胸膜外定位法CT导引下经肺穿刺活检

目的 探讨胸膜外定位(EPL)法行CT导引下经肺穿刺活检,在减少气胸发生率和气胸量方面的应用价值.方法 选取行CT导引下肺穿刺活检中肺内病变与相邻胸膜不接触的患者共115例,根据定位方法的不同,分为EPL组46例、病灶边缘定位(EEL)组69例,两组患者又根据病变外缘沿穿刺方向与胸壁内缘的距离分为近距组(距离≤2era)和远距组(距离>2cm),对比两组患者气胸发生率与气胸量,并进行行×列表X2检验.分别记录并计算两组活检针在肺内的滞留时间及其平均值.结果 EPL组气胸发生率为45.7%(21/46),脏壁层胸膜最大距离0.2～2.5cm,中位数0.4cm;IZL组气胸发生率为66.7%(46/69),脏壁层胸膜最大距离0.2～9.0cm,中位数0.3cm.病灶与胸膜距离≤2cm时,EPL组气胸发生率为39.4%(13/33);LEL组气胸发生率为73.2%(30/41),两组差异有统计学意义(X2=9.981,P=0.019).病灶与胸膜距离>2cm时,EPL组气胸发生率略低于LEL,但两组差异无统计学意义.EPL组活检针在肺内的滞留时间为(7.2±1.8)s,LEL组为(58.3±11.6)s.结论 EPL法CT导引下肺穿刺活检能明显缩短活检针在肺内的滞留时间,减少气胸发生率及产生的气胸量,具有一定价值,是一种值得推广的新方法.

Extrapleural locating method: significance in CT-guided transthoracic pulmonary biopsy

Objective To evaluate the usefulness of extrapleural locating method in CT-guidod transthoracic pulmonary biopsy to prevent or reduce the size of peumothorax.Methods One hundred and fifteen cases of CT-gnided transthoracic pulmonary biopsy with the pulmonary lesions not in direct contact with the pleura were selected.Of 115 cases,46 were performed with extrapleural locating method (EPL) and 69 cases with lesion edge locating method (LEL).Taking the maximum distance between the partial and visceral pleura (MPVD) measured on the CT image after the procedure as the index of the volume of pneumothorax.The incidence and volume of pneumothorax of both groups were compared and statistically analysed with R ×C Chi-Square test.The retention time of the biopsy needle in the lung parenchyma of the two group was documented and the average time was calculated in each group.Results The incidence of pneumothorax was 45.7% (21/46),median 0.4 cm with EPL group,and 66.7% (46/69) and median 0.3cm with LEL group.When the distance between the lesion and pleura was equal or smaller than 2 cm (≤2cm),the incidence of pneumothorax was 39.4% (13/33) with EPL group and 73.2% (30/41) with LEL group,and the difference of incidence and volume of the pneumothorax between two groups was statistically signifieant(X2 =9.981,P =0.019).When the distance was larger than 2 cm( >2 cm),the incidence and volume of pneumothorax between two groups were not significant statistically.The average retention time of the biopsy needle in the lung parenchyma was (7.2±1.8)s with EPL group and (58.3±11.6) s with LEL group.Conclusion The extrapleural locating method can reduce effectively the retention time of the biopsy needle in the lung parenchyma and the incidence and volume of pneumothorax in CT-gnided transthoracic pulmonary biopsy.