螺旋CT引导下经皮肺活检术的临床应用价值及安全性分析

目的：探讨螺旋CT引导下经皮肺活检术的临床应用价值及安全性。方法：66例患者在螺旋CT引导下经皮肺活检术,分析病灶大小对临床诊断正确率的影响,病灶大小及病灶离胸膜距离与肺活检术并发症的关系。结果：66例患者中有60例得到明确的病理学诊断,经术后病理、临床治疗及随诊,最终临床诊断正确率为86.67%,大病灶（直径〉2 cm）和小病灶（直径≤2 cm）的诊断正确率分别为93.02%和70.59%,差异有统计学意义（χ2=5.307,P〈0.05）。大小病灶活检术的气胸发生率分别是11.36%和13.64%,差异无统计学意义（χ2=0.071,P〉0.05）,肺出血发生率分别是11.36%和22.73%,差异无统计学意义（χ2=1.473,P〉0.05）;病灶离胸膜距离≤5 cm和〉5 cm的气胸发生率分别为5.13%和22.22%,差异有统计学意义（χ2=4.277,P〈0.05）,肺出血的发生率分别为7.69%和25.93%,差异有统计学意义（χ2=4.126,P〈0.05）。结论：螺旋CT引导下经皮肺活检术诊断正确率较高,尤其对肺内较大病灶,其并发症以气胸和肺出血为主,与病灶大小无关,而随病灶离胸膜距离的增加而增高,其安全性较高,是值得推广的一种检查手段。

Clinical application value and security analysis of spiral CT-guided percutaneous lung biopsy

Objective： To investigate the clinical application value and security of spiral CT-guided percutaneous lung biopsy.Methods： 66 patients underwent spiral CT-guided percutaneous lung biopsy.Then we analyzed the influence of lesion size on the accuracy of clinical diagnosis and the relations between lesion size,the distance between lesion and pleura and the complications caused by percutaneous lung biopsy.Results： There was definite pathological diagnosis in 60 patients among 66 cases.Ultimate clinical diagnostic precision rate was 86.67% confirmed by post-operative pathology reports,clinical treatment and follow-up.Diagnostic precision rate of big lesions with diameter more than 2 cm and small lesions,less than or equal to 2 cm in diameter,were respectively 93.02% and 70.59%,which had significant difference（χ2=5.307,P0.05）.Pneumothorax rate of 11.36% in big lesions and 13.64% in small ones,had no significance in statistics（χ2=0.071,P0.05）,and there was also no clear difference in pneumorrhagia rates of 11.36% in big lesions and 22.73% in small ones（χ2=1.473,P0.05）.But it was obviously different that pneumothorax rates were 5.13% in the lesions with less than or equal to 5 cm distance from pleura and 22.22% in the ones with more than this distance（χ2=4.277,P0.05）,and pneumorrhagia rates were 7.69% in the lesions with less than or equal to 5 cm distance from pleura and 25.93% in the ones with more than this distance,which was evidently different（χ2=4.126,P0.05）.Conclusion： Spiral CT-guided percutaneous lung biopsy can improve greatly the correct rate of clinical diagnosis of pulmonary lesions,especially bigger ones.And its main complications are pneumothorax and pneumorrhagia,which has nothing to do with the lesion size,but is higher along with the longer distance from pleura.It is a detection method that is worth popularizing because of its security.