C-arm cone-beam CT结合iGuide引导系统在经皮经胸肺肿物穿刺活检中的临床应用

发布时间：2018-03-18 17:32

本文选题：肺活检　切入点：CBCT　出处：《广州医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨C-arm cone-beam CT(CBCT)联合iGuide引导系统在经皮经胸肺肿物穿刺活检(percutaneous transthoracic needle biopsy PTNB)的诊断性能、并发症及其可能的影响因素。材料和方法回顾性分析30例(30个肺肿物)进行了PTNB手术的肺肿瘤患者(20例男性,10例女性;58.4岁±16.4[均数±标准差])。肿瘤平均直径为3.4厘米±1.9(直径范围0.8-8.2厘米)。使用CBCT采集三维类CT多层平面重组图像,通过iGuide导航系统仔细规划穿刺路径,利用18g同轴切割活检针进行活检穿刺。统计诊断性能、手术细节、并发症和患者射线暴露情况等指标,并比较分析各因素对诊断准确性、并发症可能存在的影响。结果在这30例患者中,病理结果显示,24例(80%)诊断为恶性,6例(20%)为良性病变。在PTNB中,28例结节诊断正确,2例失败(1例为取材不够,1例为假阴性结果)。诊断准确率、灵敏度、特异度、阳性预测值及阴性预测值分别为93%、96%、100%、100%及83%。对于诊断正确组及诊断错误组而言,实体瘤和磨玻璃样肿瘤之间的诊断准确率有差异性(p=0.023)。有6例(20%)患者术后发生气胸,3例(10%)患者发生咯血。统计结果表明,穿刺途径有无肺气肿或肺大疱(p=0.001)及穿刺次数的不同(p=0.003),气胸的发生率有显著差异。而对于咯血及非咯血组,其年纪(p=0.009)、穿刺深度(p=0.041)、病灶内部特点(p=0.009)及穿刺次数(p=0.022)的不同,其咯血的发生率也有显著差异。总的平均手术时间为13.0 min±3.6,平均有效辐射剂量为7.9 m Sv±4.6。结论应用CBCT联合iGuide引导系统在经皮经胸肺肿物穿刺活检中具有较高的诊断准确率和技术成功率以及合理的辐射暴露。
[Abstract]:Objective to investigate the diagnostic performance of C-arm cone-beam CTT combined with iGuide guidance system in percutaneous transthoracic needle biopsy PTNB (percutaneous transthoracic lung mass biopsy). Materials and methods A retrospective analysis of 30 patients (30 lung masses) with pulmonary tumors undergoing PTNB surgery was made in 20 patients with lung tumors, 10 males and 10 females, aged 58.4 years 卤16.4 [mean 卤standard deviation]. The mean diameter of the tumor was 3.4%. Meters 卤1.9 (diameter range: 0.8-8.2 cm). CBCT was used to collect three-dimensional CT multi-slice planar reconstruction images, The iGuide navigation system was used to carefully plan the puncture path and 18g coaxial cut biopsy needle was used to perform the biopsy puncture. The diagnostic performance, operation details, complications and patients' radiographic exposure were statistically analyzed, and the diagnostic accuracy of each factor was compared and analyzed. The possible impact of complications. Results in these 30 patients, The pathological results showed that 24 cases were diagnosed as malignant and 20%) as benign lesions. In PTNB, 28 cases of nodules were diagnosed correctly and 2 cases failed, 1 case was false negative results, the diagnostic accuracy, sensitivity, specificity, accuracy, sensitivity, specificity, and accuracy of diagnosis. The positive predictive value and the negative predictive value were 100% and 83%, respectively. There was a difference in the diagnostic accuracy between solid tumor and ground glass tumor. There were 6 cases with pneumothorax and 3 cases with hemoptysis after operation. The incidence of pneumothorax was significantly different in the patients with hemoptysis or non-hemoptysis, the age of the patients with hemoptysis or non-hemoptysis, the depth of puncture, the depth of puncture, the internal features of the lesion, and the times of puncture p0.022). There was also significant difference in the incidence of hemoptysis. The total average operative time was 13.0 min 卤3.6, and the average effective radiation dose was 7.9 mSv 卤4.6. Conclusion CBCT combined with iGuide guidance system has a higher diagnostic accuracy in percutaneous transthoracic lung mass biopsy. Accuracy and technical success rate and reasonable radiation exposure.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2;R730.44

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