目的：探讨在CT引导下经皮肺穿刺直径≤30 mm的肺内结节的准确率的影响因素及其安全性分析。方法：经伦理委员会批准，每例患者均经知情同意后，回顾性分析本院2013年1月—2014年3月期间行经皮穿刺肺活检的155例肺部直径≤30 mm结节患者的临床及病理资料，分析患者年龄、性别、吸烟史、结节是否与胸膜粘连、穿刺深度、结节大小、穿刺次数对穿刺准确率的影响及其相关主要并发症（出血、气胸）的发生率的影响。所有患者的影像学资料由两位资深的放射线科医生重新判断患者有无气胸、出血等并发症，若出现意见分歧，由第三名放射科医生做最终的诊断。结果：155例结节中，穿刺准确率为90.32%（140/155）。直径≤10 mm，穿刺准确率85.71%（6/7）、直径＞10～20 mm结节，穿刺准确率85.00%（68/80）直径＞20～30 mm结节，穿刺准确率97.06%（66/68），差异有统计学意义（χ2=6.293，P<0.05）。与胸膜粘连的结节穿刺准确率100%（31/31），与胸膜不粘连的结节穿刺准确率87.90%（109/124），差异有统计学意义（χ2=4.152，P<0.05）；穿刺次数4～6次的气胸及出血的发生率要远大于穿刺次数3次之内的发生率，且差异有统计学意义；直径越小、穿刺深度越大、穿刺次数越多越容易发生出血，且差异有统计学意义。年龄、性别、吸烟史、穿刺次数、穿刺深度对穿刺准确率无明显影响。其中肺腺癌114例，肺鳞癌10例，肺慢性炎症4例，肺转移癌4例，肺结核3例，肺泡细胞原位癌1例，肺球孢子菌病1例，肺腺鳞癌1例，肺小细胞肺癌1例，恶性间皮瘤1例，肺组织及坏死组织15例。结论：结节大小、结节是否与胸膜粘连对CT引导下肺内≤30 mm结节穿刺准确率具有较大的影响，而随着穿刺次数的增多，患者更容易出现主要并发症，而以上两点与结节大小、结节是否与胸膜粘连、年龄、性别、吸烟史、穿刺深度无明显相关性。CT引导下经皮肺穿刺活检术在直径≤30 mm孤立小结节诊断中具有准确率高、操作简单、安全实用，可作为临床诊断肺内≤30 mm孤立结节定性诊断的主要方法，掌握肺内小结节的穿刺技巧可以有效的提高穿刺准确率，并且值得临床广泛推广。
Abstract
Objective: To analyze the factors influencing the accuracy rate of CT-guided percutaneous biopsy and the security for lung nodules(≤30 mm): to facilitate the clinical application. Methods: The study has been allowed by the IRB in Shengjing hospital. Retrospectively analyze the clinical and pathological data of 155 patients who had undergone CT-guided percutaneous biopsy and with lung nodules(≤30 mm). The factors which influence the success rate such as gender, age, smoking history, whether the lesion and pleural adhesion, lesion size, puncture depth, times of percutaneous biopsy and the incidence of major complications such as hemorrhage, pneumothorax, will be analyzed. Two senior radiology physicians redetermine whether patients have pneumothorax, bleeding and other complications. If there is disagreement, a third radiologist will make a final diagnosis. Results: Among 155 cases, the accuracy rate of percutaneous biopsy was 90.32%(140/155). For the largest lesion diameter ≤10 mm, ＞10～20 mm and ＞20～30 mm, the accuracy rate was 85.71%(6/7）, 85.00%(68/80) and 97.06%(66/68), separately, differences reach statistic significance(χ2=6.293, P<0.05). The accuracy rate of lesions with or without lesion and pleural adhesion was 100%(31/31) and 87.90%(109/124), differences reach statistic significance(χ2=4.152, P<0.05). The incidence of pneumothorax and hemorrhage during 4～6 times puncture is much more than that during 3 times or even low, and the difference was statistically significant. The smaller the diameter, the greater the depth of the puncture, the more the times of puncture, the more prone to bleeding, and the difference was statistically significant. Age, gender, smoking history, times of percutaneous biopsy and puncture depth had no impact on the accuracy rate. One hundred and fourteen cases of pulmonary adenocarcinoma, 10 cases of squamous cell carcinoma, 4 cases of pulmonary chronic inflammation, 4 cases of metastatic lung cancer, 3 cases of pulmonary tuberculosis, 1 case of alveolar cell carcinoma insitu, 1 case of pulmonary coccidioidomycosis, 1 case of adenosquamous carcinoma of the lung, 1 case of small cell lung cancer, 1 case of malignant mesothelioma, 15 cases of lung tissue and necrotic tissue. Conclusion: The nodule size and whether with pleural adhesions have a greater impact on lung nodule(≤30 mm) accuracy of CT-guided puncture. With the increase in the times of puncture patients are more likely to have major complications, but all the above two points have no significant correlation between nodule size, nodules whether with pleural adhesions, age, gender, smoking history, depth of the puncture. CT guided percutaneous lung biopsy in diameter less than 30 mm nodules has high accuracy rate, simple operation, safe and practical advantages, which can be used as a major diagnosis method of less than 30 mm lung nodules. Mastering the puncture skills of pulmonary nodules can effectively improve the accuracy rate, and worth promoting in clinical application.
关键词
肺疾病 /
肺肿瘤 /
体层摄影术 /
螺旋计算机 /
活组织检查 /
针吸
Key words
Lung diseases /
Lung neoplasms /
Tomography /
spiral computed /
Biopsy /
fine-needle
中图分类号：
Ｒ563
Ｒ734.2
Ｒ814.42
Ｒ446.8
