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目的探讨多层螺旋CT(multislice computed tomography,MSCT)引导下经皮肺穿刺活检术(percutaneous transthoracic needle biopsy,PTNB)的临床价值和并发症因素分析。方法回顾川北医学院附属医院和重庆市垫江县人民医院2013年1月—2016年12月行MSCT引导下PTNB的179例肺部周围性结节患者,分析并发症的发生率及影响因素,总结穿刺活检结果及诊断准确率。结果 179例患者中,MSCT引导下PTNB检出129例恶性肿瘤,与手术切除病灶后的病理结果及临床保守治疗随访结果对照比较,总体诊断正确率93.30%,恶性肿瘤诊断正确率92.14%,主要并发症为气胸、肺出血、呼吸困难、咯血。并发症主要危险因素为病灶大小≤2 cm、距离膈面短径≤5 cm、穿刺深度>5 cm、穿刺胸膜角度>50°、穿刺次数≥2次、穿刺时间≥20 min、患者年龄>60岁、合并肺部疾病(P<0.05)。结论 MSCT引导下PTNB临床应用价值高,穿刺技术熟练、选择合适的穿刺方案有利于减少穿刺活检的并发症。
Objective To investigate the clinical value and complications of percutaneous transthoracic needle biopsy (PTNB) guided by multislice computed tomography (MSCT). Methods From January 2013 to December 2016, 179 patients with peripheral pulmonary nodules undergoing MSCT guided by PTBT in the affiliated hospital of North Sichuan Medical College and Dianjiang People’s Hospital of Chongqing were analyzed. The incidence and influencing factors of complications were analyzed. Summary puncture biopsy results and diagnostic accuracy. Results Among the 179 patients, 129 malignant tumors were detected by MSCT. Compared with the results of pathological resection and clinical follow-up, the overall diagnostic accuracy rate was 93.30%, and the malignant tumor diagnosis rate was 92.14%. The main Complications of pneumothorax, pulmonary hemorrhage, dyspnea, hemoptysis. The main risk factors for complications were ≤ 2 cm in lesion size, ≤ 5 cm in diameter from phrenic surface,> 5 cm in depth of puncture,> 50 ° in puncture of pleura, ≥ 2 in puncture, ≥ 20 min in puncture, and> 60 in patients Year old, with pulmonary disease (P <0.05). Conclusion The clinical application value of PTNB under the guidance of MSCT is high, and the technique of puncture is proficient. Selecting appropriate puncture protocol is helpful to reduce the complications of biopsy.