【摘要】：前言:肺癌,是起源于支氣管粘膜或者腺體的惡性腫瘤,是目前全球發(fā)病率及死亡率最高的惡性腫瘤之一。全球范圍內(nèi)每年平均新發(fā)肺癌約250萬(wàn),約有150萬(wàn)的患者死亡。在我國(guó),肺癌是最常見(jiàn)的惡性腫瘤之一,其發(fā)病率及死亡率呈逐年上升趨勢(shì)。2008年衛(wèi)生部有關(guān)癌癥的統(tǒng)計(jì)數(shù)據(jù)中顯示:因肺癌死亡的病例占惡性腫瘤死亡病例的22.7%,居惡性腫瘤死亡病例的首位。隨著大氣污染等環(huán)境因素日益加重,以及吸煙等個(gè)人非健康生活方式的影響,肺癌的發(fā)病率及死亡率可能會(huì)進(jìn)一步上升,嚴(yán)重威脅人們的健康及生命。因而,肺癌的早期診斷及治療越來(lái)越受到人們重視。隨著醫(yī)學(xué)影像技術(shù)的發(fā)展,特別是薄層胸部CT的廣泛應(yīng)用,越來(lái)越多的肺部小結(jié)節(jié)可被發(fā)現(xiàn),因而肺部病變的早期明確診斷越來(lái)越受到重視。目前肺部病變組織的獲得主要依靠纖維氣管鏡活檢,透視、B超、CT及MR引導(dǎo)下經(jīng)皮肺穿刺,超聲內(nèi)鏡引導(dǎo)下經(jīng)支氣管針吸活檢(EBUS)及經(jīng)胸腔鏡胸膜活檢等方法。目前關(guān)于MR引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)的臨床報(bào)道少見(jiàn)�，F(xiàn)通過(guò)回顧性研究山東省立醫(yī)院磁共振介入室行MR引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)的病例,分析MR引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)穿刺的成功率、并發(fā)癥的發(fā)生率及引起并發(fā)癥的相關(guān)危險(xiǎn)因素,探究該技術(shù)對(duì)肺部病變的臨床診斷價(jià)值。目的:分析MR引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)穿刺成功率、診斷的準(zhǔn)確率、靈敏度、特異度、并發(fā)癥的發(fā)生率及引起并發(fā)癥的相關(guān)危險(xiǎn)因素,探究該技術(shù)對(duì)肺部病變的臨床診斷價(jià)值。方法:依據(jù)嚴(yán)格的納入及排除標(biāo)準(zhǔn),回顧性選取2015年9月-2016年3月在山東省立醫(yī)院磁共振介入室行MR引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)病例221例。按照年齡、性別、病變大小、穿刺深度、病變性質(zhì)、病變形態(tài)、是否緊貼胸膜及是否合并肺氣腫等因素對(duì)患者進(jìn)行分組,運(yùn)用卡方檢驗(yàn)等統(tǒng)計(jì)方法對(duì)各組進(jìn)行比較分析,分析各種因素對(duì)該技術(shù)術(shù)后肺出血及氣胸等并發(fā)癥發(fā)生率的影響。結(jié)果:1、本研究中221例患者均一次穿刺取材成功,活檢成功率為1000%。2、穿刺病理診斷為惡性腫瘤155例,良性病變65例,壞死組織1例。經(jīng)胸外科手術(shù)后病理診斷、臨床治療效果或隨訪觀察最終診斷為惡性腫瘤165例,良性病變56例。3、穿刺結(jié)果的準(zhǔn)確率為94.6%,特異度為100%,靈敏度為93.9%,陰性預(yù)測(cè)值為89.6%,陽(yáng)性預(yù)測(cè)值為100%。4、術(shù)后肺出血52例(23.5%),與術(shù)后肺出血發(fā)生的相關(guān)危險(xiǎn)因素有:病變形態(tài)、病變大小、是否緊貼胸膜(p0.05);術(shù)后氣胸22例(10%),與氣胸發(fā)生的相關(guān)危險(xiǎn)因素有:穿刺進(jìn)針的深度以及術(shù)前是否合并肺氣腫(p0.05)。結(jié)論:1、MR引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)是一種微創(chuàng)的、無(wú)放射性損傷的診斷手段,對(duì)肺部病變的診斷具有重要的臨床價(jià)值。2、本研究中MR引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)穿刺成功率為100%,對(duì)肺部病變?cè)\斷的準(zhǔn)確率為94.6%,對(duì)惡性腫瘤診斷的靈敏度及特異度分別為93.9%、100%。準(zhǔn)確率、靈敏度、特異度均較高,陰性預(yù)測(cè)值、陽(yáng)性預(yù)測(cè)值亦較高。3、MR引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)具有創(chuàng)傷小、安全性高、并發(fā)癥少的優(yōu)點(diǎn)。術(shù)后主要并發(fā)癥為肺出血和氣胸,其中與肺出血發(fā)生相關(guān)的危險(xiǎn)因素包括病變形態(tài)、病變大小和是否緊貼胸膜;與氣胸發(fā)生相關(guān)的危險(xiǎn)因素包括穿刺進(jìn)針的深度以及是否合并肺氣腫。
[Abstract]:Lung cancer, a malignant tumor originating in the bronchial mucosa or gland, is one of the most common malignant tumors in the world. Globally, about 2.5 million new lung cancer is produced annually and about 1.5 million patients die. Lung cancer is one of the most common malignant tumors in China. The incidence and mortality of lung cancer are increasing year by year. In 2008, the Ministry of Health's statistics on cancer showed that the death of lung cancer accounted for 22. 7% of the death cases of malignant tumor. With the increasing of environmental factors such as air pollution and the influence of non-healthy lifestyle such as smoking, the incidence and death rate of lung cancer may rise further, threatening people's health and life seriously. As a result, early diagnosis and treatment of lung cancer are becoming more and more important. With the development of medical image technology, especially the wide application of thin-layer chest CT, more and more pulmonary nodules can be found. At present, the acquisition of lung lesions mainly relies on fiber bronchoscope biopsy, perspective, B-ultrasound, CT and MR guided percutaneous lung puncture, ultrasound endoscope guided percutaneous aspiration biopsy (EBUS) and thoracoscopic pleural biopsy. At present, clinical reports on percutaneous lung puncture biopsy under MR guidance are rare. The success rate, the incidence of complications and the related risk factors of complications were analyzed retrospectively by retrospective study of percutaneous lung puncture biopsy under MR-guided percutaneous lung biopsy in Shandong province. To explore the clinical diagnostic value of the technique on pulmonary lesions. Objective: To investigate the diagnostic accuracy, sensitivity, specificity, complication rate and risk factors of complications associated with percutaneous lung puncture biopsy under MR guidance. Methods: 221 cases were retrospectively selected from September 2015 to March 2016 under the guidance of MR-guided percutaneous lung biopsy in Shandong province. The patients were grouped according to age, sex, lesion size, puncture depth, pathological nature, lesion morphology, whether close to the pleura and whether or not emphysema were combined, and the groups were compared and analyzed by using statistical methods such as card square test and so on. The effects of various factors on the incidence of postoperative pulmonary hemorrhage and pneumothorax were analyzed. Results: 1. The success rate of biopsy was 1000% in 221 patients in this study. The pathological diagnosis of puncture was 155 cases of malignant tumor, 65 cases of benign lesion and 1 case of necrotic tissue. The accuracy rate of the puncture was 94.6%, the specificity was 100%, the sensitivity was 93.9%, the negative predictive value was 89.6%, and the positive predictive value was 100%. There were 52 cases (23. 5%) of postoperative pulmonary hemorrhage. The risk factors associated with postoperative pulmonary hemorrhage were: lesion morphology, size of lesion, whether it was close to pleura (P0.05), postoperative pneumothorax in 22 cases (10%), and related risk factors related to pneumothorax: The depth of the puncture needle and the presence of emphysema prior to operation (SPC.05). Conclusion: 1. Percutaneous lung puncture biopsy under MR guidance is a kind of minimally invasive and non-radioactive diagnostic method, which has important clinical value for the diagnosis of pulmonary disease. The accuracy of diagnosis of lung lesions was 94.6%, and the sensitivity and specificity of diagnosis of malignant tumors were 93. 9% and 100%, respectively. Accuracy, sensitivity, specificity were higher, negative predictive value and positive predictive value were higher. The major complications after operation were pulmonary hemorrhage and pneumothorax, in which the risk factors associated with the occurrence of pulmonary hemorrhage included lesion morphology, lesion size, and whether it was snug against the pleura; the risk factors associated with the occurrence of pneumothorax included the depth of the puncture needle and whether it was combined with emphysema.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2

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