老年人CT引导下经皮肺穿刺活检技术难点探讨.docx

老年人CT引导下经皮肺穿刺活检技术难点探讨

【摘要】目的探讨CT引导下老年人肺部肿块及肺结节穿刺活检技术难点。方法回顾性分析CT引导下经皮肺穿刺活检证实的496例老年人肺部肿块和肺结节SPN病例。重点研究患者“年龄较大、病灶较小和磨玻璃结节”的穿刺技巧，即“老、小、磨”3个问题，重点是：老年人要注意术前心理疏导，穿刺用18G细切割针，肺功能测定FEV1/FVC占预计值50%以下者，患者术中需带氧气面罩，在心电监护仪监护下进行手术；小病灶根据CT增强征象决定穿刺靶心，采取分步进针法垂直进针，必要时应用MPR技术；对磨玻璃病灶，先行双源CT双能量碘图分析，穿刺取实性成分，即病灶碘图中含碘成分高的部分。结果496例肺肿块及肺结节全部取材成功，穿刺病理提示恶性肿瘤353例,占71.2%，良性病变143例，占28.8%。诊断准确率为96.4%。全组并发症为气胸9.1%（n=45/496）和咯血4.8%（n=24/496），16例气胸行闭式引流术，占3.2%，无致死性不良反应发生。结论CT引导下经皮肺穿刺活检是一种创伤小且实用的定性诊断方法，对“老、小、磨”3个技术难点问题，综合采取系列技术，可以提高穿刺活检诊断阳性率和准确率，降低并发症，对老年人肺部肿块、肺结节的诊断具有较高的临床应用价值。

【关键词】肺穿刺活检;肺肿块；肺结节;老年;诊断

TechnicaldifficultiesofCT-guidedpercutaneouslungbiopsyinthe

【Abstract】objectivetoexplorethetechnicaldifficultiesofCT-guidedpercutaneousbiopsyoflungmassesandpulmonarynodulesintheelderly.Methods496elderlypatientswithpulmonarymassesandpulmonarynodulesconfirmedbyCT-guidedpercutaneouslungbiopsywereanalyzedretrospectively.Thepuncturetechniqueof“Old,smallandground-glassnodules”wasmainlystudied.Thekeypointswereasfollows:theelderlyshouldpayattentiontopsychologicalguidancebeforeoperationanduse18Gfine-cutneedleforpuncture,pulmonaryfunctionmeasurementFEV1/FVCaccountedforlessthan50%oftheestimatedvalue.Patientswererequiredtowearanoxygenmaskduringtheoperationandunderwenttheoperationunderthesupervisionofanelectrocardiograph,whennecessary,MPRtechniqueshouldbeused;Forground-glassLesions,dual-sourceCT(DSCT)anddual-energyiodographywereusedtoanalyzethesolidcomponents,whichwerethehighiodinecomponentsinthelesions.Results496casesoflungmassandPulmonarynodulesweresuccessfullyobtained,353cases(71.2%)weremalignanttumor,143cases(28.8%)werebenign.Thediagnosticaccuracywas96.4%.Thecomplicationswerepneumothorax9.1%(n=45/496)andhemoptysis4.8%(n=24/496).16casesofpneumothoraxunderwentcloseddrainage(3.2%).Conclusion