二种方式的CT引导下经皮肺穿刺活检结果的比较

发布时间：2017-12-27 17:41

本文关键词：二种方式的CT引导下经皮肺穿刺活检结果的比较　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:比较增强CT和常规CT扫描引导下经皮肺穿刺肺活检术的取材的满意率、病理阳性率、恶性病灶的检出率、感染性疾病病原学的检出率以及并发症的发生率等结果。探讨增强CT引导下经皮肺穿刺活检术的临床应用价值,探讨增强CT引导下的单纯抽吸活检的临床应用价值。方法:采用回顾性研究的方法,回顾自2005年7月~2014年7月于天津市胸科医院符合纳入标准的423例接受CT引导下经皮肺穿刺活检患者的临床资料。比较常规CT组和增强CT组患者在标本获取的满意率、病理阳性率、肺恶性病灶的检出率、感染性疾病病原学的检出率、平均活检次数、更换穿刺点的患者比例和并发症的差异。对增强CT组中未进行弹簧针切割活检仅给予空针负压抽吸活检的少部分患者的结果进行统计分析。结果:1、共有423例患者纳入研究,男257例,女166例。年龄22~85岁,平均年龄61.71岁。其中常规CT组178例,增强CT组245例。423例中病灶位于胸膜下者259例,远离胸膜(病灶不贴近胸壁穿刺针必须穿过正常肺组织)者164例;小病灶(病灶最大直径2 cm)23例,合并慢性阻塞性肺疾病(COPD)85例,合并肺纤维化15例。两组在性别、年龄、小病灶比例,远离胸膜病灶的比例,合并肺气肿患者的比例以及合并肺纤维化患者的比例均无显著性差异(P0.05)。2增强CT组和常规CT组弹簧针取材满意率分别为90.13%和73.60%,差异有统计学意义(P0.01)3增强CT组和常规CT组病理的阳性率分别为76.62%和63.36%,差异有统计学意义(P0.01)4增强CT组和常规CT组肺恶性病灶检出率以及感染性疾病病原学检出率的差异有统计学意义(94.51%vs85.00%,56.14%vs34.69%,P0.05)。5增强CT组和常规CT组的平均活检次数及更换穿刺点患者比例的差异有统计学意义(3.08±1.05 vs3.75±1.34,8.52%vs 18.54%,均P0.01)。6增强CT组和常规CT组气胸和出血的发生率的差异有统计学意义(15.51%vs 27.53%,7.76%vs 14.04%,P0.05)。7在增强CT组中有22例患者单用针吸活检,其中13例阳性均为肺癌,阳性率59.09%。结论:增强CT引导下经皮穿刺肺活检取材满意率高,更容易获得病理阳性结果,疾病检出率高,有利于合理高效的选择检验方法,减少活检次数,并发症少,安全并且值得推广。在特殊情况下为了规避风险如果不宜行弹簧针切割活检而单用空针抽吸也能够获得阳性结果,有较高的应用价值。但该方法不适用于造影剂过敏、甲状腺功能亢进、肾功能不全以及因糖尿病近期口服二甲双胍的患者。
[Abstract]:Objective: To compare the satisfaction rate, the positive rate of Pathology, the detection rate of malignant lesions, the detectable rate of infectious diseases and the incidence of complications between enhanced CT and conventional CT guided percutaneous lung biopsy. To explore the clinical value of percutaneous lung biopsy under the guidance of enhanced CT and to explore the clinical value of simple aspiration biopsy under the guidance of enhanced CT. Methods: a retrospective study was conducted to review the clinical data of 423 patients who received CT guided percutaneous lung biopsy in Tianjin Thoracic Hospital from July July 2005 to July. The satisfaction rate, the positive rate of Pathology, the detection rate of lung malignancy, the detection rate of infectious diseases, the average number of biopsy times, the proportion of patients who changed the puncture point and the difference of complications between the routine CT group and the enhanced CT group were compared. The results of a few patients who were only given an empty needle negative pressure aspiration biopsy without a needle biopsy in the enhanced CT group were analyzed. Results: 1. A total of 423 patients were included in the study, 257 men and 166 women. Age 22~85 years, the average age of 61.71 years. Among them, there were 178 cases in the routine CT group and 245 in the enhanced CT group. 259 cases of pleural lesions located in 423 cases, away from the pleura (lesion is not close to the chest wall puncture needle must pass through the normal lung tissue) in 164 cases; small lesions (maximum lesion diameter of 2 cm) in 23 cases, complicated with chronic obstructive pulmonary disease (COPD) in 85 cases, 15 cases with pulmonary fibrosis. There was no significant difference between the two groups in sex, age, proportion of small lesions, far from the pleura lesions, the proportion of patients with emphysema and the proportion of patients with pulmonary fibrosis (P0.05). 2 enhanced CT group and conventional group CT spring needle materials satisfaction rate were 90.13% and 73.60%, the difference was statistically significant (P0.01 3) to enhance the positive rate of CT group and routine group CT pathology were 76.62% and 63.36%, the difference was statistically significant (P0.01) between the 4 enhanced malignant lesions in CT group and normal CT group lung detection the rate of infectious disease and pathogen detection rate was statistically significant (94.51%vs85.00%, 56.14%vs34.69%, P0.05). 5, the average number of biopsies in the CT group and the conventional CT group was significantly different from that in the conventional group vs3.75 (3.08 + 1.05 vs3.75 + 1.34,8.52%vs 18.54%, all P0.01). 6 there was significant difference in the incidence of pneumothorax and bleeding between the enhanced CT group and the routine CT group (15.51%vs 27.53%, 7.76%vs 14.04%, P0.05). 7 in the enhanced CT group, 22 patients had a single needle aspiration biopsy, and 13 of them were lung cancer with a positive rate of 59.09%. Conclusion: enhanced CT guided percutaneous lung biopsy has higher satisfaction rate, and is more likely to get pathological positive results. The disease detection rate is high, which is conducive to rational and efficient selection of test methods, fewer biopsy times, fewer complications, and is safe and worthy of promotion. In the special case, in order to avoid the risk, if the needle aspiration biopsy is not suitable for the needle, the positive results can be obtained by air needle aspiration alone. It is of high application value. However, this method does not apply to patients with contrast agent allergy, hyperthyroidism, renal insufficiency, and recent oral metformin for diabetes.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R816.4

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