不同影像学辅助下检查手段在肺周围型病变诊断中的应用

Clinical application of different kinds of imaging assisted examination scheme on patients with peripheral pulmonary lesions

摘要:

摘要：目的 探讨CT引导经皮肺穿刺术（CT-PNB）和超声引导经支气管镜肺活检术（EBUS-TBLB）对肺周围型病变患者诊断阳性率及术后并发症的影响。方法 回顾性分析该院2015年4月－2017年10月收治的肺周围型病变患者218例，分析相关临床资料，根据检查方案不同分为A组（116例）和B组（102例），分别行CT-PNB和EBUS-TBLB完成检查；比较两组患者的诊断阳性率和术后并发症发生率，并分析相关影响因素。结果 A组患者诊断阳性率明显高于B组（P <0.05）；B组患者术后并发症发生率明显低于A组（P <0.05）；A组病变直径≥3 cm患者气胸发生率明显低于<3 cm者（P <0.05）；B组病变直径≥3 cm患者诊断阳性率明显高于<3 cm者（P <0.05）；A组病灶和胸壁间距离≥2 cm患者气胸发生率明显高于<2 cm者（P <0.05）；B组病灶和胸壁间距离≥2 cm患者诊断阳性明显高于<2 cm者（P <0.05）；同时A组病变未贴壁患者气胸发生率明显高于贴壁者（P <0.05）。结论 CT-PNB较EBUS-TBLB用于肺周围型病变诊断价值更佳，尽管可能增加术后并发症发生风险，但未见严重并发症出现；同时在实践过程中，还应综合考虑病变位置、病灶大小及贴壁情况来进行选择。

Abstract:

Abstract: Objective To investigate the influence of CT-PNB and EBUS-TBLB on the diagnosis positive rate and postoperative complications of patients with peripheral pulmonary lesions. Methods Clinical data of 218 patients with peripheral pulmonary lesions were retrospectively chosen from April 2015 to October 2017 and divided into two groups according to diagnosis scheme: A group (116 patients) with CT-PNB and B group (102 patients) with EBUS-TBLB; the diagnosis positive rate and postoperative complications incidence of both groups were compared and the related influence factors were analyzed. Results The diagnosis positive rate of A group were significantly higher than that in B group (P < 0.05). The postoperative complications incidence of B group were significantly lower than that in A group (P < 0.05). The pneumothorax incidence of patients with lesions ≥ 3 cm in diameter in A group were significantly lower than <3 cm (P < 0.05). The diagnosis positive rate of patients with lesions ≥3 cm in diameter in B group were significantly higher than <3 cm (P < 0.05). The pneumothorax incidence of patients with distance between lesion and chest wall ≥2 cm in diameter in A group were significantly higher than <2 cm (P < 0.05). The diagnosis positive rate of patients with distance between lesion and chest wall ≥2 cm in diameter in B group were significantly higher than <3 cm (P < 0.05). The pneumothorax incidence of patients with no adhered to chest wall in A group were significantly higher than adhered to chest wall (P < 0.05). Conclusion Compared with EBUS-TBLB, CT-PNB application on patients with peripheral pulmonary lesions possess the better diagnosis value; though may increase the postoperative complications risk, but have no serious complications. In the mean-time it should be considered including lesion location, lesion size and adherence.