超声引导下经皮肺穿刺组织学活检对周围型肺病变的诊断价值  

Diagnostic value of ultrasound-guided percutaneous lung biopsy in peripheral lung lesions

作　　者：刘士源 林浩 李谦[3] 乔哲[1] 李少民[1] Liu Shiyuan;Lin Hao;Li Qian;Qiao Zhe;Li Shaomi(Department of Thoracic Surgery,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China;Department of Thoracic Surgery,Xi'an Central Hospital,Xi'an 710003,China;Department of Medical Ultrasound,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院胸外科,710004 [2]西安市中心医院胸外科,710003 [3]西安交通大学第二附属医院医用超声研究室,710004

出　　处：《中华医学超声杂志（电子版）》2022年第6期573-577,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金项目(81602023);中央高校基本科研业务费项目(xjj2018143);西安交通大学第二附属医院科研基金项目[YJ(QN)201611]。

摘　　要：目的探讨超声引导下经皮肺穿刺组织学活检在周围型肺病变(PPL)中的应用价值。方法回顾性选取2015年1月至2019年12月就诊于西安交通大学第二附属医院,具有完整病例资料的PPL患者176例。所有患者均经胸部CT等影像学检查明确诊断为PPL,均进行超声引导下经皮肺穿刺活检术,并均行手术治疗取得最终病理学诊断结果。分析超声引导下穿刺取材成功率,以手术后病理结果为金标准,计算超声引导下经皮肺穿刺活检诊断PPL的效能,并观察穿刺术后并发症发生率。结果176例患者中,172例取材成功,取材成功率为97.72%(172/176)。与术后病理结果比较,超声引导下穿刺活检诊断正确168例,诊断准确性为97.67%(168/172),余4例肺腺癌伴坏死感染穿刺活检诊断为炎性坏死组织。以外科手术后病理结果为金标准,超声引导经皮肺穿刺诊断肺周围型恶性肿瘤的敏感度为96.77%(120/124),特异度100%(48/48),阴性预测值为92.31%(48/52),阳性预测值为100%(120/120)。超声引导经皮肺穿刺活检术后出现少量气胸9例,少量胸腔积液8例,痰中带血丝6例,并发症发生率为13.07%(23/176)。结论超声引导下经皮肺穿刺活检是一种微创、便捷、安全的检查技术,对PPL具有较高的诊断价值,值得临床推广应用。Objective To assess the value of ultrasound-guided percutaneous lung biopsy in the diagnosis of peripheral lung lesions(PPL).Methods A total of 176 PPL patients with complete clinical data were selected at the Second Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2019.All patients were clearly diagnosed as having PPL by chest CT and other imaging examinations,and underwent ultrasound-guided percutaneous lung biopsy and surgical treatment to obtain final pathological results.The success rate of ultrasound-guided puncture was calculated.Using the final postoperative pathological results as the gold standard,the performance of ultrasound-guided percutaneous lung biopsy in the diagnosis of PPL was assessed.The incidence of complications after puncture was also recorded.Results Of the 176 patients included,biopsies were successfully in obtained in 172 cases,with a success rate of 97.72%(172/176).Compared with the final postoperative pathological results,168 cases were diagnosed correctly by ultrasound-guided needle biopsy,with a diagnostic accuracy rate of 97.67%(168/172).The remaining four cases of lung adenocarcinoma with necrotic infection were diagnosed as inflammatory necrotic tissue by needle biopsy.Taking the postoperative pathological results as the gold standard,the sensitivity,specificity,negative predictive value,and positive predictive value of ultrasound-guided percutaneous lung puncture in diagnosing peripheral lung malignant tumors were 96.77%(120/124),100%(48/48),92.31%(48/52),and 100%(120/120),respectively.After ultrasound-guided percutaneous lung biopsy,9 cases developed a small amount of pneumothorax,8 developed a small amount of pleural effusion,and 6 had blood shot sputum.The complication rate was 13.07%(23/176).Conclusion Ultrasound-guided percutaneous lung biopsy is a minimally invasive,convenient,and safe examination technique.It has high diagnostic efficiency for PPL and has important clinical application value in the pathological diagnosis and treatment of PPL.

关 键 词：超声检查 介入性 活组织检查 针吸 周围型肺病变 

分 类 号：R445.1[医药卫生—影像医学与核医学] R563[医药卫生—诊断学]