超声造影与常规超声引导在肝脏肿物穿刺活检中应用效果的比较

目的：探讨超声造影引导肝肿物穿刺活检的临床应用价值和影响活检准确率的相关因素，为肝肿物的早期诊断提供依据。方法：选取肝肿物患者71例（73枚肿物），其中45枚肿物行常规超声引导下穿刺（常规超声组），28枚肿物行超声造影引导下穿刺（超声造影组），将穿刺结果与术后病理结果对照分析。同时分析穿刺准确率与肿物各项特征的关系。结果：常规超声组肝肿物穿刺活检准确率为73.33%，超声造影组肝肿物穿刺活检准确率为92.86%，2组患者肝肿物穿刺活检准确率比较差异有统计学意义（χ²=4.245，P<0.05）。常规超声组直径2~4 cm肿物活检准确率高于直径0~2 cm活检准确率（χ²=11.54，P<0.05），穿刺深度<5 cm肿物活检准确率高于>5 cm活检准确率（χ²=16.67，P<0.05），回声均匀肿物活检准确率高于回声不均活检准确率（χ²=9.66，P<0.05），边界清晰肿物活检准确率高于边界不清活检准确率（χ²=13.31，P<0.05），血流Ⅱ~Ⅳ级活检准确率高于0~Ⅰ级活检准确率（χ²=9.82，P<0.05）。而超声造影组在穿刺深度>5 cm、回声不均匀和边界不清的肝脏肿物中的活检准确率高于常规超声组（P<0.05）。结论：超声造影引导可以明显提高肝脏肿物的活检准确率。对于直径<2 cm、回声不均匀（伴或不伴液化）、边界不清、血流0~Ⅰ级及穿刺深度>5 cm的肝脏肿物，常规超声引导穿刺的活检准确率相对较低，建议在超声造影引导下进行穿刺活检。

Comparison of application effects bwtween contrast-enhanced ultrasound and conventional ultrasound in liver neoplasm biopsy

Objective: To investigate the clinical application value of contrast-enhanced ultrasound in liver neoplasm biopsy and the related factors influencing the accuracy rate of biopsy,and to provide the useful evidence for early diagnosis of liver neoplasm.Methods: A total of 71 patients with liver neoplasms(73 neoplasms) were selected and divided into conventional ultrasound group (underwent biopsy guided by conventional ultrasound) (45 neoplasms) and contrast-enhanced ultrasound group(underwent biopsy guided by contrast-enhanced ultrasound) (28 neoplasms).The biopsy results were compared with the pathologic results.At the same time,the relationships between the accuracy rate of puncture and the characteristics of neoplasms were analyzed.Results: The accuracy rates of biopsy in conventional ultrasound group was 73.33%,and 92.86% in contrast-enhanced ultrasound group;there was significant difference between two groups(χ²=4.245,P<0.05).In conventional ultrasound group,the accuracy rate of 2-4 cm tumor was higher than that of 0-2 cm tumor(χ²=11.54,P<0.05);the accuracy rate of tumor with puncture depth < 5 cm was higher than that of tumor with puncture depth>5 cm (χ²=16.67,P<0.05);the accuracy rate of homogenous tumor was higher than that of inhomogenous tumor(χ²=9.66,P<0.05); the accuracy rate of clear margin tumor was higher than that of vague margin tumor(χ²=13.31,P<0.05);the accuracy rate of level Ⅱ-Ⅳ tumor was higher than that of level 0-Ⅰ tumor(χ²=9.82,P<0.05). The accuracy rates of tumor with puncture depth>5 cm and inhomogenous tumor in contrast-enhanced ultrasound group were higher than those in conventrional ultrasound group(P<0.05).Conclusion: Contrast-enhanced ultrasound can obviously increase the accuracy rate of liver neoplasm biopsy. Conventional ultrasound gets the low accuracy rates of liver neoplasm biopsy,especially for the tumor with diameter < 2 cm, inhomogeneous echoes (with liquefaction or not),vague margin,level 0-Ⅰ blood flow classification,and puncture depth >5 cm,suggesting contrast-enhanced ultrasound should be performed.