超声引导下经皮穿刺活检肺周围型小结节的安全性和确诊率及其影响因素  

The diagnostic rate and adverse event rate of ultrasound-guided percutaneous core needle biopsy of small peripheral pulmonary nodules and their influence factors:a retrospective analysis

作　　者：蓝宁辉 黄伟俊[2] 叶洁仪 邱懿德[2] 彭巍炜 胡秋根 黄婷[2] LAN Ning-hui;HUANG Wei-jun;YE Jie-yi;QIU Yi-de;PENG Wei-wei;HU Qiu-gen;HUANG Ting(Department of Radiology,Shunde Hospital,Southern Medical University(The First People’s Hospital of Shunde),Foshan Guangdong 528308,China;Department of Medical Ultrasonic,the First People’s Hospital of Foshan,Foshan Guangdong 528000,China)

机构地区：[1]南方医科大学顺德医院(佛山市顺德区第一人民医院)放射科,广东佛山528308 [2]佛山市第一人民医院超声诊疗中心,广东佛山528000

出　　处：《中国临床医学影像杂志》2022年第12期854-858,共5页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨超声引导下经皮穿刺活检肺周围型小结节的确诊率和并发症发生率,以及影响确诊率和并发症的因素。方法:回顾性分析2014—2020年在我院行超声引导下经皮穿刺活检的肺周围型小结节的病例。排除信息不全的病例。同时收集纳入病人的临床特点,如病人年龄、性别、穿刺体位、病灶大小、位置、穿刺针型、穿刺次数等。最后,采用单因素分析和多因素Logistic回归分析评估穿刺确诊率和并发症发生率的影响因素。结果:最后纳入病人数为325例。其中男183例,女142例,年龄18~80岁,平均(57.2±13.0)岁。研究涉及325个病灶,直径平均(2.0±0.6)cm。最后确认穿刺确诊率为83.07%(270/325),并发症发生率为7.69%(25/325)。多因素Logistics回归分析显示,病灶大小(OR=1.056,95%CI=1.001~1.114,P=0.048)、穿刺针型(OR=3.910,95%CI=1.710~8.940,P=0.001)、穿刺2次(OR=2.532,95%CI=1.101~5.822,P=0.029)、穿刺3次(OR=3.180,95%CI=1.094~9.247,P=0.034)是确诊率的独立影响因素。病灶≤1 cm(OR=3.586,95%CI=1.047~12.285,P=0.042)是发生并发症的独立危险因素。结论:超声引导下经皮穿刺活检是诊断肺周围型小结节高效且安全的检查方法。病灶大小、针型、穿刺2次或3次是肺周围型小结节穿刺确诊率的影响因素。病灶≤1 cm是发生并发症的高危因素。Objective:To investigate the influence factors of true positive rate and safety of the ultrasound-guided core needle biopsy(CNB)in the diagnosis of peripheral pulmonary nodules≤3 cm.Methods:Cases of small peripheral pulmonary nodules≤3 cm with ultrasound-guided percutaneous CNB performed in our hospital from 2014 to 2020 were reviewed.We excluded the patients with incomplete information.Clinicopathological characteristics of the included patients,such as patient age,gender,puncture position,lesion size,location,puncture needle type,and the number of punctures,were collected.Finally,the factors influencing the true positive rate and adverse event rate of the CNB were assessed using multivariate logistic regression analysis.Results:A total of 325 patients(183 men,142 women;mean age(57.2±13.0)years)were included in the final analysis.The true diagnostic rate of CNB was 83.07%(270/325).The overall AE rate was 7.69%(25/325),including pneumothorax,hemoptysis,pleural effusion,and vasovagal reaction,which occurred in 2.15%(7/325),4.31%(14/325),0.92%(3/325),and 0.31%(1/325)of patients,respectively.Multivariate logistic regression analysis revealed lesion size(OR=1.056,P=0.048),needle size(OR=3.910,P=0.001),and the number of punctuations of two(OR=2.532,P=0.029)or three times(OR=3.180,P=0.034)were independent influence factors of diagnostic yield,while lesion size≤1 cm(OR=3.586,P=0.042)was an independent influence factor of post-procedural complications.Conclusions:Ultrasound-guided percutaneous CNB for peripheral pulmonary nodules≤3 cm is a feasible and safe technique.Lesion size,needle size,and needle pass of two or three times are independent influence factors of diagnostic yield.Lesion size≤1 cm is a risk factor for post-procedural complications.

关 键 词：多发性肺结节 活组织检查 针吸 超声检查 介入性 

分 类 号：R734.2[医药卫生—肿瘤] R445.1[医药卫生—临床医学]