超声引导经胸穿刺活检周围型肺病变的 影响因素及临床价值

Influencing factors and clinical value of ultrasound-guided transthoracic biopsy for peripheral pulmonary lesions

摘要:

目的 探讨超声引导经胸穿刺活检周围型肺病变的影响因素、穿刺技巧及安全性。方法 回顾 性分析177 例可疑周围型肺病变患者行超声引导经胸穿刺活检的病理结果，分析患者年龄、性别、穿刺体位、 穿刺部位、病灶大小、穿刺角度、穿刺针数及穿刺针型号对穿刺有效率的影响。结果 病理做出明确诊断患 者153 例，穿刺无效24 例，穿刺有效率为86.44%。病灶大小>50 mm 及26 ～ 50 mm 的患者穿刺有效率高于 病灶大小<26 mm（P <0.05），患者穿刺时体位采取坐位、平卧位者的穿刺有效率高于侧卧位（P <0.05），穿 刺针型号16 G 穿刺有效率高于18 G（P <0.05）。患者性别、穿刺部位、穿刺角度及穿刺针数比较，差异无统 计学意义（P >0.05）。177 例患者穿刺术后并发症总发病率为5.65%（10/177），其中气胸3 例（1.69%）、胸膜 反应5 例（2.82%）、咳血痰2 例（1.13%）。结论 病灶大小、穿刺时患者体位是影响超声引导经胸穿刺活检 有效率的主要因素，应规范各项操作，为周围型肺病变的临床诊疗提供可靠的依据。

Abstract:

Objective To evaluate the influencing factors and skills and safety of ultrasound-guided transthoracic biopsy for peripheral pulmonary lesions. Methods The pathological results of 177 patients with suspected peripheral pulmonary lesions who underwent ultrasound-guided transthoracic biopsy were retrospectively analyzed. Factors including age, gender, position during biopsy, biopsy site, lesion size, puncture angle, number of needle passes and needle size that could influence the biopsy efficacy were analyzed. Results Among the 177 patients, there were 70 cases of malignant lesions, 83 benign lesions and 24 indeterminate lesions, and the biopsy efficacy was 86.44% (153/177). The age, gender, biopsy site, puncture angle, number of needle passes and needle size had no impact on the biopsy efficacy (P > 0.05). The biopsy efficacy of lesion sizes larger than 50 mm and of 26-50 mm was significantly higher than that of those smaller than 26 mm (P < 0.05). For position during biopsy, supine and sitting positions were better than side-lying position (P < 0.05). The biopsy efficacy of 16 G needle was greater than that of 18 G needle (P < 0.05). Besides, the incidence of complications was 5.65% (10/177). Conclusions The lesion size and position during biopsy are the main influencing factors of ultrasound-guided transthoracic biopsy for peripheral pulmonary lesions. Therefore, the normative procedures could provide reliable basis and guidance for clinical diagnosis and treatment.