惠俊國(guó) 肖揚(yáng)銳 高瑞杰 夏水偉
[摘要] 目的 探討超聲與CT引導(dǎo)下經(jīng)皮肺穿刺活檢診斷周圍型肺癌的臨床應(yīng)用及對(duì)咯血發(fā)生率的影響。 方法 選取168例疑似周圍型肺癌患者作為研究對(duì)象,使用抽簽法,隨機(jī)分為對(duì)照組與實(shí)驗(yàn)組,分別為51例與117例,給予對(duì)照組患者超聲引導(dǎo),給予實(shí)驗(yàn)組患者CT引導(dǎo)。對(duì)其臨床資料進(jìn)行回顧分析,對(duì)比兩組患者確診率與咯血發(fā)生率,使用統(tǒng)計(jì)學(xué)進(jìn)行分析。 結(jié)果 實(shí)驗(yàn)組診斷胰癌71例、鱗癌27例、小細(xì)胞癌6例、差分化癌1例;對(duì)照組診斷胰癌33例、鱗癌5例、小細(xì)胞癌6例、差分化癌0例,對(duì)照組患者與實(shí)驗(yàn)組患者周圍型肺癌確診率比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。對(duì)照組患者的咯血發(fā)生率7.84%與氣胸發(fā)生率3.92%,與實(shí)驗(yàn)組患者比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。針對(duì)兩組的診斷情況進(jìn)行調(diào)查發(fā)現(xiàn),實(shí)驗(yàn)組患者的滿意率為95.73%,高于對(duì)照組(90.20%),組間比較無統(tǒng)計(jì)學(xué)意義(P>0.05)。 結(jié)論 選超聲與CT引導(dǎo)對(duì)周圍型肺癌患者經(jīng)皮肺穿刺活檢均具有較高的準(zhǔn)確率,咯血的發(fā)病率較低,均值得臨床上推廣及使用。
[關(guān)鍵詞] 超聲;CT;引導(dǎo);皮肺穿刺活檢;周圍型肺癌;咯血發(fā)生率
[中圖分類號(hào)] R445.1;R734.2;R730.44 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 1673-9701(2018)32-0119-03
Clinical application of ultrasound and CT guided percutaneous lung needle biopsy in the diagnosis of peripheral lung cancer and its effect on the incidence rate of hemoptysis
HUI Junguo XIAO Yangrui GAO Ruijie XIA Shuiwei
Department of Radiology, the Central Hospital of Lishui City in Zhejiang Province, Lishui 323000, China
[Abstract] Objective To investigate the clinical application of ultrasound and CT-guided percutaneous lung needle biopsy in the diagnosis of peripheral lung cancer and its effects on the incidence rate of hemoptysis. Methods 168 patients with suspected peripheral lung cancer were selected as study subjects. The method of drawing lots was used, and the patients were randomly divided into the control group and the experimental group, with 51 cases and 117 cases in each group respectively. The control group was given ultrasound guidance, and the experimental group was given CT guidance. The clinical data were retrospectively analyzed. The diagnosis rate and the incidence rate of hemoptysis were compared between the two groups, and statistical analysis was carried out. Results In the experimental group, there were 71 cases of pancreatic cancer, 27 cases of squamous cell carcinoma, 6 cases of small cell carcinoma, and 1 case of differentiated carcinoma. In the control group, there were 33 cases of pancreatic cancer, 5 cases of squamous cell carcinoma, 6 cases of small cell carcinoma, and 0 case of differentiated carcinoma. There was no statistically significant difference in the diagnosis rate of peripheral lung cancer between the control group and the experimental group(P>0.05). In the control group, the incidence rate of hemoptysis was 7.84% and the incidence rate of pneumothorax was 3.92%. There was no statistically significant difference compared with those in the experimental group(P>0.05). According to the investigation of the diagnosis of the two groups, the satisfaction rate in the experimental group was 95.73%, which was higher than that in the control group(90.20%). There was no statistically significant difference between the two groups(P>0.05). Conclusion Ultrasound and CT guidance for percutaneous lung needle biopsy have a higher accuracy in the diagnosis of patients with peripheral lung cancer. The incidence rate of hemoptysis is low, and it is worthy of clinical promotion and application.
[Key words] Ultrasound; CT; Guidance; Percutaneous lung needle biopsy; Peripheral lung cancer; Incidence rate of hemoptysis
肺癌是一種常見的惡性腫瘤,具有發(fā)病率高、死亡率高的特點(diǎn),肺癌的臨床癥狀會(huì)受到部位、轉(zhuǎn)移、并發(fā)癥等因素影響,表現(xiàn)復(fù)雜,早期無明顯的臨床表現(xiàn)[1]。肺癌分為中央型與周圍型,中央型肺癌的癥狀常會(huì)在發(fā)病早期出現(xiàn),且比較重,但是周圍型肺癌的臨床癥狀往往出現(xiàn)較晚且癥狀不明顯[2]。臨床上常使用CT與超聲引導(dǎo)經(jīng)皮肺穿刺活檢對(duì)周圍型肺癌進(jìn)行診斷,本文對(duì)我院168例疑似周圍型肺癌患者進(jìn)行分析,現(xiàn)報(bào)道如下。
1 資料與方法
1.1 一般資料
選取2016年5月~2017年11月168例疑似周圍型肺癌患者作為研究對(duì)象。納入標(biāo)準(zhǔn):所有患者均經(jīng)CT檢測(cè),出現(xiàn)周圍型肺部病變;使用常規(guī)痰檢未確診,符合本次研究的標(biāo)準(zhǔn),并表示自愿參加本次研究。排除標(biāo)準(zhǔn):排除嚴(yán)重咯血、肺氣腫、心臟功能不全、肺動(dòng)脈高壓、精神疾病等患者[3]。使用抽簽法,隨機(jī)分為對(duì)照組與實(shí)驗(yàn)組,分別為51例與117例。其中對(duì)照組男32例、女19例;年齡38~80歲,平均(57.85±5.71)歲。實(shí)驗(yàn)組男76例、女41例;年齡40~82歲,平均(58.01±5.35)歲。兩組患者的性別、年齡等資料對(duì)比無統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性。
1.2 方法
1.2.1 對(duì)照組 給予對(duì)照組患者超聲引導(dǎo):使用的超聲設(shè)備為彩色多普勒超聲診斷儀,型號(hào)為東芝SSD240。具體操作為:對(duì)患者進(jìn)行胸部CT檢測(cè),確定病灶的具體位置,使用超聲探頭對(duì)患者肺部病變的具體情況進(jìn)行探查,其中包括部位、至胸壁的距離以及組織關(guān)系,以便確定進(jìn)針的部位、路徑、深度以及角度。對(duì)穿刺的部位進(jìn)行常規(guī)消毒,并鋪墊洞巾,使用麻醉劑進(jìn)行局部麻醉,核對(duì)穿刺點(diǎn)、路徑、深度以及角度,在超聲檢測(cè)下進(jìn)行穿刺活檢,以及對(duì)組織一般活檢2~3次,使用甲醛溶液(濃度為10%)將穿刺組織進(jìn)行固定,送去檢測(cè)病理[3]。
1.2.2 實(shí)驗(yàn)組 給予實(shí)驗(yàn)組患者CT引導(dǎo):使用的CT設(shè)備為32排螺旋CT機(jī),型號(hào)為西門子。對(duì)患者進(jìn)行胸部CT檢測(cè),確定病灶的具體位置,以便確定穿刺的位置與進(jìn)針部位。根據(jù)患者的實(shí)際情況,使患者保持有利的體位,以每層3 mm的方式對(duì)患者的病灶進(jìn)行掃描。對(duì)病灶處的體表使用金屬條進(jìn)行定位并掃描,確定最合適的穿刺點(diǎn)、進(jìn)針的距離、進(jìn)針的角度、進(jìn)針的深度。對(duì)穿刺的部位進(jìn)行常規(guī)消毒,并鋪墊洞巾,使用浸潤(rùn)麻醉(濃度為2%的利多卡因)進(jìn)行麻醉,進(jìn)行病理活檢2~4次,使用甲醛溶液(濃度為10%)將穿刺組織進(jìn)行固定,送去檢測(cè)病理。
1.3 觀察指標(biāo)
對(duì)比兩組患者確診率與咯血發(fā)生率。以自制管理滿意度問卷為工具對(duì)兩組研究樣本行診斷后滿意度檢測(cè)評(píng)定,滿意度賦分范圍在0~10分,8分以上者納入滿意者行列,計(jì)算兩組診斷滿意率。
1.4統(tǒng)計(jì)學(xué)方法
運(yùn)用SPSS21.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析,計(jì)數(shù)資料用%表示,采用χ2檢驗(yàn),計(jì)量資料用(x±s)表示,采用t檢驗(yàn),P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2 結(jié)果
2.1 兩組患者確診率比較
實(shí)驗(yàn)組診斷胰癌71例、鱗癌27例、小細(xì)胞癌6例、差分化癌1例;對(duì)照組診斷胰癌33例、鱗癌5例、小細(xì)胞癌6例、差分化癌0例,對(duì)照組患者與實(shí)驗(yàn)組患者周圍型肺癌確診率比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。
2.2兩組患者并發(fā)癥發(fā)生率比較
對(duì)照組患者的咯血發(fā)生率7.84%與氣胸發(fā)生率3.92%,與實(shí)驗(yàn)組患者比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。
2.3兩組患者滿意率比較
實(shí)驗(yàn)組患者的滿意率為95.73%,高于對(duì)照組(90.20%),組間比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05)
3 討論
人體的肺器官屬于較容易發(fā)生原發(fā)性癌細(xì)胞的器官,同時(shí)也是較為容易出現(xiàn)癌細(xì)胞轉(zhuǎn)移的器官[4]。肺癌是目前臨床上常見的呼吸系統(tǒng)疾病,預(yù)后效果非常差。而研究表明,非小細(xì)胞肺癌能夠及時(shí)準(zhǔn)確地制定治療方案能有效增強(qiáng)患者的預(yù)后效果[5]。但是,醫(yī)學(xué)界上對(duì)于肺癌的診斷及時(shí)性并不高,往往是出現(xiàn)相關(guān)的癥狀之后才發(fā)現(xiàn)病情。以往對(duì)疑似原發(fā)肺癌病例均采取傳統(tǒng)的X線胸片進(jìn)行診斷,X線胸片雖然操作簡(jiǎn)單、方便,但是由于其存在著漏診率高的缺點(diǎn),因此,臨床獲得的診斷結(jié)果可信度不高[6]。近年來,原發(fā)性肺癌的發(fā)病率呈逐年上升趨勢(shì)。目前,該疾病的誘發(fā)機(jī)制尚未明確,有學(xué)者指出,可能與遺傳因素、激素水平、長(zhǎng)期輻射等存在一定的關(guān)系[7-8]。
目前,傳統(tǒng)主要以彩色多普勒超聲診斷為主,該診斷方式能夠清楚地觀察到腫瘤的位置、回聲、血流運(yùn)行情況等,然而單純超聲診斷受到分辨率低的影響,對(duì)直徑較小的腫塊診出率相對(duì)較低,會(huì)增加疾病誤診或漏診的幾率[9]。隨著醫(yī)學(xué)科研水平與臨床治療水平的不斷發(fā)展進(jìn)步,CT的影像學(xué)診斷技術(shù)被廣泛運(yùn)用到臨床對(duì)惡性腫瘤類疾病的診斷中[10]。CT可以通過多層的觀察以及多個(gè)平面重建功能,在對(duì)原發(fā)肺癌患者進(jìn)行掃描觀察時(shí),對(duì)病灶的形態(tài)表現(xiàn)做出立體觀察與分析;并且在實(shí)際的檢查過程中,CT對(duì)病灶的密度、大小、位置、數(shù)目、形態(tài)、邊緣、周圍細(xì)節(jié)以及病灶內(nèi)部結(jié)構(gòu)等可以實(shí)現(xiàn)綜合分析,這些優(yōu)勢(shì)不僅提高CT對(duì)原發(fā)肺癌病灶的檢出率,也大大降低漏診率,給臨床診斷、治療原發(fā)肺癌患者提供實(shí)質(zhì)性的依據(jù)[11-12]。借助超聲通過或CT引導(dǎo)經(jīng)病理活檢對(duì)肺癌患者進(jìn)行確診,各有優(yōu)勢(shì),超聲引導(dǎo)行肺部的病理活檢診斷,具有無輻射、體位要求低、實(shí)時(shí)檢測(cè)、創(chuàng)傷小等特點(diǎn)[13-14]。CT技術(shù)具有密度大于分辨率高等特點(diǎn),能夠清晰地顯示病灶的有關(guān)情況,其中包括形態(tài)、大小、密度與組織結(jié)構(gòu)等,使穿刺針的部位、角度與深度等有關(guān)情況更加準(zhǔn)確,有效的提高了病理活檢操作的安全性與準(zhǔn)確性[15-17]。CT引導(dǎo)行肺部的病理活檢診斷,具有創(chuàng)傷小、定位準(zhǔn)等特點(diǎn),在對(duì)患者的周圍型肺癌診斷中,均具有較高的診斷率,有助于患者早發(fā)現(xiàn)早治療[18]。但是由于其創(chuàng)傷性,容易使患者出現(xiàn)咯血、氣胸等多種并發(fā)癥,在對(duì)患者進(jìn)行治療時(shí),操作人員需熟練掌握穿刺技術(shù),并且做好術(shù)前準(zhǔn)備與預(yù)后護(hù)理[19-20]。本次研究表明,對(duì)照組患者與實(shí)驗(yàn)組患者周圍型肺癌確診率,差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。對(duì)照組患者的咯血發(fā)生率與氣胸發(fā)生率與實(shí)驗(yàn)組患者比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。
綜上,選超聲與CT引導(dǎo)對(duì)周圍型肺癌患者經(jīng)皮肺穿刺活檢均具有較高的準(zhǔn)確率,咯血的發(fā)病率較低,均值得臨床上推廣及使用。
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(收稿日期:2018-08-14)