CT与超声引导经皮肺穿刺活组织检查术对肺周围型肿块诊断价值的Meta分析

目的 系统评价CT引导与超声引导经皮肺穿刺活组织检查术对肺周围型肿块诊断的有效性与安全性。方法 检索国内外相关数据库如PubMed、Web of Science、Cochrane Library、OVID、中国生物医学文献数据库、维普、万方及中国知网,收集关于CT引导与超声引导经皮肺穿刺活组织检查术应用的随机对照试验,提取相关数据,采用RevMan 5.2及Stata软件进行Meta分析。结果 符合纳入标准的文献共有10篇,总样本量1 158例,其中经CT引导穿刺活组织检查635例,经超声引导穿刺活组织检查523例。Meta分析结果显示,CT引导组穿刺成功率与超声引导组差异无统计学意义[97.48%(619/635)比96.56%(505/523),RR=1.01,95%CI 0.99~1.03,P=0.360];CT引导组穿刺确诊率低于超声引导组,差异有统计学意义[92.44%(587/635)比96.56%(505/523),RR=0.97,95%CI 0.94~0.99,P=0.007];CT引导组穿刺术后总并发症发生率高于超声引导组,差异有统计学意义[14.49%(92/635)比9.56%(50/523),RR=1.56,95%CI 1.11~2.19,P=0.010];CT引导组穿刺术后气胸发生率高于超声引导组,差异有统计学意义[11.50%(73/635)比6.31%(33/523),RR=1.77,95%CI 1.17~2.68,P=0.007];CT引导组穿刺后出血发生率与超声引导组差异无统计学意义[2.99%(19/635)比3.25%(17/523),RR=1.08,95%CI 0.59~1.98,P=0.800]。结论 CT引导与超声引导经皮肺周围型肿块穿刺活组织检查术均具有较好临床诊断价值,但是,对于超声能显示的肺内周围型肿块,超声引导肺穿刺活组织检查术手术时间更短,经济性更好,安全性更高。

CT-guided versus ultrasound-guided percutaneous lung puncture biopsy in the diagnosis of peripheral pulmonary masses:a Meta-analysis

Objective To systematically evaluate the efficacy and safety of CT-guided percutaneous lung puncture biopsy versus ultrasound-guided percutaneous lung puncture biopsy.Methods Relevant domestic and foreign related databases such as PubMed,Web of Science,Cochrane Library,OVID,China Biology Medicine,VIP,Wanfang and CNKI databases were searched,the randomized controlled trial about the applications of CT-guided and ultrasound-guided percutaneous lung puncture biopsy were collected.After extracting the relevant data,a Meta-analysis was performed using RevMan 5.2 and Stata softwares.Results Ten studies met the inclusion criteria,with a total sample size of 1158 cases,of which 635 were CT-guided puncture biopsy and 523 were ultrasound-guided puncture biopsy.Meta-analysis showed that the difference of the success rate between the CT-guided group and the ultrasound-guided group was not statistically significant[97.48%(619/635)vs.96.56%(505/523),RR=1.01,95%CI 0.99-1.03,P=0.360];the puncture diagnosis rate in the CT-guided group was lower than in the ultrasound-guided group,and the difference was statistically significant[92.44%(619/635)vs.96.56%(505/523),RR=0.97,95%CI 0.94-0.99,P=0.007].The total incidence of complications after puncture in the CT-guided group was higher than that in the ultrasound-guided group,and the difference was statistically significant[14.49%(92/635)vs.9.56%(50/523),RR=1.56,95%CI 1.11-2.19,P=0.010];the incidence of pneumothorax after puncture in the CT-guided group was higher than that in the ultrasound-guided group,and the difference was statistically significant[11.50%(73/635)vs.6.31%(33/523),RR=1.77,95%CI 1.17-2.68,P=0.007];the difference of the incidence of bleeding after puncture between the CT-guided group and the ultrasound-guided group was not statistically significant[2.99%(19/635)vs.3.25%(17/523),RR=1.08,95%CI 0.59-1.98,P=0.800].Conclusions Both CT-guided and ultrasound-guided percutaneous lung puncture biopsy have good clinical diagnostic value.However,for the intrapulmonary masses shown by ultrasound,the ultrasound-guided lung puncture biopsy has a shorter operation time,lower cost,and higher safety.