CT引导下经皮肺穿刺活检在老年孤立性肺结节中的应用

目的 探讨CT引导下经皮肺穿刺活检对老年孤立性肺结节的诊断价值及并发症。方法 回顾性分析2008年1月至2014年1月行CT引导下经皮肺穿刺活检并经手术病理、临床治疗或随访观察证实的113例老年孤立性肺结节病例。根据CT扫描图像选择最佳穿刺层面及穿刺点获取标本。结果 113例孤立性肺结节全部取材成功，穿刺病理提示恶性肿瘤94例，良性病变19例。经手术病理、临床治疗或随访观察证实为恶性肿瘤96例（85.0％），良性病变17例（15.0％），诊断准确率为96.5％，灵敏度为97.1％，特异度为90.0％。大结节组（＞15mm且≤30mm，n=98）的诊断准确率为98.9％，显著高于小结节组（≤15mm，n=15）的80.0％（P=0.007）。全组并发症为气胸（n=22）和肺内自限性出血（n=15），症状均较轻；无致死性不良反应发生。气胸发生与穿刺次数（P=0.002）及肺内针道距离（P=0.06）有关。结论 CT引导下经皮肺穿刺活检是一种创伤小且实用的定性诊断方法，对老年孤立性肺结节具有较高的临床应用价值。

CT-guided percutaneous lung biopsy for the elderly solitary pulmonary nodules

Objective To evaluate the diagnostic value and complications of CT-guided percutaneous lung biopsy for the eld- erly solitary pulmonary nodules. Methods A total of 113 patients from January 2008 to January 2014 with solitary pulmonary nodules who were performed by percutaneous transthoracic needle biopsy by CT-guided were reviewed. All of the patients were confirmed by pa- thology or clinical course. The CT scan was used to choose the best targeted level and the puncture point. Results Specimens of 113 patients were obtained successfully. Ninety-four cases were proved to be malignancies and 19 cases of benign lesions by biopsy. Ninety- six cases （85.0%） of malignancies and 17 cases （15.0%） of benign lesions were proved by pathology and clinical course. The diag- nostic accuracy, sensitivity and specificity were 96. 5%, 97. 1% and 90. 0%, respectively. The diagnostic accuracy of large nodules group （ 〉15mm and ≤30mm,n=98） was 98.9%, higher than 80.0% of small nodules group （ ≤15mm, n= 15） with statistical sig- nificance （P=0. 007）. The main complications were phenmothorax （ 19. 5%） and self-limiting bleeding （13.3%） and both of them were mild. No death-related complications happened. The incidence of phenmothorax was related to puncture times （P= 0. 002） and the length of puncture needle in lung tissues （P=O. 06）. Conclusion CT-guided percutaneous lung biopsy for the elderly solitary pulmo- nary nodules is an efficient and safe diagnostic method with few complications.