老年患者胸部病变CT引导下穿刺活检的临床分析(1)
 |
 |
[摘要] 目的 探讨老年人群胸部病变CT引导下穿刺活检的价值和安全性。方法 128例行CT穿刺活检的老年胸部病变患者,含肺内病变115例,纵隔病变8例,胸膜病变5例。CT扫描确定并引导穿刺途径,达预定位置取材。回顾总结分析其诊断正确率及并发症发生率。结果 128例老年患者的胸部病变中最终诊断恶性106例,良性22例,CT引导下穿刺活检病理诊断的正确率为91.4%(117/128)。其中良、恶性病变的诊断正确率分别为75.0%(21/28)、90.6%(96/106),恶性病变病理分型的诊断正确率为91.7%(77/84)。23例出现并发症,总发生率为18.0%。包括气胸17例(13.3%),皮下气肿6例,纵隔气肿1例,肺内出血4例,发生率分别为13.3%、4.7%、0.8%、3.1%;无针道种植播散、肺扭转及空气栓塞等并发症发生。2例气胸患者需行闭式引流,其余患者无须特殊处理。结论 CT引导下穿刺活检术,在老年人群的胸部疾病中是一种安全、准确、有效的诊断及鉴别诊断手段。
[关键词] 胸部病变; 活检组织检查; 体层摄技术; X线计算机
, http://www.100md.com
[中图分类号] R446.8 [文献标识码] A [文章编号] 1673-9701(2009)23-08-04
Clinical Analysis of CT-guided Biopsy in Elderly Patients with Chest Disease
ZHENG Xi1 DING Mingchao1 CHENG Gang1 YANG Minghong2
1.Department of Radiology,Beijing Geriatrics Hospital,Haidian District,Beijing 100095,China;2.Hubu Hospital,Shandong 262303,China
[Abstract] ObjectiveTo study the value and safety of CT-guided percutaneous transthoracic biopsy in the elderly with chest diseases. MethodsWe used CT-guided biopsy for 128 elderly patients with chest diseases,of which 115 cases of lung disease,8 cases of mediastinal disease and 5 cases of pleural diseases. The way of guided puncture was determined by CT scan and when the needle reached the desired target,a tissue specimen was taken. The final diagnosis need to be confirmed by surgery,and pathology. The diagnostic accuracy rate and the incidence of complications were analyzed. ResultsIn the 128 elderly patients with chest diseases,the final diagnosis showed 106 cases of m alignant tumor and 22 cases of benign,with the correct diagnosis rate of CT-guided biopsy as 91.4%(117/128). The correct diagnosis rates of benign and m alignant lesions were 75.0%(21/28),and 90.6%(96/106),respectively and the diagnostic accuracy for pathological typing of the m alignant lesions was 91.7%(77/84). And 23 cases had complications. The total incidence was 18.0%,including 17 cases of pneumothorax(13.3%),6 cases of subcutaneous emphysema,1 case of mediastinal emphysema and 4 cases of pulmonary hemorrhage ,with the incidence of 13.3%,4.7%,0.8% and 3.1%,respectively. No complications like reverse pulmonary and air embolism were found. Drainage was required for 2 cases of pneumothorax,and the remaining patients needed no special treatment. ConclusionCT-guided biopsy in the elderly with chest diseases is a safe,accurate and effective diagnostic techniquee,and can also be used in the differential diagnosis.
, 百拇医药
[Key Words]Chest disease; Biopsy examination; Tomography; X-ray computer
CT引导下胸部病变穿刺活检作为一种微创诊断和鉴别诊断方法,越来越受到临床医师和影像医师的重视;并有较多文献讨论其应用价值和并发症的发生率[1-4]。但针对老年患者的胸部病变CT引导下穿刺活检分析尚无报道。文中回顾总结128例行CT引导下胸部病变穿刺活检的老年患者资料,探讨老年人群胸部病变CT引导下穿刺活检的价值和安全分析。
1 资料与方法
1.1 一般资料
2000年1月～2006年12月行CT引导下胸部病变穿刺活检的128例老年患者,男75例,女53例;年龄61～82 岁,平均年龄为(66.74±4.62)岁。病灶直径1.4～10.3cm,平均直径(4.82±1.31)cm;病灶位于上肺野39例,中肺野28例,下肺野48例,纵隔8例,胸膜5例。115例肺内病变中斑片状病变19例,见图1。单发结节或肿块病变78例,见图2。多发结节或弥漫性病变18例,见图3。病灶距离皮肤1.3～10.2cm,平均(5.23±1.82)cm;距离胸膜0～6.7cm,平均(2.12±0.62)cm。活检时仰卧位49例,侧卧位24例,俯卧位42例,斜卧位13例。气促分级0～3级,平均(1.82±0.89)级。, 百拇医药(郑 曦 丁明超 程 钢 杨明洪)