CT引导下经胸肺活检术的临床应用  

Clinical application of computed tomography-guided transthoracic lung biopsy

作　　者：Nakib UL Alam 许芸 李春海[1] 贾海鹏[1] 刘波 孟红[1] 薛玉文[1] XU Yun;LI Chunhai;JIA Haipeng;LIU Bo;MENG Hong;XUE Yuwen(Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院,济南250012

出　　处：《山东医药》2019年第6期17-20,共4页Shandong Medical Journal

基　　金：山东省科技厅重点研发计划项目(2015GGH318021)

摘　　要：目的观察CT引导下经胸肺活检(TNB)术的有效性及安全性,探讨提高CT引导下经胸肺活检成功率及减少并发症的策略。方法接受CT引导下TNB的患者共120例。TNB前认真分析受检患者的胸部CT影像,选择最佳穿刺点及穿刺路径,采用同轴套管针加活检针穿刺,必要时借助人工气胸及联合PET-CT引导定位,分析穿刺成功率、诊断率及并发症,总结CT引导下经胸肺活检技术的操作要点。结果 120例受检患者共接受穿刺130次,接受1次穿刺者111例、2次穿刺者8例、3次穿刺者1例;穿刺成功127次,穿刺取材成功率97. 69%(127/130);穿刺后明确诊断119例,其中肺癌82例、结核9例、非特异性炎症9例、机化性肺炎6例、真菌性肺炎4例、血管炎4例、结节病2例、淋巴瘤2例、嗜酸粒细胞性肺炎1例,诊断率99. 17%(119/120);取材成功直径<1 cm的微结节12例,最小直径0. 7 cm; 1例肺部病变分散,通过人工气胸使病变集中,然后行CT引导下TNB,取材成功; 2例肺部病变毗邻心脏大血管,通过人工气胸使病变与心脏大血管分离,然后行CT引导下TNB,取材成功,避免了伤及心脏及大血管的风险。7例初始CT引导下TNB病理报告为炎症但抗炎治疗效果不佳,后经PET-CT引导定位再次经胸肺活检,均确诊为肺癌; 120例受检患者中,发生并发症24例(20. 00%),其中气胸11例、咯血8例、胸膜腔感染2例、胸膜腔出血2例,无致命性并发症发生。结论 CT引导下TNB诊断的准确性及安全性均高。其技术要点包括活检前根据受检患者的胸部CT影像选择最佳穿刺点及穿刺路径,尽量避开血管、肺大疱;采用同轴套管针加活检针穿刺;对于较分散或临近心脏大血管病变,可借助人工气胸使病变易于穿刺;对合并炎症的肿瘤性病变可联合PET-CT引导定位。ObjectiveTo investigate the efficacy and safety of computed tomography-guided transthoracic needle biopsy(CT-guided TNB),and to explore the strategies for more diagnostic yield and lower complications.MethodsTotally 120 cases who underwent CT-guided TNB were enrolled.The CT images were analyzed carefully and the optimal approach was selected.The lung biopsy was performed with Argon coaxial trocar and biospsy needle.Artificial pneumothorax was established if necessary.In some cases,the combination of the CT and PET/CT-guided TNB was applied.The puncture success rate,diagnostic yield and the complications were assessed.The key points of procedure were studied.ResultsIn 120 patients,130 times of procedure were performed.1,2 and 3 times of procedure were performed respectively on 111,8,and 1 patients.Totally 127 times of procedure were successful.The procedure success rate was 97.69%(127/130).In 120 patients,119 patients achieved accurate diagnosis,which included 82 cases of lung cancer,9 cases of tuberculosis,9 cases of non-specific pneumonia,6 cases of organizing pneumonia,4 cases of fungal pneumonia,4 cases of vasculitis,2 cases of sarcoidosis,2 cases of lymphoma and 1 case of eosinophilic pneumonia,with the diagnostic rate of 99.17%(119/120).Twelve nodes with diameters<1 cm were punctured successfully,with the minimum diameter of 0.7cm.One case with discreted lesion was punctured successfully with artificial pneumothorax which concentrated the lesion;2 cases of lesions adjacent to heart and large vessel were punctured successfully with artificial pneumothorax which separated the lesions from heart or large vessel;7 cases with initial pathologic finding of inflammation by CT-guided TNB and poor anti-inflammation were proved finally to be lung cancer by combining with PET-CT guided pre-procedure.Twenty-four of 120 cases had complications.The incidence of complication was 20%,which included 11 cases of pneumothorax,8 cases of hemoptysis,2 cases of pleural infection,and 2 cases of hemothorax.No fatal complications oc

关 键 词：肺活检术 经胸肺活检术 CT引导下经胸肺活检术 人工气胸 正电子发射计算机断层显像技术 

分 类 号：R814.42[医药卫生—影像医学与核医学]