基于“PET”原则的CT引导下经皮肺穿刺活检术的临床应用-现代医学

基于“PET”原则的CT引导下经皮肺穿刺活检术的临床应用

单位：1. 广东医科大学附属中山医院呼吸内科, 广东中山 528400;
2. 南方医科大学中西医结合医院呼吸内科, 广东广州 510220

分类号：R563.9

出版年·卷·期（页码）：2017·36·第八期（1134-1140）

摘要：

目的：探讨基于"PET"原则的CT引导下经皮肺穿刺活检术（PTNB）（PET-CT-PTNB）的诊断效果及并发症，并对并发症的危险因素行进一步分析。方法：2015年1月至2017年1月间前瞻性入组肺部病变需行CT引导下PTNB的患者220例，其中112例患者行PET-CT-PTNB，108例患者行常规CT引导下PTNB （CT-PTNB）。分析两组的临床资料，比较两组的诊断率、气胸发生率和胸腔闭式引流率，并探讨气胸发生的危险因素。结果：两组的诊断率无统计学差异（94.6%vs 92.6%，P>0.05）；PET-CT-PTNB组气胸发生率低于CT-PTNB组（8.9%vs 19.4%，P<0.05）；两组胸腔闭式引流率无统计学差异（1.8%vs 3.7%，P>0.05）；在PET-CT-PTNB组中，翻转时间 < 15 s亚组气胸发生率低于翻转时间 > 15 s亚组（5.3%vs 16.7%，P<0.05），且前者胸腔闭式引流率亦低于后者（0%vs 5.6%，P<0.05）。多因素分析显示在CT-PTNB组中，病灶大小 < 3 cm、病灶深度 > 5 cm、穿刺次数 > 3次、合并COPD均是危险因素，但只有病灶深度 > 5 cm、合并COPD有统计学意义（OR值 > 1，P<0.05）；在PET-CT-PTNB组中，病灶大小 < 3 cm、病灶深度>5 cm、穿刺次数>3次、合并COPD均是危险因素，但所有因素均无统计学意义（OR值>1，P>0.05）；在危险因素中，病灶深度>5 cm、合并慢阻肺在PET-CT-PTNB组明显减弱。结论：在对患者行CT引导下肺穿刺活检时，选择PET-CT-PTNB法可在不影响诊断效果的情况下有效减少气胸并发症的出现，尤其对于合并多个危险因素的患者。

Objective: To investigate the diagnostic efficacy and complications of CT-guided percutaneous transthoracic needle biopsy(PTNB) based on PET(PET-CT-PTNB), and to further analyze the risk factors of complications.Methods: Two hundred and twenty patients with lung lesions having a demand for CT-guided PTNB between January 2015 and January 2017 were prospectively analyzed. Among them, 112 patients were subjected to PET-CT-PTNB, and 108 underwent routine CT-guided PTNB(CT-PTNB). Clinical data of the 2 groups were analyzed; diagnostic rate, the incidence of pneumothorax and the rate of closed thoracic drainage were compared; and the risk factors of pneumothorax were explored. Results: There was no statistical difference in the diagnostic rate between the two groups(94.6% vs. 92.6%, P>0.05). The incidence of pneumothorax in the PET-CT-PTNB group was lower as compared with the CT-PTNB group(8.9% vs. 19.4%, P<0.05). There was no statistical difference in the rate of closed thoracic drainage between the two groups(1.8% vs. 3.7%, P>0.05). In the PET-CT-PTNB group, the incidence of pneumothorax and the rate of closed thoracic drainage were lower in both subgroups of turnover time < 15 s and > 15 s(5.3% vs. 16.7%, P<0.05; 0% vs. 5.6%, P<0.05). Multivariate analysis demonstrated that in the CT-PTNB group, the size of lesion<3 cm, the depth of lesion>5 cm, the number of puncture>3, and combined COPD were all risk factors, with only the depth of lesion>5 cm and combined COPD presenting statistical significance(OR>1, P<0.05). In the PET-CT-PTNB group, the size of lesion<3 cm, the depth of lesion>5 cm, the number of puncture>3, and combined COPD were all risk factors, showing no statistical significance(OR>1, P>0.05). Among these risk factors, the depth of lesion>5 cm and combined COPD were obviously weakened in the PET-CT-PTNB group.Conclusion: When patients undergo CT-guided needle biopsy of the lung, PET-CT-PTNB is suggested to effectively reduce the incidence of pneumothorax without influencing the incidence of pneumothorax, especially for patients combined with multiple risk factors.

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