本文關(guān)鍵詞：二種方式的CT引導(dǎo)下經(jīng)皮肺穿刺活檢結(jié)果的比較　出處：《天津醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

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【摘要】：目的:比較增強(qiáng)CT和常規(guī)CT掃描引導(dǎo)下經(jīng)皮肺穿刺肺活檢術(shù)的取材的滿意率、病理陽(yáng)性率、惡性病灶的檢出率、感染性疾病病原學(xué)的檢出率以及并發(fā)癥的發(fā)生率等結(jié)果。探討增強(qiáng)CT引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)的臨床應(yīng)用價(jià)值,探討增強(qiáng)CT引導(dǎo)下的單純抽吸活檢的臨床應(yīng)用價(jià)值。方法:采用回顧性研究的方法,回顧自2005年7月~2014年7月于天津市胸科醫(yī)院符合納入標(biāo)準(zhǔn)的423例接受CT引導(dǎo)下經(jīng)皮肺穿刺活檢患者的臨床資料。比較常規(guī)CT組和增強(qiáng)CT組患者在標(biāo)本獲取的滿意率、病理陽(yáng)性率、肺惡性病灶的檢出率、感染性疾病病原學(xué)的檢出率、平均活檢次數(shù)、更換穿刺點(diǎn)的患者比例和并發(fā)癥的差異。對(duì)增強(qiáng)CT組中未進(jìn)行彈簧針切割活檢僅給予空針負(fù)壓抽吸活檢的少部分患者的結(jié)果進(jìn)行統(tǒng)計(jì)分析。結(jié)果:1、共有423例患者納入研究,男257例,女166例。年齡22~85歲,平均年齡61.71歲。其中常規(guī)CT組178例,增強(qiáng)CT組245例。423例中病灶位于胸膜下者259例,遠(yuǎn)離胸膜(病灶不貼近胸壁穿刺針必須穿過(guò)正常肺組織)者164例;小病灶(病灶最大直徑2 cm)23例,合并慢性阻塞性肺疾病(COPD)85例,合并肺纖維化15例。兩組在性別、年齡、小病灶比例,遠(yuǎn)離胸膜病灶的比例,合并肺氣腫患者的比例以及合并肺纖維化患者的比例均無(wú)顯著性差異(P0.05)。2增強(qiáng)CT組和常規(guī)CT組彈簧針取材滿意率分別為90.13%和73.60%,差異有統(tǒng)計(jì)學(xué)意義(P0.01)3增強(qiáng)CT組和常規(guī)CT組病理的陽(yáng)性率分別為76.62%和63.36%,差異有統(tǒng)計(jì)學(xué)意義(P0.01)4增強(qiáng)CT組和常規(guī)CT組肺惡性病灶檢出率以及感染性疾病病原學(xué)檢出率的差異有統(tǒng)計(jì)學(xué)意義(94.51%vs85.00%,56.14%vs34.69%,P0.05)。5增強(qiáng)CT組和常規(guī)CT組的平均活檢次數(shù)及更換穿刺點(diǎn)患者比例的差異有統(tǒng)計(jì)學(xué)意義(3.08±1.05 vs3.75±1.34,8.52%vs 18.54%,均P0.01)。6增強(qiáng)CT組和常規(guī)CT組氣胸和出血的發(fā)生率的差異有統(tǒng)計(jì)學(xué)意義(15.51%vs 27.53%,7.76%vs 14.04%,P0.05)。7在增強(qiáng)CT組中有22例患者單用針吸活檢,其中13例陽(yáng)性均為肺癌,陽(yáng)性率59.09%。結(jié)論:增強(qiáng)CT引導(dǎo)下經(jīng)皮穿刺肺活檢取材滿意率高,更容易獲得病理陽(yáng)性結(jié)果,疾病檢出率高,有利于合理高效的選擇檢驗(yàn)方法,減少活檢次數(shù),并發(fā)癥少,安全并且值得推廣。在特殊情況下為了規(guī)避風(fēng)險(xiǎn)如果不宜行彈簧針切割活檢而單用空針抽吸也能夠獲得陽(yáng)性結(jié)果,有較高的應(yīng)用價(jià)值。但該方法不適用于造影劑過(guò)敏、甲狀腺功能亢進(jìn)、腎功能不全以及因糖尿病近期口服二甲雙胍的患者。
[Abstract]:Objective: To compare the satisfaction rate, the positive rate of Pathology, the detection rate of malignant lesions, the detectable rate of infectious diseases and the incidence of complications between enhanced CT and conventional CT guided percutaneous lung biopsy. To explore the clinical value of percutaneous lung biopsy under the guidance of enhanced CT and to explore the clinical value of simple aspiration biopsy under the guidance of enhanced CT. Methods: a retrospective study was conducted to review the clinical data of 423 patients who received CT guided percutaneous lung biopsy in Tianjin Thoracic Hospital from July July 2005 to July. The satisfaction rate, the positive rate of Pathology, the detection rate of lung malignancy, the detection rate of infectious diseases, the average number of biopsy times, the proportion of patients who changed the puncture point and the difference of complications between the routine CT group and the enhanced CT group were compared. The results of a few patients who were only given an empty needle negative pressure aspiration biopsy without a needle biopsy in the enhanced CT group were analyzed. Results: 1. A total of 423 patients were included in the study, 257 men and 166 women. Age 22~85 years, the average age of 61.71 years. Among them, there were 178 cases in the routine CT group and 245 in the enhanced CT group. 259 cases of pleural lesions located in 423 cases, away from the pleura (lesion is not close to the chest wall puncture needle must pass through the normal lung tissue) in 164 cases; small lesions (maximum lesion diameter of 2 cm) in 23 cases, complicated with chronic obstructive pulmonary disease (COPD) in 85 cases, 15 cases with pulmonary fibrosis. There was no significant difference between the two groups in sex, age, proportion of small lesions, far from the pleura lesions, the proportion of patients with emphysema and the proportion of patients with pulmonary fibrosis (P0.05). 2 enhanced CT group and conventional group CT spring needle materials satisfaction rate were 90.13% and 73.60%, the difference was statistically significant (P0.01 3) to enhance the positive rate of CT group and routine group CT pathology were 76.62% and 63.36%, the difference was statistically significant (P0.01) between the 4 enhanced malignant lesions in CT group and normal CT group lung detection the rate of infectious disease and pathogen detection rate was statistically significant (94.51%vs85.00%, 56.14%vs34.69%, P0.05). 5, the average number of biopsies in the CT group and the conventional CT group was significantly different from that in the conventional group vs3.75 (3.08 + 1.05 vs3.75 + 1.34,8.52%vs 18.54%, all P0.01). 6 there was significant difference in the incidence of pneumothorax and bleeding between the enhanced CT group and the routine CT group (15.51%vs 27.53%, 7.76%vs 14.04%, P0.05). 7 in the enhanced CT group, 22 patients had a single needle aspiration biopsy, and 13 of them were lung cancer with a positive rate of 59.09%. Conclusion: enhanced CT guided percutaneous lung biopsy has higher satisfaction rate, and is more likely to get pathological positive results. The disease detection rate is high, which is conducive to rational and efficient selection of test methods, fewer biopsy times, fewer complications, and is safe and worthy of promotion. In the special case, in order to avoid the risk, if the needle aspiration biopsy is not suitable for the needle, the positive results can be obtained by air needle aspiration alone. It is of high application value. However, this method does not apply to patients with contrast agent allergy, hyperthyroidism, renal insufficiency, and recent oral metformin for diabetes.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R816.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 敬文斌;原明選;;增強(qiáng)掃描在CT引導(dǎo)下對(duì)肺周?chē)圆∽兇┐袒顧z的臨床價(jià)值[J];吉林醫(yī)學(xué);2011年35期

2 楊賢衛(wèi);周偉生;何蓉;;CT引導(dǎo)下經(jīng)皮肺穿刺切割活檢對(duì)肺部病變的診斷價(jià)值[J];中國(guó)介入影像與治療學(xué);2006年03期

3 涂紅纓;李淑玲;;CT引導(dǎo)下經(jīng)皮肺穿刺活檢和B超引導(dǎo)下經(jīng)皮肺穿刺活檢在肺周?chē)约膊≈袘?yīng)用的比較[J];中國(guó)實(shí)用醫(yī)藥;2010年16期

4 趙振軍,梁長(zhǎng)虹,謝淑飛,何暉,茹光騰;多層螺旋CT肺灌注對(duì)肺腫瘤的診斷價(jià)值[J];中國(guó)醫(yī)學(xué)影像技術(shù);2004年02期

，

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