超声造影引导肝穿刺活检的临床应用价值

发布时间：2018-12-10 22:16

【摘要】：目的:比较常规超声及超声造影对肝实性占位病变的诊断价值,并探讨二者引导经皮肝脏穿刺活检的准确率及其影响因素。方法:本研究选取2012年6月-2016年6月就诊于我院的肝实性占位病变患者,共89例,95个病灶,将其随机分为常规组及造影组,其中常规组53个病灶,造影组42个病灶,将常规组及造影组诊断结果与病理结果、穿刺结果与病理结果分别进行比较,并分析病灶基本情况对穿刺结果的影响。结果:常规组诊断准确率为71.6%,造影组诊断准确率为90.5%,两组准确率比较,(?)~2=5.164,P0.05,差异具有统计学意义;常规组诊断敏感性为75.6%,造影组诊断敏感性为91.2%,两组数据敏感性比较,(?)~2=3.143,P(29)0.05,差异不具有统计学意义;常规组诊断特异性为58.3%,造影组诊断特异性为87.5%,两组数据特异性比较,(?)~2=5.787,P0.05,差异具有统计学意义。常规组穿刺准确率为77.4%,造影组穿刺准确率为95.2%,两组数据准确率比较,(?)~2=5.691,P0.05,差异具有统计学意义;常规组穿刺敏感性为80.5%,造影组穿刺敏感性为97.1%,两组数据敏感性比较,(?)~2=4.833,P0.05,差异具有统计学意义;常规组穿刺特异性为66.7%,造影组穿刺特异性为87.5%,两组数据特异性比较,(?)~2=1.111,P(29)0.05,差异不具有统计学意义。常规组病灶直径2cm者与直径≥2cm者穿刺准确率分别为31.25%,97.2%,比较两组穿刺准确率,(?)~2=27.819,P0.05,差异具有统计学意义;当病灶直径2cm时,造影组穿刺准确率为90.9%,常规组穿刺准确率为31.25%,比较两组穿刺准确率,(?)~2=9.396,P0.05,差异具有统计学意义。常规组病灶边界清晰者与边界不清晰者穿刺准确率分别为93.1%、58.3%,比较两组穿刺准确率,(?)~2=9.064,P0.05,差异具有统计学意义;当病灶边界不清晰时,造影组穿刺准确率为94.7%,常规组穿刺准确率为58.3%,比较两组穿刺准确率,(?)~2=7.382,P0.05,差异具有统计学意义。常规组病灶内部回声均匀者与内部回声不均匀者穿刺准确率分别为95.2%、65.6%,比较两组穿刺准确率,(?)~2=6.348,P0.05,差异具有统计学意义;当病灶内部回声不均匀时,造影组穿刺准确率为95.0%,常规组穿刺准确率为65.6%,比较两组穿刺准确率,(?)~2=5.983,P0.05,差异具有统计学意义。常规组病灶距肝脏表面≥5cm者与距肝脏表面5cm者穿刺准确率分别为60.7%、96.0%,比较两组穿刺准确率,(?)~2=9.389,P0.05,差异具有统计学意义;当病灶距离肝脏表面≥5cm时,造影组穿刺准确率为94.4%,常规组穿刺准确率为60.7%,比较两组穿刺准确率,(?)~2=6.465,P0.05,差异具有统计学意义。常规组病灶背景肝实质伴肝硬化者与背景肝实质不伴肝硬化者穿刺准确率分别为55.0%、90.9%,比较两组穿刺准确率,(?)~2=9.168,P0.05,差异具有统计学意义;当病灶背景肝实质伴有肝硬化时,造影组穿刺准确率为94.4%,常规组穿刺准确率为55.0%,比较两组穿刺准确率,(?)~2=7.602,P0.05,差异具有统计学意义。结论:超声造影对肝脏实性占位性病变诊断准确率较常规超声高;超声造影引导经皮肝实性占位病变穿刺活检准确率较常规超声高;常规超声引导肝实性占位病变穿刺活检时,直径≥2cm者较直径2cm者穿刺活检准确率高;边界清晰者较边界不清晰者穿刺活检准确率高;内部回声均匀者较内部回声不均者穿刺活检准确率高;穿刺深度5cm者较穿刺深度≥5cm者穿刺活检准确率高;背景肝实质不伴肝硬化者较伴肝硬化者穿刺活检准确率高。当肝实性占位病变直径2cm、边界不清晰、内部回声不均匀、穿刺深度≥5cm、背景肝实质伴肝硬化时,超声造影引导穿刺活检准确率高于常规超声。
[Abstract]:Objective: To compare the diagnostic value of conventional ultrasound and ultrasound in the diagnosis of liver-solid occupying lesions, and to explore the accuracy and the influencing factors of the guided percutaneous liver biopsy. Methods: From June 2012 to June, 2016, 89 cases and 95 lesions were randomly divided into the normal group and the contrast group, among which 53 lesions and 42 lesions in the normal group were randomly divided into the normal group and the contrast group. The results of the diagnosis and the pathological results of the conventional group and the contrast group were compared, and the effect of the basic condition of the lesion on the results of the puncture was analyzed. Results: The diagnostic accuracy of routine group was 71.6%, and the diagnostic accuracy of contrast group was 90. 5%. The diagnostic sensitivity of the conventional group was 75.6%, the diagnostic sensitivity of the contrast group was 91.2%, and the data sensitivity of the two groups was compared, (? (2 = 3.143, P (29) 0.05, the difference was not statistically significant; the diagnostic specificity of the conventional group was 58.3%, the diagnostic specificity of the contrast group was 87.5%, and the two groups of data were specifically compared, (? () ~ 2 = 5.787, P0.05, the difference was of statistical significance. The accuracy of the puncture in the conventional group was 70.4%, the accuracy of the puncture in the contrast group was 95.2%, and the accuracy of the two groups of data was more accurate (? 2 = 5.691, P0.05, the difference was statistically significant; the sensitivity of the conventional group was 80.5%, the puncture sensitivity of the contrast group was 97.1%, and the data sensitivity of the two groups was compared, (? () ~ 2 = 4.833, P0.05, the difference was of statistical significance; the puncture specificity of the conventional group was 65.7%, the puncture specificity of the contrast group was 87.5%, and the two groups of data were specifically compared, (? () ~ 2 = 1.111, P (29) 0.05, the difference was not statistically significant. The accuracy of the puncture was 31. 25% and 97. 2% in the conventional group with the diameter of 2 cm and the diameter of 2 cm, and the accuracy of the two groups was compared. 2 = 27. 819, P 0.05, the difference was of statistical significance; when the diameter of the lesion was 2 cm, the puncture rate of the contrast group was 90.9%, the accuracy of the conventional group was 31. 25%, and the accuracy of the two groups was compared with that of the two groups (? () ~ 2 = 9.396, P0.05, the difference was of statistical significance. The accuracy of the puncture was 93.1% and 58.3%, respectively, and the accuracy of the two groups was compared in the conventional group. 2 = 9.064, P0.05, the difference was statistically significant; when the boundary of the lesion was not clear, the puncture rate of the contrast group was 94.7%, the accuracy of the conventional group was 58.3%, and the accuracy of the two groups was compared. () ~ 2 = 7.382, P0.05, the difference was of statistical significance. The accuracy of the puncture was 95.2% and 65.6%, respectively, and the accuracy of the two groups was compared in the conventional group. 2 = 6.348, P0.05, the difference was statistically significant; when the internal echo of the lesion was not uniform, the accuracy of the puncture of the contrast group was 90.0%, the accuracy of the conventional group was 65.6%, and the accuracy of the two groups was compared. () ~ 2 = 5.983, P0.05, the difference was of statistical significance. The accuracy of the puncture was 60.7% and 96.0%, respectively, compared with that of the 5cm from the surface of the liver, and the accuracy of the two groups was compared. 2 = 9.389, P0.05, the difference was statistically significant; when the focus distance was 5cm from the surface of the liver, the puncture rate of the contrast group was 94.4%, the accuracy of the conventional group was 60.7%, and the accuracy of the two groups was compared with that of the two groups (? () ~ 2 = 6.465, P0.05, the difference was of statistical significance. The accuracy of the puncture was 55. 0% and 90. 9%, respectively, and the accuracy of the two groups was compared between the two groups. (2 = 9.168, P <0.05). The accuracy of the puncture was 94.4% in contrast group and 52.0% in the conventional group, and the accuracy of the two groups was compared with that of the two groups (? () ~ 2 = 7.602, P0.05, the difference was of statistical significance. Conclusion: The accuracy of ultrasound contrast in the diagnosis of the real occupying lesion of the liver is higher than that of the conventional ultrasound. The accuracy of the ultrasound contrast-guided percutaneous biopsy is higher than that of the conventional method. The accuracy of the biopsy with a diameter of 2 cm was high, the accuracy of the biopsy was high, the accuracy of the biopsy was high, and the accuracy of the puncture biopsy of the inner echo was higher than that of the inner echo. The accuracy of the biopsy with the puncture depth of 5cm was higher than that of the puncture depth of 5cm. Background: The accuracy of the biopsy with liver cirrhosis is higher than that of the patients with liver cirrhosis. When the diameter of the solid occupying lesion was 2cm, the boundary was not clear, the internal echo was not uniform, the depth of the puncture was 5cm, and the accuracy of the ultrasound-guided puncture biopsy was higher than that of the conventional ultrasound in the case of liver parenchyma with liver cirrhosis.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R735.7

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