实时超声造影引导经皮肺穿刺活检的应用价值

发布时间：2018-06-15 18:10

本文选题：肺周围病变 + 超声造影　；参考：《南昌大学》2014年硕士论文

【摘要】：目的：本研究采用第二代超声造影剂SonoVue结合实时超声造影成像技术对近胸膜的肺周围性肿块进行研究，了解肺周围性肿块的增强特征，探讨实时超声造影引导经皮肺穿刺活检术对近胸膜的肺周围性肿块穿刺活检的应用价值。方法：将100例经CT检查确定存在邻近胸膜的肺周围性肿块患者随机分为两组，其中行超声造影同时穿刺活检者50例（实验组），常规超声引导穿刺者50例（对照组），所有病灶均进行二维超声及彩色多普勒超声检查，确定病灶的位置、形态、大小、回声、血流情况及与毗邻脏器之间的关系。实验组在二维超声明确病变位置后，行超声造影检查，造影剂为意大利Bracco公司生产的六氟化硫（商品名：SonoVue），在低机械指数的状态下实时监测病变内造影剂灌注及增强情况，同时对病灶增强区域行穿刺活检。对照组则在二维超声引导下行经皮肺穿刺活检术，尽量穿取病变彩色血流信号区或边缘实性区域。对比实验组与对照组的穿刺成功率、并发症发生率。结果： 1.实验组中恶性病变36例，其中腺癌16例，麟状细胞癌13例，转移性癌2例，小细胞性肺癌1例，B细胞淋巴瘤1例，非霍奇金淋巴瘤1例，支气管肺泡癌1例，肉瘤样癌1例。良性病变14例，肺结核7例，炎性包块4例,肺隐性球菌感染2例，肺脓肿1例。造影显示50.00%（25/50）病变存在不同程度的坏死，且病灶出现坏死的比例随着占位体积增大而增加，本研究中造影显示，5例病变最大径线3.5cm，占位未见明显坏死；28例病变最大径线3.5—5.5cm，占位中出现坏死者占42.86%（12/28)；17例病变最大径线5.5cm，占位中出现坏死者高达占76.47%（13/17)。 2.实验组中恶性病变36例，低回声23例，不均匀低回声13例，无回声0例；良性病变14例，低回声9例，不均匀低回声4例，无回声1例。对比良、恶性病变二维声像图改变，差异无明显统计学意义（P0.05）。 3.实验组中病灶内彩色血流分级，恶性病变36例，0级4例，I级11例，II级17例，III级4例；良性病变14例，0级5例，I级6例，II级2例，III级1例。对比良、恶性病变的彩色血流分布，差异具有统计学意义（P0.05）。 4.实验组中病灶的增强情况，恶性病变36例，，均匀增强17例，不均匀增强19例，无增强0例。良性病变14例，均匀增强10例，不均匀增强3例，无增强1例。对比良、恶性病变的增强情况，差异具有统计学意义(P0.05). 5.实验组穿刺平均针数（1.38±0.57），对照组穿刺平均针数（1.63±0.63），两组病灶的穿刺针数差异有统计学意义（t=-2.16,P=0.033，P0.05）。 6.实验组与对照组穿刺成功率对比，实时超声造影引导穿刺成功率明显高于二维超声（2=8.955,P=0.003）。两组穿刺并发症发生率对比，二者并发症发生率差异具有统计学意义（2=4.225,P=0.040）。结论：实时超声造影引导经皮肺穿刺能明显提高肺周围占位性病变的穿刺成功率，为临床疾病诊断提供了十分重要的价值。
[Abstract]:Objective: in this study, the second generation ultrasound contrast agent SonoVue combined with real-time contrast-enhanced imaging technique was used to study the peripheral pulmonary masses in the near pleura. To evaluate the value of percutaneous lung biopsy guided by real-time contrast-enhanced ultrasound in the biopsy of pulmonary masses near pleura. Methods: a total of 100 patients with peripheral pulmonary masses identified by CT scan were randomly divided into two groups. Among them, 50 cases (experimental group) and 50 cases (conventional ultrasound guided puncture group) were examined by ultrasound and color Doppler ultrasound to determine the location, shape, size and echo of the lesions. Blood flow and its relationship with adjacent organs. In the experimental group, after the location of the lesion was determined by two-dimensional ultrasound, contrast-enhanced ultrasound was performed. The contrast agent was sulfur hexafluoride (commercial name: Sono Vueo) produced by Braco Company of Italy. The perfusion and enhancement of contrast media in the lesions were monitored in real time under the condition of low mechanical index. At the same time, biopsy was performed on the enhancement area of the lesion. In the control group, percutaneous pulmonary biopsy was performed under the guidance of two dimensional ultrasound, and the lesion color flow signal area or marginal solid area was obtained as far as possible. The success rate of puncture and the incidence of complications were compared between the experimental group and the control group. Results: 1. There were 36 cases of malignant lesions, including 16 cases of adenocarcinoma, 13 cases of luteal cell carcinoma, 2 cases of metastatic carcinoma, 1 case of small cell lung cancer, 1 case of B cell lymphoma, 1 case of non-Hodgkin 's lymphoma, 1 case of bronchoalveolar carcinoma and 1 case of sarcomatoid carcinoma. There were 14 cases of benign lesions, 7 cases of pulmonary tuberculosis, 4 cases of inflammatory mass, 2 cases of recessive pneumococcal infection and 1 case of pulmonary abscess. Angiographic findings showed that there was necrosis in different degrees in 50.00and 25 / 50) lesions, and the proportion of necrosis increased with the increase of space occupying volume. In this study, the maximum diameter of 5 lesions was 3.5 cm, and no obvious necrosis was found in the lesions. In 28 cases, the maximum diameter line was 3.5-5.5 cm, and the necrotic area accounted for 42.86% of 12 / 28% and 17 cases of the largest diameter line 5.5 cm, and the percentage of necrosis in the occupying space was 76.477 / 13 / 17 / 2. In the experimental group, there were 36 cases of malignant lesions, 23 cases of hypoechoic lesions, 13 cases of heterogeneous hypoechoic lesions, 13 cases of non-echoic lesions, 14 cases of benign lesions, 9 cases of hypoechoic lesions, 4 cases of heterogeneous hypoechoic lesions and 1 case of anechoic lesions. There was no significant difference between benign and malignant lesions in two dimensional sonogram (P 0.05). In the experimental group, there were 36 cases of malignant lesions, 4 cases of grade I, 11 cases of grade I, 17 cases of grade III, 14 cases of benign lesions, 5 cases of grade I, 6 cases of grade I, 2 cases of grade III, and 1 case of grade III. Compared with the distribution of color blood flow in benign and malignant lesions, the difference was statistically significant (P 0.05). 4. In the experimental group, there were 36 cases of malignant lesions, 17 cases of homogeneous enhancement, 19 cases of uneven enhancement, and 0 cases of no enhancement. Benign lesions in 14 cases, homogeneous enhancement in 10 cases, uneven enhancement in 3 cases, and no enhancement in 1 case. Compared with benign and malignant lesions, the difference was statistically significant (P 0.05). The average number of puncture needles was 1.38 卤0.57 in the experimental group and 1.63 卤0.63 in the control group. There was significant difference in the number of puncture needles between the two groups. Compared with the control group, the successful rate of puncture guided by real time contrast-enhanced ultrasound was significantly higher than that of two dimensional ultrasound with 8.955 and 0.003. The incidence of puncture complications in the two groups was significantly higher than that in the control group (P < 0. 040). Conclusion: the percutaneous lung puncture guided by real-time contrast-enhanced ultrasound can significantly improve the puncture success rate of peripulmonary space occupying lesions and provide a very important value for the diagnosis of clinical diseases.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1

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