Application research of diagnose lung mini-nodule by CT combined high accuracy Electronic level guidance percutaneous lung biopsy
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摘要:
目的 评价CT联合电子水平仪技术引导下经皮肺对诊断肺部微小结节（直径≤2.0 cm）穿刺的应用价值。 方法 根据结节大小、病变所在肺叶等条件应用配对设计分组法，将60例肺微小结节患者分别采用CT联合电子水平仪引导穿刺（联合引导法）和常规穿刺（常规法）活检，每组30例，由同一医师操作，术后组织送病理学检查。结节以切除术后病理及临床诊疗后随访12月以上的诊断结果为最终结果。对比分析2种方法的穿刺结果。 结果 60例病灶中，联合引导组和常规组穿刺靶点到位率分别为100%和96.7%，首次穿刺成功率分别为53.33%（16/30）和20.00%（6/30），穿刺成功所用时间分别为14.16±2.27、19.33±4.59 min。联合引导组中28例穿刺活检得到的组织细胞学结果与手术后病理或临床最终诊断相符，2例因取材组织过少病理无法作出明确诊断，其中活检确定恶性肿瘤20例，良性病变8例；穿刺诊断符合率为93.33%。常规组中26例穿刺活检得到的组织细胞学结果与手术后病理或临床最终诊断相符，3例因取材组织过少病理无法作出明确诊断，1例穿刺过程中出现气胸、咳血，患者要求终止操作，其中活检确定恶性肿瘤18例，良性病变8例，穿刺穿刺诊断符合率为86.67%。联合引导组的诊断符合率高于常规组（P<0.05）。2种方法穿刺成功操作时间比较，联合引导法低于常规法（P<0.05）。联合引导组和常规组穿刺并发症的发生率分别为13.3%（4/30）和40%（12/30），经处理后均治愈，联合引导组并发症发生率低于常规组，差异有统计学意义（P<0.05）。 结论 CT联合电子水平仪技术可明显提高肺部微小结节病变首次穿刺的成功率，减少操作时间和并发症的发生率。 Abstract:Objective To evaluate the applied value of diagnose lung mini-nodule by CT combined high accuracy Electronic level guidance percutaneous lung biopsy (diameter≤2.0 cm). Method Sixty patients with lung mini-nodule were included in this study．According to the nodule size and the lesion position, they were divided into study group (with CT combined high accuracy Electronic level guidance method) and conventional group (with conventional method)．Needle biopsy was performed by the same attending doctor. The tissues were send to do the pathology examination after operation. The results of the two methods were compared. Results In 60 cases of lesions, the arrival rate of target puncture were 100% and 96.7%. The successful rates at first puncture using CT combined high accuracy Electronic level guidance method and conventional method were 53.33% and 20.00%, while the successful puncture time were 14.16±2.27 min and 19.33±4.59 min. In study group, the histocytolog report of 28 cases aspiration biopsy was consistent with postoperative pathologic or clinical final diagnosis. Two of them could not provide the histocytology diagnosis because the tissues were too little to make a pathological examination. Among them, 20 cases were confirmed malignancy by biopsy, 8 cases of benign lesions, and the diagnose accordance rate was 93.33%. While the histocytolog report of 26 cases aspiration biopsy was consistent with postoperative pathologic or clinical final diagnosis, 3 of them could not provide the histocytology diagnosis because the tissues were too little to make a pathological examination. One of them was failure due to stoped by the patient with pneumothorax and coughing up blood in the process of puncuere. Twenty cases were confirmed malignancy by biopsy, 8 cases of benign lesions, and the diagnose accordance rate was 86.67%.The time needed successful puncture at the CT combined high accuracy Electronic level guidance method was shorter than that at conventional method. In study group, the complication rate was 13.33%（4/30）, while 40.00%（12/30）in conventional group (P<0.05)． Conclusion CT combined high accuracy Electronic level guidance percutaneous lung biopsy can obviously improve one-time success rate and reduce the complication rate and operative time． -
Key words:
- lung mini-nodule /
- biopsy /
- electronic level /
- CT
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表 1 2种方法穿刺结果的对比
组别 靶点到位率（%） 首次穿刺成功率（%） 平均穿刺成功次数（次） 诊断符合率（%） 联合引导组 100 53.33 1.536 93.33 常规组 96.67 20 2.154 86.67 χ2 1.016 7.177 − 0.741 P 0.313 0.007 − 0.389 
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表 2 2种方法在不同结节大小穿刺时间（min，Mean±SD）
穿刺直径（cm） 例数 联合引导法 常规法 t P 0.5~1.0 7 14.07±2.21 21.94±4.62 –4.068 0.020 1.1~1.5 11 14.26±2.51 18.43±5.03 –2.454 0.023 1.6~2.0 12 14.3 ±2.33 18.2±5.4 –2.409 0.024
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表 3 2种方法穿刺并发症的对比
并发症 病灶大小 0.5~1.0 cm 1.1~1.5 cm 1.6~2.0 cm 联合引导组 常规组 联合引导组 常规组 联合引导组 常规组 气胸 1 2 0 1 0 1 肺内出血 1 4 0 1 1 2 痰中带血 0 1 1 0 0 0
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