本文選題：肺活檢　切入點：CBCT　出處：《廣州醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討C-arm cone-beam CT(CBCT)聯(lián)合iGuide引導(dǎo)系統(tǒng)在經(jīng)皮經(jīng)胸肺腫物穿刺活檢(percutaneous transthoracic needle biopsy PTNB)的診斷性能、并發(fā)癥及其可能的影響因素。材料和方法回顧性分析30例(30個肺腫物)進(jìn)行了PTNB手術(shù)的肺腫瘤患者(20例男性,10例女性;58.4歲±16.4[均數(shù)±標(biāo)準(zhǔn)差])。腫瘤平均直徑為3.4厘米±1.9(直徑范圍0.8-8.2厘米)。使用CBCT采集三維類CT多層平面重組圖像,通過iGuide導(dǎo)航系統(tǒng)仔細(xì)規(guī)劃穿刺路徑,利用18g同軸切割活檢針進(jìn)行活檢穿刺。統(tǒng)計診斷性能、手術(shù)細(xì)節(jié)、并發(fā)癥和患者射線暴露情況等指標(biāo),并比較分析各因素對診斷準(zhǔn)確性、并發(fā)癥可能存在的影響。結(jié)果在這30例患者中,病理結(jié)果顯示,24例(80%)診斷為惡性,6例(20%)為良性病變。在PTNB中,28例結(jié)節(jié)診斷正確,2例失敗(1例為取材不夠,1例為假陰性結(jié)果)。診斷準(zhǔn)確率、靈敏度、特異度、陽性預(yù)測值及陰性預(yù)測值分別為93%、96%、100%、100%及83%。對于診斷正確組及診斷錯誤組而言,實體瘤和磨玻璃樣腫瘤之間的診斷準(zhǔn)確率有差異性(p=0.023)。有6例(20%)患者術(shù)后發(fā)生氣胸,3例(10%)患者發(fā)生咯血。統(tǒng)計結(jié)果表明,穿刺途徑有無肺氣腫或肺大皰(p=0.001)及穿刺次數(shù)的不同(p=0.003),氣胸的發(fā)生率有顯著差異。而對于咯血及非咯血組,其年紀(jì)(p=0.009)、穿刺深度(p=0.041)、病灶內(nèi)部特點(p=0.009)及穿刺次數(shù)(p=0.022)的不同,其咯血的發(fā)生率也有顯著差異�？偟钠骄中g(shù)時間為13.0 min±3.6,平均有效輻射劑量為7.9 m Sv±4.6。結(jié)論應(yīng)用CBCT聯(lián)合iGuide引導(dǎo)系統(tǒng)在經(jīng)皮經(jīng)胸肺腫物穿刺活檢中具有較高的診斷準(zhǔn)確率和技術(shù)成功率以及合理的輻射暴露。
[Abstract]:Objective to investigate the diagnostic performance of C-arm cone-beam CTT combined with iGuide guidance system in percutaneous transthoracic needle biopsy PTNB (percutaneous transthoracic lung mass biopsy). Materials and methods A retrospective analysis of 30 patients (30 lung masses) with pulmonary tumors undergoing PTNB surgery was made in 20 patients with lung tumors, 10 males and 10 females, aged 58.4 years 鹵16.4 [mean 鹵standard deviation]. The mean diameter of the tumor was 3.4%. Meters 鹵1.9 (diameter range: 0.8-8.2 cm). CBCT was used to collect three-dimensional CT multi-slice planar reconstruction images, The iGuide navigation system was used to carefully plan the puncture path and 18g coaxial cut biopsy needle was used to perform the biopsy puncture. The diagnostic performance, operation details, complications and patients' radiographic exposure were statistically analyzed, and the diagnostic accuracy of each factor was compared and analyzed. The possible impact of complications. Results in these 30 patients, The pathological results showed that 24 cases were diagnosed as malignant and 20%) as benign lesions. In PTNB, 28 cases of nodules were diagnosed correctly and 2 cases failed, 1 case was false negative results, the diagnostic accuracy, sensitivity, specificity, accuracy, sensitivity, specificity, and accuracy of diagnosis. The positive predictive value and the negative predictive value were 100% and 83%, respectively. There was a difference in the diagnostic accuracy between solid tumor and ground glass tumor. There were 6 cases with pneumothorax and 3 cases with hemoptysis after operation. The incidence of pneumothorax was significantly different in the patients with hemoptysis or non-hemoptysis, the age of the patients with hemoptysis or non-hemoptysis, the depth of puncture, the depth of puncture, the internal features of the lesion, and the times of puncture p0.022). There was also significant difference in the incidence of hemoptysis. The total average operative time was 13.0 min 鹵3.6, and the average effective radiation dose was 7.9 mSv 鹵4.6. Conclusion CBCT combined with iGuide guidance system has a higher diagnostic accuracy in percutaneous transthoracic lung mass biopsy. Accuracy and technical success rate and reasonable radiation exposure.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2;R730.44

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 王鑫;柳林;朱坤;萬泰虎;荊濤;;DSA實時導(dǎo)向結(jié)合iGuide路徑引導(dǎo)及Dyna CT三維重建技術(shù)在經(jīng)皮穿刺肺結(jié)節(jié)的應(yīng)用[J];中國實驗診斷學(xué);2011年07期

2 譚小云;陳德基;;介入性磁共振臨床應(yīng)用的研究現(xiàn)狀[J];廣州醫(yī)學(xué)院學(xué)報;2008年03期

，

本文編號：1630598