CAJ | 학술논문

背景与目的:CT引导下经皮胸部穿刺是目前被广泛应用的非血管性介入技术,包括活检组织病理和针吸细胞学后续两种诊断方法,对病变的临床定性诊断、治疗及预后有极其重要的意义.本研究旨在探讨CT引导下经皮胸部病灶穿刺术活检组织病理和针吸细胞学诊断是否具有差异,以及胸部穿刺术诊断正确率和并发症及其相关因素.方法:选择2006年4月—2012年3月胸部疾病CT引导下经皮胸部穿刺术的患者1027例,回顾性研究活检组织病理和针吸细胞学诊断之间是否具有差异性,同时分析胸部穿刺术的诊断正确率及并发症与各种影响因素的关系.结果:活检组织病理与针吸脱落细胞学检测在诊断的阳性率和正确率中差异均无统计学意义(P>0.05).1027例患者中,恶性病变859例,良性病变168例,诊断正确率为90.6%,其中对恶性肿瘤的诊断正确率为89.1%,良性病变的诊断正确率为98.2%.病灶的良恶性、疾病部位和病灶形态对诊断正确率的影响差异有统计学意义(P<0.05).不良反应(气胸和出血)的发生率为19.9%,与穿刺深度和病灶至胸膜距离密切相关(P<0.05).结论:CT引导下胸部穿刺术是安全、可靠的微创诊断方法.在某些条件下,CT引导下胸部穿刺针吸脱落细胞学检测可以代替活检,以避免那些需要通过增加穿刺风险获取足够组织进行的活检.诊断正确率与病灶的良恶性、发生部位和形态相关.并发症的发生与穿刺深度和病灶至胸膜距离密切相关,应当给予重视.
배경여목적:CT인도하경피흉부천자시목전피엄범응용적비혈관성개입기술,포괄활검조직병리화침흡세포학후속량충진단방법,대병변적림상정성진단、치료급예후유겁기중요적의의.본연구지재탐토CT인도하경피흉부병조천자술활검조직병리화침흡세포학진단시부구유차이,이급흉부천자술진단정학솔화병발증급기상관인소.방법:선택2006년4월—2012년3월흉부질병CT인도하경피흉부천자술적환자1027례,회고성연구활검조직병리화침흡세포학진단지간시부구유차이성,동시분석흉부천자술적진단정학솔급병발증여각충영향인소적관계.결과:활검조직병리여침흡탈락세포학검측재진단적양성솔화정학솔중차이균무통계학의의(P>0.05).1027례환자중,악성병변859례,량성병변168례,진단정학솔위90.6%,기중대악성종류적진단정학솔위89.1%,량성병변적진단정학솔위98.2%.병조적량악성、질병부위화병조형태대진단정학솔적영향차이유통계학의의(P<0.05).불량반응(기흉화출혈)적발생솔위19.9%,여천자심도화병조지흉막거리밀절상관(P<0.05).결론:CT인도하흉부천자술시안전、가고적미창진단방법.재모사조건하,CT인도하흉부천자침흡탈락세포학검측가이대체활검,이피면나사수요통과증가천자풍험획취족구조직진행적활검.진단정학솔여병조적량악성、발생부위화형태상관.병발증적발생여천자심도화병조지흉막거리밀절상관,응당급여중시.
@@@@Background and purpose:Percutaneous transthoracic needle biopsy with computed tomographic (CT) guidance, following two diagnostic methods of needle biopsy and needle aspiration cytology, is a widely used non-vascular interventional technique, regarded as an extremely important technique for clinical qualitative diagnosis, treatment and the prognosis. This study aimed to evaluate and to compare the diagnostic value of needle biopsy and needle aspiration cytology in CT-guided percutaneous chest lesion puncture, and to analyze the variables affecting the diagnostic accuracy and rates of complications. Methods:A retrospective study was conducted of 1 027 patients who underwent CT-guided percutaneous thoracopathy puncture from Apr. 2006 to Mar. 2012. Results:There were no significant differences in diagnostic positive rate and accuracy between needle biopsy and needle aspiration cytology in CT-guided percutaneous chest lesion puncture (P>0.05). There were 859 malignant and 168 benign lesions. Overall diagnostic accuracy was 90.6%. The diagnostic accuracy for malignancy was 89.1%and for benign was 98.2%. There was significant correlation among the diagnostic accuracy and the final diagnosis (benign and malignant), lesion site, and lesion type (P<0.05). The total complication incidence rate (pneumothorax and bleeding) was 19.9%. The significant factors affecting complications were the depth of puncture and distance between lesion and pleura (P<0.05). Conclusion:The CT-guided percutaneous chest lesion puncture is a reliable and safe minimally invasive diagnostic technique on chest disease. Under certain conditions, in order to avoid the risk of increasing numbers of needle passes to get enough tissue for biopsy, the needle aspiration cytology could replace the needle biopsy during CT-guided percutaneous chest lesion puncture. We should pay attention to the nature of the disease, lesion site and lesion type,which were closely related to the diagnostic accuracy. Meanwhile, it is necessary to notice the depth of puncture and distance between lesion and pleura, which significantly influenced the complications.