本文選題：肺周圍病變 + 超聲造影��； 參考：《南昌大學》2014年碩士論文

【摘要】：目的：本研究采用第二代超聲造影劑SonoVue結(jié)合實時超聲造影成像技術(shù)對近胸膜的肺周圍性腫塊進行研究，了解肺周圍性腫塊的增強特征，探討實時超聲造影引導(dǎo)經(jīng)皮肺穿刺活檢術(shù)對近胸膜的肺周圍性腫塊穿刺活檢的應(yīng)用價值。 方法：將100例經(jīng)CT檢查確定存在鄰近胸膜的肺周圍性腫塊患者隨機分為兩組，其中行超聲造影同時穿刺活檢者50例（實驗組），常規(guī)超聲引導(dǎo)穿刺者50例（對照組），所有病灶均進行二維超聲及彩色多普勒超聲檢查，確定病灶的位置、形態(tài)、大小、回聲、血流情況及與毗鄰臟器之間的關(guān)系。實驗組在二維超聲明確病變位置后，行超聲造影檢查，造影劑為意大利Bracco公司生產(chǎn)的六氟化硫（商品名：SonoVue），在低機械指數(shù)的狀態(tài)下實時監(jiān)測病變內(nèi)造影劑灌注及增強情況，同時對病灶增強區(qū)域行穿刺活檢。對照組則在二維超聲引導(dǎo)下行經(jīng)皮肺穿刺活檢術(shù)，盡量穿取病變彩色血流信號區(qū)或邊緣實性區(qū)域。對比實驗組與對照組的穿刺成功率、并發(fā)癥發(fā)生率。 結(jié)果： 1.實驗組中惡性病變36例，其中腺癌16例，麟狀細胞癌13例，轉(zhuǎn)移性癌2例，小細胞性肺癌1例，B細胞淋巴瘤1例，非霍奇金淋巴瘤1例，支氣管肺泡癌1例，肉瘤樣癌1例。良性病變14例，肺結(jié)核7例，炎性包塊4例,肺隱性球菌感染2例，肺膿腫1例。造影顯示50.00%（25/50）病變存在不同程度的壞死，且病灶出現(xiàn)壞死的比例隨著占位體積增大而增加，本研究中造影顯示，5例病變最大徑線3.5cm，占位未見明顯壞死；28例病變最大徑線3.5—5.5cm，占位中出現(xiàn)壞死者占42.86%（12/28)；17例病變最大徑線5.5cm，占位中出現(xiàn)壞死者高達占76.47%（13/17)。 2.實驗組中惡性病變36例，低回聲23例，不均勻低回聲13例，無回聲0例；良性病變14例，低回聲9例，不均勻低回聲4例，無回聲1例。對比良、惡性病變二維聲像圖改變，差異無明顯統(tǒng)計學意義（P0.05）。 3.實驗組中病灶內(nèi)彩色血流分級，惡性病變36例，0級4例，I級11例，II級17例，III級4例；良性病變14例，0級5例，I級6例，II級2例，III級1例。對比良、惡性病變的彩色血流分布，差異具有統(tǒng)計學意義（P0.05）。 4.實驗組中病灶的增強情況，惡性病變36例，，均勻增強17例，不均勻增強19例，無增強0例。良性病變14例，均勻增強10例，不均勻增強3例，無增強1例。對比良、惡性病變的增強情況，差異具有統(tǒng)計學意義(P0.05). 5.實驗組穿刺平均針數(shù)（1.38±0.57），對照組穿刺平均針數(shù)（1.63±0.63），兩組病灶的穿刺針數(shù)差異有統(tǒng)計學意義（t=-2.16,P=0.033，P0.05）。 6.實驗組與對照組穿刺成功率對比，實時超聲造影引導(dǎo)穿刺成功率明顯高于二維超聲（2=8.955,P=0.003）。兩組穿刺并發(fā)癥發(fā)生率對比，二者并發(fā)癥發(fā)生率差異具有統(tǒng)計學意義（2=4.225,P=0.040）。 結(jié)論：實時超聲造影引導(dǎo)經(jīng)皮肺穿刺能明顯提高肺周圍占位性病變的穿刺成功率，為臨床疾病診斷提供了十分重要的價值。
[Abstract]:Objective: in this study, the second generation ultrasound contrast agent SonoVue combined with real-time contrast-enhanced imaging technique was used to study the peripheral pulmonary masses in the near pleura. To evaluate the value of percutaneous lung biopsy guided by real-time contrast-enhanced ultrasound in the biopsy of pulmonary masses near pleura. Methods: a total of 100 patients with peripheral pulmonary masses identified by CT scan were randomly divided into two groups. Among them, 50 cases (experimental group) and 50 cases (conventional ultrasound guided puncture group) were examined by ultrasound and color Doppler ultrasound to determine the location, shape, size and echo of the lesions. Blood flow and its relationship with adjacent organs. In the experimental group, after the location of the lesion was determined by two-dimensional ultrasound, contrast-enhanced ultrasound was performed. The contrast agent was sulfur hexafluoride (commercial name: Sono Vueo) produced by Braco Company of Italy. The perfusion and enhancement of contrast media in the lesions were monitored in real time under the condition of low mechanical index. At the same time, biopsy was performed on the enhancement area of the lesion. In the control group, percutaneous pulmonary biopsy was performed under the guidance of two dimensional ultrasound, and the lesion color flow signal area or marginal solid area was obtained as far as possible. The success rate of puncture and the incidence of complications were compared between the experimental group and the control group. Results: 1. There were 36 cases of malignant lesions, including 16 cases of adenocarcinoma, 13 cases of luteal cell carcinoma, 2 cases of metastatic carcinoma, 1 case of small cell lung cancer, 1 case of B cell lymphoma, 1 case of non-Hodgkin 's lymphoma, 1 case of bronchoalveolar carcinoma and 1 case of sarcomatoid carcinoma. There were 14 cases of benign lesions, 7 cases of pulmonary tuberculosis, 4 cases of inflammatory mass, 2 cases of recessive pneumococcal infection and 1 case of pulmonary abscess. Angiographic findings showed that there was necrosis in different degrees in 50.00and 25 / 50) lesions, and the proportion of necrosis increased with the increase of space occupying volume. In this study, the maximum diameter of 5 lesions was 3.5 cm, and no obvious necrosis was found in the lesions. In 28 cases, the maximum diameter line was 3.5-5.5 cm, and the necrotic area accounted for 42.86% of 12 / 28% and 17 cases of the largest diameter line 5.5 cm, and the percentage of necrosis in the occupying space was 76.477 / 13 / 17 / 2. In the experimental group, there were 36 cases of malignant lesions, 23 cases of hypoechoic lesions, 13 cases of heterogeneous hypoechoic lesions, 13 cases of non-echoic lesions, 14 cases of benign lesions, 9 cases of hypoechoic lesions, 4 cases of heterogeneous hypoechoic lesions and 1 case of anechoic lesions. There was no significant difference between benign and malignant lesions in two dimensional sonogram (P 0.05). In the experimental group, there were 36 cases of malignant lesions, 4 cases of grade I, 11 cases of grade I, 17 cases of grade III, 14 cases of benign lesions, 5 cases of grade I, 6 cases of grade I, 2 cases of grade III, and 1 case of grade III. Compared with the distribution of color blood flow in benign and malignant lesions, the difference was statistically significant (P 0.05). 4. In the experimental group, there were 36 cases of malignant lesions, 17 cases of homogeneous enhancement, 19 cases of uneven enhancement, and 0 cases of no enhancement. Benign lesions in 14 cases, homogeneous enhancement in 10 cases, uneven enhancement in 3 cases, and no enhancement in 1 case. Compared with benign and malignant lesions, the difference was statistically significant (P 0.05). The average number of puncture needles was 1.38 鹵0.57 in the experimental group and 1.63 鹵0.63 in the control group. There was significant difference in the number of puncture needles between the two groups. Compared with the control group, the successful rate of puncture guided by real time contrast-enhanced ultrasound was significantly higher than that of two dimensional ultrasound with 8.955 and 0.003. The incidence of puncture complications in the two groups was significantly higher than that in the control group (P < 0. 040). Conclusion: the percutaneous lung puncture guided by real-time contrast-enhanced ultrasound can significantly improve the puncture success rate of peripulmonary space occupying lesions and provide a very important value for the diagnosis of clinical diseases.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1

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