CT引导下经皮肺穿刺活检术在肺部疾病诊断中的临床应用

目的探讨CT引导下经皮肺穿刺活检术在肺部疾病诊断中的应用价值。 方法收集西部战区总医院全院2015年1月至2017年12月在CT引导下行经皮肺穿刺活检术的298例患者临床资料，采用回顾性研究方法，统计其穿刺成功率、并发症发生率及病理诊断结果，分析与并发症发生率相关的影响因素。 结果295例患者穿刺成功，穿刺成功率达98.99% (295/298)；其中，252例通过穿刺病理结果确诊，确诊率达84.56%(252/298)；术后71例出现并发症，其发生率为23.83%(71/298)，主要表现为气胸及咯血，其中气胸33例，发生率为11.07%(33/298)，咯血31例，发生率为10.40%(31/298)；术后1例因大咯血抢救无效死亡，死亡率为0.34%(1/298)。术后气胸及咯血的发生率在不同性别(χ²＝2.18，1.86；均P>0.05)、年龄(χ²＝0.53，2.36；均P>0.05)、体重指数(BMI)(χ²＝0.02，0.00；均P>0.05)、吸烟史(χ²＝0.05，2.98；均P>0.05)及基础疾病史(χ²＝0.26，0.01；均P>0.05)患者中差异无统计学意义；患者肺部病灶直径越小(χ²＝10.61，7.63；均P<0.05)、病灶至胸壁间距离越大(χ²＝25.58，7.20；均P<0.05)，其术后气胸及咯血的发生率越高。 结论CT引导下经皮肺穿刺活检术穿刺成功率及确诊率高，其术后并发症主要为气胸及咯血，且并发症的发生主要与病灶直径及病灶至胸壁间距离有关。

Analysis of the clinical application of CT-guided percutaneous lung biopsy in diagnosis of pulmonary diseases

ObjectiveTo investigate the application of CT-guided percutaneous lung biopsy in diagnosis of pulmonary diseases and analyze the complications of CT-guided percutaneous lung biopsy. MethodsThe retrospective study reviewed data of 298 patients who were hospitalized in the General Hospital of Western Theater Command and underwent CT-guided percutaneous biopsy of lung lesions from January 2015 to December 2017. The success rate of puncture, the incidence of complications and the results of pathological diagnosis were statistically analyzed, and the correlation between the clinical data and lesion characteristics and postoperative complications were analyzed. ResultsPunctures in 295 patients were successful and the success rate was 98.99% (295/298), and the diagnoses of 252 cases were confirmed with a diagnosis rate of 84.56% (252/298). Furthermore, complications occurred in 71 patients, mainly manifested as pneumothorax and hemoptysis, and the incidence rate was 23.83%(71/298), including 33 cases of pneumothorax (11.07%, 33/298) and 31 cases of hemoptysis (10.40%, 31/298). Unfortunately, 1 patient died of massive hemoptysis with a mortality rate of 0.34% (1/298). Factors related to pneumothorax and hemoptysis were also analyzed. There were no significant difference in the rate of pneumothorax and hemoptysis among patients with different gender (χ²=2.18, 1.86; all P>0.05), age (χ²=0.53, 2.36, all P>0.05), body mass index (BMI) (χ²=0.02, 0.00, all P>0.05), smoking history (χ²=0.05, 2.98, all P>0.05) and underlying diseases (χ²=0.26, 0.01, all P>0.05). However, higher incidence of pneumothorax and hemoptysis were found in the patients with smaller lesions (χ²=10.61, 7.63, P<0.05) or greater distance (χ²=25.58, 7.20, P<0.05) between lesions and the chest wall. ConclusionCT-guided percutaneous lung biopsy possesses high success rate and diagnosis rate, and the complications are mainly pneumothorax and hemoptysis which mainly related to the diameter of the lesion and the distance between the lesion and the chest wall.