【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,約有150萬的患者死亡。在我國,肺癌是最常見的惡性腫瘤之一,其發(fā)病率及死亡率呈逐年上升趨勢。2008年衛(wèi)生部有關(guān)癌癥的統(tǒng)計數(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)的臨床報道少見�，F(xiàn)通過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)危險因素,探究該技術(shù)對肺部病變的臨床診斷價值。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)危險因素,探究該技術(shù)對肺部病變的臨床診斷價值。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患者進(jìn)行分組,運(yùn)用卡方檢驗(yàn)等統(tǒng)計方法對各組進(jìn)行比較分析,分析各種因素對該技術(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)測值為89.6%,陽性預(yù)測值為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、無放射性損傷的診斷手段,對肺部病變的診斷具有重要的臨床價值。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%,對肺部病變診斷的準(zhǔn)確率為94.6%,對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)測值、陽性預(yù)測值亦較高。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)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張永順;CT引導(dǎo)經(jīng)皮肺穿刺的掃描方法和技巧[J];放射學(xué)實(shí)踐;2001年06期

2 曹偉;郝敬明;趙寶忠;胡春艾;;CT引導(dǎo)經(jīng)皮肺穿刺活檢臨床應(yīng)用[J];醫(yī)藥產(chǎn)業(yè)資訊;2006年06期

3 何林;陳業(yè)通;;CT引導(dǎo)經(jīng)皮肺穿刺活檢85例臨床分析[J];微創(chuàng)醫(yī)學(xué);2010年02期

4 張改明,宋景蓮;X線導(dǎo)向經(jīng)皮肺穿刺活檢的護(hù)理[J];護(hù)士進(jìn)修雜志;1992年08期

5 呂蕾,范剛;CT導(dǎo)向經(jīng)皮肺穿刺活檢38例體會[J];鎮(zhèn)江醫(yī)學(xué)院學(xué)報;2000年04期

6 蔣德升,尚寧,姜靜,顧曉燕;經(jīng)皮肺穿刺活檢106例分析[J];江蘇醫(yī)藥;2001年03期

7 賈友明,張新;經(jīng)皮肺穿刺活檢有關(guān)問題探討[J];中華結(jié)核和呼吸雜志;2001年04期

8 曹躍勇,陳波,陳杰,刁顯明,胡明宗;CT導(dǎo)向經(jīng)皮肺穿刺活檢的臨床應(yīng)用(附35例報道)[J];瀘州醫(yī)學(xué)院學(xué)報;2002年05期

9 張和平,張晨;CT引導(dǎo)經(jīng)皮肺穿刺活檢的臨床應(yīng)用[J];中原醫(yī)刊;2002年03期

10 梁棟;CT引導(dǎo)經(jīng)皮肺穿刺活檢的臨床體會[J];南華大學(xué)學(xué)報(醫(yī)學(xué)版);2003年03期

相關(guān)會議論文 前10條

1 張斌;王東林;丁同文;靳國慶;龐言;;16層螺旋CT引導(dǎo)下經(jīng)皮肺穿刺活檢的診斷價值[A];河南省首屆腫瘤微創(chuàng)治療學(xué)術(shù)會議暨河南省抗癌協(xié)會腫瘤微創(chuàng)治療專業(yè)委員會成立大會論文匯編[C];2006年

2 王嵇;朱炯;池嘉昌;沈加林;許建榮;;DSA Innova CT重建在體表區(qū)域定位經(jīng)皮肺穿刺活檢術(shù)的應(yīng)用價值[A];2009中華醫(yī)學(xué)會影像技術(shù)分會第十七次全國學(xué)術(shù)大會論文集[C];2009年

3 劉鳳秀;黃學(xué)全;陳莉;;CT導(dǎo)向經(jīng)皮肺穿刺活檢應(yīng)用探討[A];2010中華醫(yī)學(xué)會影像技術(shù)分會第十八次全國學(xué)術(shù)大會論文集[C];2010年

4 陳勇;莊一平;沈文榮;;CT導(dǎo)向經(jīng)皮肺穿刺活檢術(shù)(附170例分析)[A];第三屆全國腫瘤介入大會暨腫瘤介入進(jìn)展學(xué)術(shù)研討會論文匯編[C];2005年

5 浦英彥;;經(jīng)皮肺穿刺活檢的護(hù)理配合及心理護(hù)理[A];2011年江蘇省中西醫(yī)結(jié)合學(xué)會老年醫(yī)學(xué)專業(yè)委員會學(xué)術(shù)年會暨中西醫(yī)結(jié)合老年醫(yī)學(xué)進(jìn)展學(xué)習(xí)班論文集[C];2011年

6 王友;張如春;浦英彥;;經(jīng)皮肺穿刺微波治療肺癌[A];第六屆全國老年醫(yī)學(xué)進(jìn)展學(xué)術(shù)會議論文集[C];2006年

7 錢麒鈺;馬希濤;;經(jīng)皮肺穿刺對確定無反應(yīng)肺炎病原體的臨床分析[A];中華醫(yī)學(xué)會呼吸病學(xué)年會——2013第十四次全國呼吸病學(xué)學(xué)術(shù)會議論文匯編[C];2013年

8 王愛玉;陳立斌;許幼峰;;超聲引導(dǎo)下經(jīng)皮肺穿刺活檢20例分析[A];第二屆長三角超聲醫(yī)學(xué)論壇暨2009年浙江省超聲醫(yī)學(xué)學(xué)術(shù)年會論文匯編[C];2009年

9 薛岑;龍啟忠;雷顯萍;;經(jīng)皮肺穿刺活檢與纖維支氣管鏡檢查在不明原因肺部病變診斷價值[A];中華醫(yī)學(xué)會呼吸病學(xué)年會——2011（第十二次全國呼吸病學(xué)學(xué)術(shù)會議）論文匯編[C];2011年

10 浦英彥;;經(jīng)皮肺穿刺微波治療肺癌的護(hù)理[A];第六屆全國老年醫(yī)學(xué)進(jìn)展學(xué)術(shù)會議論文集[C];2006年

相關(guān)碩士學(xué)位論文 前10條

1 王斌;CT引導(dǎo)經(jīng)皮肺穿刺活檢對肺部惡性腫瘤的臨床應(yīng)用價值及安全性分析[D];第三軍醫(yī)大學(xué);2015年

2 劉斌;二種方式的CT引導(dǎo)下經(jīng)皮肺穿刺活檢結(jié)果的比較[D];天津醫(yī)科大學(xué);2015年

3 李波;CT引導(dǎo)下經(jīng)皮穿刺肺活檢與外科手術(shù)獲得的肺癌標(biāo)本病理結(jié)果的差異[D];天津醫(yī)科大學(xué);2015年

4 王志敏;負(fù)壓墊固定CT引導(dǎo)下經(jīng)皮肺穿刺活檢的診斷價值及并發(fā)癥分析[D];重慶醫(yī)科大學(xué);2016年

5 黃立鵬;電磁導(dǎo)航經(jīng)皮肺穿刺動物實(shí)驗(yàn)研究[D];福建醫(yī)科大學(xué);2016年

6 柳騰;MR引導(dǎo)下經(jīng)皮肺穿刺活檢在肺部病變的診斷價值及并發(fā)癥分析[D];山東大學(xué);2017年

7 鄭靜;老年人CT引導(dǎo)下經(jīng)皮肺穿刺的安全性及影響因素分析[D];浙江大學(xué);2013年

8 葉菊貞;CT引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)在肺部占位性病變中的診斷價值[D];浙江大學(xué);2011年

9 樸范洙;CT引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)對肺部病變診治價值的研究[D];延邊大學(xué);2009年

10 段超;CT引導(dǎo)下經(jīng)皮肺穿刺活檢術(shù)對于肺癌的診斷價值[D];中國醫(yī)科大學(xué);2010年

，

本文編號：2267179