MR引导下经皮肺穿刺活检在肺部病变的诊断价值及并发症分析

发布时间：2018-10-12 18:36

【摘要】：前言:肺癌,是起源于支气管粘膜或者腺体的恶性肿瘤,是目前全球发病率及死亡率最高的恶性肿瘤之一。全球范围内每年平均新发肺癌约250万,约有150万的患者死亡。在我国,肺癌是最常见的恶性肿瘤之一,其发病率及死亡率呈逐年上升趋势。2008年卫生部有关癌症的统计数据中显示:因肺癌死亡的病例占恶性肿瘤死亡病例的22.7%,居恶性肿瘤死亡病例的首位。随着大气污染等环境因素日益加重,以及吸烟等个人非健康生活方式的影响,肺癌的发病率及死亡率可能会进一步上升,严重威胁人们的健康及生命。因而,肺癌的早期诊断及治疗越来越受到人们重视。随着医学影像技术的发展,特别是薄层胸部CT的广泛应用,越来越多的肺部小结节可被发现,因而肺部病变的早期明确诊断越来越受到重视。目前肺部病变组织的获得主要依靠纤维气管镜活检,透视、B超、CT及MR引导下经皮肺穿刺,超声内镜引导下经支气管针吸活检(EBUS)及经胸腔镜胸膜活检等方法。目前关于MR引导下经皮肺穿刺活检术的临床报道少见。现通过回顾性研究山东省立医院磁共振介入室行MR引导下经皮肺穿刺活检术的病例,分析MR引导下经皮肺穿刺活检术穿刺的成功率、并发症的发生率及引起并发症的相关危险因素,探究该技术对肺部病变的临床诊断价值。目的:分析MR引导下经皮肺穿刺活检术穿刺成功率、诊断的准确率、灵敏度、特异度、并发症的发生率及引起并发症的相关危险因素,探究该技术对肺部病变的临床诊断价值。方法:依据严格的纳入及排除标准,回顾性选取2015年9月-2016年3月在山东省立医院磁共振介入室行MR引导下经皮肺穿刺活检术病例221例。按照年龄、性别、病变大小、穿刺深度、病变性质、病变形态、是否紧贴胸膜及是否合并肺气肿等因素对患者进行分组,运用卡方检验等统计方法对各组进行比较分析,分析各种因素对该技术术后肺出血及气胸等并发症发生率的影响。结果:1、本研究中221例患者均一次穿刺取材成功,活检成功率为1000%。2、穿刺病理诊断为恶性肿瘤155例,良性病变65例,坏死组织1例。经胸外科手术后病理诊断、临床治疗效果或随访观察最终诊断为恶性肿瘤165例,良性病变56例。3、穿刺结果的准确率为94.6%,特异度为100%,灵敏度为93.9%,阴性预测值为89.6%,阳性预测值为100%。4、术后肺出血52例(23.5%),与术后肺出血发生的相关危险因素有:病变形态、病变大小、是否紧贴胸膜(p0.05);术后气胸22例(10%),与气胸发生的相关危险因素有:穿刺进针的深度以及术前是否合并肺气肿(p0.05)。结论:1、MR引导下经皮肺穿刺活检术是一种微创的、无放射性损伤的诊断手段,对肺部病变的诊断具有重要的临床价值。2、本研究中MR引导下经皮肺穿刺活检术穿刺成功率为100%,对肺部病变诊断的准确率为94.6%,对恶性肿瘤诊断的灵敏度及特异度分别为93.9%、100%。准确率、灵敏度、特异度均较高,阴性预测值、阳性预测值亦较高。3、MR引导下经皮肺穿刺活检术具有创伤小、安全性高、并发症少的优点。术后主要并发症为肺出血和气胸,其中与肺出血发生相关的危险因素包括病变形态、病变大小和是否紧贴胸膜;与气胸发生相关的危险因素包括穿刺进针的深度以及是否合并肺气肿。
[Abstract]:Lung cancer, a malignant tumor originating in the bronchial mucosa or gland, is one of the most common malignant tumors in the world. Globally, about 2.5 million new lung cancer is produced annually and about 1.5 million patients die. Lung cancer is one of the most common malignant tumors in China. The incidence and mortality of lung cancer are increasing year by year. In 2008, the Ministry of Health's statistics on cancer showed that the death of lung cancer accounted for 22. 7% of the death cases of malignant tumor. With the increasing of environmental factors such as air pollution and the influence of non-healthy lifestyle such as smoking, the incidence and death rate of lung cancer may rise further, threatening people's health and life seriously. As a result, early diagnosis and treatment of lung cancer are becoming more and more important. With the development of medical image technology, especially the wide application of thin-layer chest CT, more and more pulmonary nodules can be found. At present, the acquisition of lung lesions mainly relies on fiber bronchoscope biopsy, perspective, B-ultrasound, CT and MR guided percutaneous lung puncture, ultrasound endoscope guided percutaneous aspiration biopsy (EBUS) and thoracoscopic pleural biopsy. At present, clinical reports on percutaneous lung puncture biopsy under MR guidance are rare. The success rate, the incidence of complications and the related risk factors of complications were analyzed retrospectively by retrospective study of percutaneous lung puncture biopsy under MR-guided percutaneous lung biopsy in Shandong province. To explore the clinical diagnostic value of the technique on pulmonary lesions. Objective: To investigate the diagnostic accuracy, sensitivity, specificity, complication rate and risk factors of complications associated with percutaneous lung puncture biopsy under MR guidance. Methods: 221 cases were retrospectively selected from September 2015 to March 2016 under the guidance of MR-guided percutaneous lung biopsy in Shandong province. The patients were grouped according to age, sex, lesion size, puncture depth, pathological nature, lesion morphology, whether close to the pleura and whether or not emphysema were combined, and the groups were compared and analyzed by using statistical methods such as card square test and so on. The effects of various factors on the incidence of postoperative pulmonary hemorrhage and pneumothorax were analyzed. Results: 1. The success rate of biopsy was 1000% in 221 patients in this study. The pathological diagnosis of puncture was 155 cases of malignant tumor, 65 cases of benign lesion and 1 case of necrotic tissue. The accuracy rate of the puncture was 94.6%, the specificity was 100%, the sensitivity was 93.9%, the negative predictive value was 89.6%, and the positive predictive value was 100%. There were 52 cases (23. 5%) of postoperative pulmonary hemorrhage. The risk factors associated with postoperative pulmonary hemorrhage were: lesion morphology, size of lesion, whether it was close to pleura (P0.05), postoperative pneumothorax in 22 cases (10%), and related risk factors related to pneumothorax: The depth of the puncture needle and the presence of emphysema prior to operation (SPC.05). Conclusion: 1. Percutaneous lung puncture biopsy under MR guidance is a kind of minimally invasive and non-radioactive diagnostic method, which has important clinical value for the diagnosis of pulmonary disease. The accuracy of diagnosis of lung lesions was 94.6%, and the sensitivity and specificity of diagnosis of malignant tumors were 93. 9% and 100%, respectively. Accuracy, sensitivity, specificity were higher, negative predictive value and positive predictive value were higher. The major complications after operation were pulmonary hemorrhage and pneumothorax, in which the risk factors associated with the occurrence of pulmonary hemorrhage included lesion morphology, lesion size, and whether it was snug against the pleura; the risk factors associated with the occurrence of pneumothorax included the depth of the puncture needle and whether it was combined with emphysema.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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