28） and pleural mesothelioma（3. 5%,1/28）,while non-neoplastic lesions accounted for 65. 9%（ 54 patients）,including organizing pneumonia（ 42. 6%,23/54）,nonspecific inflammation（ 24. 1%,13/54）,pulmonary tuberculosis（16. 7%,9/54）,purulent pneumonia（7. 4%,4/54）,cryptococcal pneumonia（3. 7%,2/54） and allergic pneumonial,nonspecific interstitial pneumonia and desquamative interstitial pneumonia（ 1 case respectively,1. 9%）. Conclusion The CT-guided transthoracic cutting needle lung biopsy is a safe technique with a high diagnostic value and low complication for single or multiple flake or/and consolidation lesions. Transthoracic lung

关 键 词：经皮肺活检 CT引导 病理 

分 类 号：R445[医药卫生—影像医学与核医学]