【摘要】：目的:比較常規(guī)超聲及超聲造影對肝實性占位病變的診斷價值,并探討二者引導經(jīng)皮肝臟穿刺活檢的準確率及其影響因素。方法:本研究選取2012年6月-2016年6月就診于我院的肝實性占位病變患者,共89例,95個病灶,將其隨機分為常規(guī)組及造影組,其中常規(guī)組53個病灶,造影組42個病灶,將常規(guī)組及造影組診斷結果與病理結果、穿刺結果與病理結果分別進行比較,并分析病灶基本情況對穿刺結果的影響。結果:常規(guī)組診斷準確率為71.6%,造影組診斷準確率為90.5%,兩組準確率比較,(?)~2=5.164,P0.05,差異具有統(tǒng)計學意義;常規(guī)組診斷敏感性為75.6%,造影組診斷敏感性為91.2%,兩組數(shù)據(jù)敏感性比較,(?)~2=3.143,P(29)0.05,差異不具有統(tǒng)計學意義;常規(guī)組診斷特異性為58.3%,造影組診斷特異性為87.5%,兩組數(shù)據(jù)特異性比較,(?)~2=5.787,P0.05,差異具有統(tǒng)計學意義。常規(guī)組穿刺準確率為77.4%,造影組穿刺準確率為95.2%,兩組數(shù)據(jù)準確率比較,(?)~2=5.691,P0.05,差異具有統(tǒng)計學意義;常規(guī)組穿刺敏感性為80.5%,造影組穿刺敏感性為97.1%,兩組數(shù)據(jù)敏感性比較,(?)~2=4.833,P0.05,差異具有統(tǒng)計學意義;常規(guī)組穿刺特異性為66.7%,造影組穿刺特異性為87.5%,兩組數(shù)據(jù)特異性比較,(?)~2=1.111,P(29)0.05,差異不具有統(tǒng)計學意義。常規(guī)組病灶直徑2cm者與直徑≥2cm者穿刺準確率分別為31.25%,97.2%,比較兩組穿刺準確率,(?)~2=27.819,P0.05,差異具有統(tǒng)計學意義;當病灶直徑2cm時,造影組穿刺準確率為90.9%,常規(guī)組穿刺準確率為31.25%,比較兩組穿刺準確率,(?)~2=9.396,P0.05,差異具有統(tǒng)計學意義。常規(guī)組病灶邊界清晰者與邊界不清晰者穿刺準確率分別為93.1%、58.3%,比較兩組穿刺準確率,(?)~2=9.064,P0.05,差異具有統(tǒng)計學意義;當病灶邊界不清晰時,造影組穿刺準確率為94.7%,常規(guī)組穿刺準確率為58.3%,比較兩組穿刺準確率,(?)~2=7.382,P0.05,差異具有統(tǒng)計學意義。常規(guī)組病灶內部回聲均勻者與內部回聲不均勻者穿刺準確率分別為95.2%、65.6%,比較兩組穿刺準確率,(?)~2=6.348,P0.05,差異具有統(tǒng)計學意義;當病灶內部回聲不均勻時,造影組穿刺準確率為95.0%,常規(guī)組穿刺準確率為65.6%,比較兩組穿刺準確率,(?)~2=5.983,P0.05,差異具有統(tǒng)計學意義。常規(guī)組病灶距肝臟表面≥5cm者與距肝臟表面5cm者穿刺準確率分別為60.7%、96.0%,比較兩組穿刺準確率,(?)~2=9.389,P0.05,差異具有統(tǒng)計學意義;當病灶距離肝臟表面≥5cm時,造影組穿刺準確率為94.4%,常規(guī)組穿刺準確率為60.7%,比較兩組穿刺準確率,(?)~2=6.465,P0.05,差異具有統(tǒng)計學意義。常規(guī)組病灶背景肝實質伴肝硬化者與背景肝實質不伴肝硬化者穿刺準確率分別為55.0%、90.9%,比較兩組穿刺準確率,(?)~2=9.168,P0.05,差異具有統(tǒng)計學意義;當病灶背景肝實質伴有肝硬化時,造影組穿刺準確率為94.4%,常規(guī)組穿刺準確率為55.0%,比較兩組穿刺準確率,(?)~2=7.602,P0.05,差異具有統(tǒng)計學意義。結論:超聲造影對肝臟實性占位性病變診斷準確率較常規(guī)超聲高;超聲造影引導經(jīng)皮肝實性占位病變穿刺活檢準確率較常規(guī)超聲高;常規(guī)超聲引導肝實性占位病變穿刺活檢時,直徑≥2cm者較直徑2cm者穿刺活檢準確率高;邊界清晰者較邊界不清晰者穿刺活檢準確率高;內部回聲均勻者較內部回聲不均者穿刺活檢準確率高;穿刺深度5cm者較穿刺深度≥5cm者穿刺活檢準確率高;背景肝實質不伴肝硬化者較伴肝硬化者穿刺活檢準確率高。當肝實性占位病變直徑2cm、邊界不清晰、內部回聲不均勻、穿刺深度≥5cm、背景肝實質伴肝硬化時,超聲造影引導穿刺活檢準確率高于常規(guī)超聲。
[Abstract]:Objective: To compare the diagnostic value of conventional ultrasound and ultrasound in the diagnosis of liver-solid occupying lesions, and to explore the accuracy and the influencing factors of the guided percutaneous liver biopsy. Methods: From June 2012 to June, 2016, 89 cases and 95 lesions were randomly divided into the normal group and the contrast group, among which 53 lesions and 42 lesions in the normal group were randomly divided into the normal group and the contrast group. The results of the diagnosis and the pathological results of the conventional group and the contrast group were compared, and the effect of the basic condition of the lesion on the results of the puncture was analyzed. Results: The diagnostic accuracy of routine group was 71.6%, and the diagnostic accuracy of contrast group was 90. 5%. The diagnostic sensitivity of the conventional group was 75.6%, the diagnostic sensitivity of the contrast group was 91.2%, and the data sensitivity of the two groups was compared, (? (2 = 3.143, P (29) 0.05, the difference was not statistically significant; the diagnostic specificity of the conventional group was 58.3%, the diagnostic specificity of the contrast group was 87.5%, and the two groups of data were specifically compared, (? () ~ 2 = 5.787, P0.05, the difference was of statistical significance. The accuracy of the puncture in the conventional group was 70.4%, the accuracy of the puncture in the contrast group was 95.2%, and the accuracy of the two groups of data was more accurate (? 2 = 5.691, P0.05, the difference was statistically significant; the sensitivity of the conventional group was 80.5%, the puncture sensitivity of the contrast group was 97.1%, and the data sensitivity of the two groups was compared, (? () ~ 2 = 4.833, P0.05, the difference was of statistical significance; the puncture specificity of the conventional group was 65.7%, the puncture specificity of the contrast group was 87.5%, and the two groups of data were specifically compared, (? () ~ 2 = 1.111, P (29) 0.05, the difference was not statistically significant. The accuracy of the puncture was 31. 25% and 97. 2% in the conventional group with the diameter of 2 cm and the diameter of 2 cm, and the accuracy of the two groups was compared. 2 = 27. 819, P 0.05, the difference was of statistical significance; when the diameter of the lesion was 2 cm, the puncture rate of the contrast group was 90.9%, the accuracy of the conventional group was 31. 25%, and the accuracy of the two groups was compared with that of the two groups (? () ~ 2 = 9.396, P0.05, the difference was of statistical significance. The accuracy of the puncture was 93.1% and 58.3%, respectively, and the accuracy of the two groups was compared in the conventional group. 2 = 9.064, P0.05, the difference was statistically significant; when the boundary of the lesion was not clear, the puncture rate of the contrast group was 94.7%, the accuracy of the conventional group was 58.3%, and the accuracy of the two groups was compared. () ~ 2 = 7.382, P0.05, the difference was of statistical significance. The accuracy of the puncture was 95.2% and 65.6%, respectively, and the accuracy of the two groups was compared in the conventional group. 2 = 6.348, P0.05, the difference was statistically significant; when the internal echo of the lesion was not uniform, the accuracy of the puncture of the contrast group was 90.0%, the accuracy of the conventional group was 65.6%, and the accuracy of the two groups was compared. () ~ 2 = 5.983, P0.05, the difference was of statistical significance. The accuracy of the puncture was 60.7% and 96.0%, respectively, compared with that of the 5cm from the surface of the liver, and the accuracy of the two groups was compared. 2 = 9.389, P0.05, the difference was statistically significant; when the focus distance was 5cm from the surface of the liver, the puncture rate of the contrast group was 94.4%, the accuracy of the conventional group was 60.7%, and the accuracy of the two groups was compared with that of the two groups (? () ~ 2 = 6.465, P0.05, the difference was of statistical significance. The accuracy of the puncture was 55. 0% and 90. 9%, respectively, and the accuracy of the two groups was compared between the two groups. (2 = 9.168, P <0.05). The accuracy of the puncture was 94.4% in contrast group and 52.0% in the conventional group, and the accuracy of the two groups was compared with that of the two groups (? () ~ 2 = 7.602, P0.05, the difference was of statistical significance. Conclusion: The accuracy of ultrasound contrast in the diagnosis of the real occupying lesion of the liver is higher than that of the conventional ultrasound. The accuracy of the ultrasound contrast-guided percutaneous biopsy is higher than that of the conventional method. The accuracy of the biopsy with a diameter of 2 cm was high, the accuracy of the biopsy was high, the accuracy of the biopsy was high, and the accuracy of the puncture biopsy of the inner echo was higher than that of the inner echo. The accuracy of the biopsy with the puncture depth of 5cm was higher than that of the puncture depth of 5cm. Background: The accuracy of the biopsy with liver cirrhosis is higher than that of the patients with liver cirrhosis. When the diameter of the solid occupying lesion was 2cm, the boundary was not clear, the internal echo was not uniform, the depth of the puncture was 5cm, and the accuracy of the ultrasound-guided puncture biopsy was higher than that of the conventional ultrasound in the case of liver parenchyma with liver cirrhosis.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R735.7

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