肺肿块超声引导穿刺活检与超声声像分析
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摘要
目的分析肺肿块超声引导经皮肺肿块穿刺活检结果及超声声像图特点,探讨超声引导穿刺活检以及超声检查在肺肿块良恶性诊断中的应用价值。方法对109例经X线及CT检查发现的周围型肺部肿块及中央型肿块伴肺实变患者应用超声引导经皮穿刺活检,分析患者穿刺活检病理结果、穿刺活检成功率,穿刺并发症以及超声声像图特征。结果 109例穿刺活检者,周围型肿块98例,中央型肿块伴肺实变9例,其中恶性病变81例(74.3%),良性病变26例(23.9%),2例不能成功取材(1.8%),余107例患者均一次取材成功(98.2%)。109例穿刺患者中,5例出现咯血(4.5%),其他无不适。超声声像图表现:良性病变多边界清楚、回声均匀,恶性病变多边界不清、回声不均匀(χ~2=2.422,P<0.05),但二者有一定交叉;恶性肿块较良性肿块大(t=1.58,P<0.05),但良恶性病变径线比较有一定交叉;恶性病变血流多较丰富而良性病变多为少血供或无血供(χ~2=8.471,P<0.05),但二者也有一定交叉。结论超声引导经皮肺肿块穿刺活检安全可靠,简便易行,对确定病理分型具有重要意义。超声声像图在肺周围型肿块及伴实变中央型肿块的良、恶性鉴别中具有一定特征性。
Objective Analysis of ultrasound guided percutaneous lung biopsy and ultrasound examination results,to explore the application value of ultrasound in the diagnosis of benign and malignant lung mass.Methods Application of percutaneous biopsy guided by ultrasound in 109 cases by X-ray and CT examination revealed lung mass patients,analysis of biopsy results and ultrasonographic characteristics,biopsy success rate and complication also be observed. Results The experimental group of 109 cases comprised 98 cases of peripheral mass and 9 cases of central mass with pulmonary consolidation,81 cases of malignant lesions(74.3%),26 cases benign lesions(23.9%),2 cases were falied(1.8%). 107 cases were success at first operation,and 5 cases had hemoptysis(incidence 3.8%). The echo types of malignant lesions and benign lesions had significant difference(χ~2=2.422,P < 0.05),but both of them had intersecting. Malignant lesions were larger than benign lesions(t = 1.58,P < 0.05),but the size of malignant lesions with benign lesions had intersecting. Patients with malignant lesions had more or abundant flow,patients with benign lesions had none or fewer flow(χ~2= 8.471,P < 0.05). but they also had intersecting. Conclusions Ultrasonography of benign and malignant lesions in peripheral pulmonary mass and central type with consolidation has certain characteristics. Ultrasound guided percutaneous lung biopsy has major value in determining the pathological type of lung mass and it is safe,reliable and easy to process.
Objective Analysis of ultrasound guided percutaneous lung biopsy and ultrasound examination results,to explore the application value of ultrasound in the diagnosis of benign and malignant lung mass.Methods Application of percutaneous biopsy guided by ultrasound in 109 cases by X-ray and CT examination revealed lung mass patients,analysis of biopsy results and ultrasonographic characteristics,biopsy success rate and complication also be observed. Results The experimental group of 109 cases comprised 98 cases of peripheral mass and 9 cases of central mass with pulmonary consolidation,81 cases of malignant lesions(74.3%),26 cases benign lesions(23.9%),2 cases were falied(1.8%). 107 cases were success at first operation,and 5 cases had hemoptysis(incidence 3.8%). The echo types of malignant lesions and benign lesions had significant difference(χ~2=2.422,P < 0.05),but both of them had intersecting. Malignant lesions were larger than benign lesions(t = 1.58,P < 0.05),but the size of malignant lesions with benign lesions had intersecting. Patients with malignant lesions had more or abundant flow,patients with benign lesions had none or fewer flow(χ~2= 8.471,P < 0.05). but they also had intersecting. Conclusions Ultrasonography of benign and malignant lesions in peripheral pulmonary mass and central type with consolidation has certain characteristics. Ultrasound guided percutaneous lung biopsy has major value in determining the pathological type of lung mass and it is safe,reliable and easy to process.
引文
[1]张红霞,何文,成晔,等.超声引导下肺外周占位病变穿刺活检技术方法探讨[J].中国介入影像与治疗学,2012,9(3):221-222.
[2]张波,尹波,孙华平,等.低剂量小范围CT引导下经皮肺穿刺活检小结节的临床应用[J].实用医学杂志,2016,32(21):3589-3592.
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[4]KANEKO M.Changes and current state of diagnosis of lung can-cer after development of the flexible bronchofiberscope[J].JpnJ Clin Oncol,2010,40(9):838-845.
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[6]颜瑾,周琪卉,宁雅静,等.53例CT引导下经皮肺穿刺活检临床分析[J].临床肺科杂志,2016,21(10):1814-1816.
[7]CHANSKY K,SCULIER J P,CROWLEY J J,et al.The inter-national association for the study of lung cancer staging project:prognostic factors andpathologic TNM stage in surgically man-aged non-small cell lung cancer[J].J Thorac Oncol,2009,4(7):792-801.
[8]刘丹,周爱云,张诚.超声造影诊断中央型肺癌并阻塞性肺实变1例[J].中国超声医学杂志,2016,32(7):673.
[9]杨慧慧,刘军杰,陈圆圆,等.超声引导下肺周围型病变穿刺活检成功率的影响因素分析[J].中国医学影像学杂志,2014,22(2):117-120.
[10]黄伟俊,邱懿德,黄婷,等.超声造影在经皮肺穿刺活检肺周围型病变中的临床研究[J].中华肺部疾病杂志:电子版,2014,7(1):37-40.
[11]杨志英,郑浩,张琦,等.超声引导经皮肺穿刺在周围型肺部病变诊断中的价值[J].临床肿瘤学杂志,2014,19(5):449-451.
[12]陈志明,吕梁,张家成,等.CT引导下经皮穿刺肺活检术诊断肺部弥漫性病变[J].中国医学影像技术,2010(3):556-558.
[13]付向宁,高淑英,张友耿,等.彩色多普勒对肺肿块的诊断价值探讨[J].中华结核和呼吸杂志,1994,17(3):173-174.
[2]张波,尹波,孙华平,等.低剂量小范围CT引导下经皮肺穿刺活检小结节的临床应用[J].实用医学杂志,2016,32(21):3589-3592.
[3]张诚,周爱云.实时超声造影引导经皮肺穿刺的应用价值[J].实用医学杂志,2013,29(18):3007-3009.
[4]KANEKO M.Changes and current state of diagnosis of lung can-cer after development of the flexible bronchofiberscope[J].JpnJ Clin Oncol,2010,40(9):838-845.
[5]金艺凤,产翠翠,田静,等.超声与CT引导下经皮肺穿刺活检诊断周围型肺癌的临床应用价值[J].临床超声医学杂志,2016,18(6):415-417.
[6]颜瑾,周琪卉,宁雅静,等.53例CT引导下经皮肺穿刺活检临床分析[J].临床肺科杂志,2016,21(10):1814-1816.
[7]CHANSKY K,SCULIER J P,CROWLEY J J,et al.The inter-national association for the study of lung cancer staging project:prognostic factors andpathologic TNM stage in surgically man-aged non-small cell lung cancer[J].J Thorac Oncol,2009,4(7):792-801.
[8]刘丹,周爱云,张诚.超声造影诊断中央型肺癌并阻塞性肺实变1例[J].中国超声医学杂志,2016,32(7):673.
[9]杨慧慧,刘军杰,陈圆圆,等.超声引导下肺周围型病变穿刺活检成功率的影响因素分析[J].中国医学影像学杂志,2014,22(2):117-120.
[10]黄伟俊,邱懿德,黄婷,等.超声造影在经皮肺穿刺活检肺周围型病变中的临床研究[J].中华肺部疾病杂志:电子版,2014,7(1):37-40.
[11]杨志英,郑浩,张琦,等.超声引导经皮肺穿刺在周围型肺部病变诊断中的价值[J].临床肿瘤学杂志,2014,19(5):449-451.
[12]陈志明,吕梁,张家成,等.CT引导下经皮穿刺肺活检术诊断肺部弥漫性病变[J].中国医学影像技术,2010(3):556-558.
[13]付向宁,高淑英,张友耿,等.彩色多普勒对肺肿块的诊断价值探讨[J].中华结核和呼吸杂志,1994,17(3):173-174.