超声造影对不同大小肺周围型病变活检的指导价值

丁雅杰; 孙医学; 李阳; 郜言坤; 朱潇

doi:10.16766/j.cnki.issn.1674-4152.003369

超声造影对不同大小肺周围型病变活检的指导价值

doi: 10.16766/j.cnki.issn.1674-4152.003369

1.
蚌埠医科大学第一附属医院超声科，安徽蚌埠 233004
2.
安徽医科大学第一附属医院放射科，安徽合肥 621099
3.
蚌埠医科大学第一附属医院胸外科

基金项目:

安徽省高校自然科学研究项目 2023AH052005

详细信息

通讯作者:
孙医学，E-mail：13309621158@163.com

中图分类号: R445.1 R734.2
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出版历程
- 收稿日期: 2023-07-21
- 网络出版日期: 2024-03-27

The value of ultrasonography as a guide to biopsy of peripheral lung-type lesions of different sizes

1.
Department of Ultrasound, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨常规超声与超声造影在不同大小的肺周围型病变活检中的指导价值。方法收集蚌埠医科大学第一附属医院2022年1月—2023年7月肺周围型病变患者361例，入组均进行常规超声或超声造影引导下的肺穿刺活检，根据病变最大径分为A、B、C三组(A组：≤20 mm；B组：21~49 mm；C组：≥50 mm)，将3组病变再进一步分为常规组与超声造影(CEUS)组。比较在不同病变大小情况下，常规组与CEUS组内部坏死区显示率、病灶及周围大血管显示率、穿刺成功率、穿刺次数及并发症发生率等情况。结果 3组患者性别、年龄等基线资料比较差异均无统计学意义(P>0.05)。A组中，常规组与CEUS组上述活检指标差异无统计学意义。C组中，CEUS组的内部坏死区显示率(70.6%, 48/68)、病灶及周围血管显示率(47.1%, 32/68)和穿刺成功率(97.1%, 66/68)明显高于常规组[17.1%(14/82)、20.7%(17/82)、87.8%(72/82)]，差异均有统计学意义(P < 0.05)。结论当病变最大径≥50 mm时，超声造影引导的穿刺活检更具有指导意义；对于较小的肺周病变(≤20 mm)更推荐常规超声引导下穿刺活检, 以节省患者就医成本及医疗资源。
- 超声造影 /
- 肺周围型病变 /
- 穿刺活检
Abstract: Objective To investigate the value of conventional ultrasound versus ultrasonography as a guide in biopsy of peripheral lung-type lesions of different sizes. Methods A total of 361 patients with peripulmonary lesions were collected from the First Affiliated Hospital of Bengbu Medical University from January 2022 to July 2023, and all of them underwent routine ultrasound or ultrasound-guided lung puncture biopsy, and were divided into three groups of A, B, and C according to the maximum diameter of the lesions (Group A: ≤20 mm; Group B: 21-49 mm; Group C: ≥50 mm), and the lesions of the three groups were further divided into the routine group and the contrast-enhanced ultrasound (CEUS). The lesions in the three groups were further divided into the conventional group and the CEUS group. The detection rate of internal necrotic areas, the detection rate of lesions and surrounding large vessels, the success rate of puncture, the number of punctures and the complication rate were compared between the conventional group and the CEUS group at different sizes. Results The differences in baseline characteristics such as gender and age among the three groups were not statistically significant (P>0.05). In group A, there was no significant difference in the above biopsy indices between the conventional group and the CEUS group. In group C, the display rate of internal necrotic area (70.6%, 48/68), the display rate of lesions and peripheral vessels (47.1%, 32/68) and the success rate of puncture (97.1%, 66/68) were significantly higher in the CEUS group than in the conventional group [17.1% (14/82), 20.7% (17/82), 87.8% (72/82)], with statistically significant differences (P < 0.05). Conclusion Ultrasound-guided puncture biopsy is more informative when the maximum diameter of the lesion is ≥50 mm; routine ultrasound-guided puncture biopsy is more recommended for smaller peripulmonary lesions (≤20 mm) to save patient's cost and medical resources.
- Contrast-enhanced ultrasound /
- Peripheral pulmonary lesions /
- Puncture biopsy

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表 1 3组肺周围型病变患者临床特征比较

Table 1. Comparison of clinical characteristics among three groups of patients with peripheral pulmonary lesions

组别	例数	年龄 (x±s, 岁)	穿刺次数 (x±s, 次)	性别(例)		病变位置(例)
组别	例数	年龄 (x±s, 岁)	穿刺次数 (x±s, 次)	男性	女性	右肺	左肺
A组	88	64.52±12.73	3.16±0.98	58	30	60	28
B组	123	66.41±11.91	3.47±0.97	86	37	70	53
C组	150	68.81± 9.90	3.79±1.00	108	42	80	70
统计量		4.181^a	11.827^a	0.977^b		5.147^b
P值		0.016	< 0.001	0.613		0.076
注：^a为F值，^b为χ²值。

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表 2 常规组与CEUS组肺周围型病变患者一般资料及活检相关指标比较

Table 2. Comparison of general data and biopsy related indicators of patients with peripheral pulmonary lesions between the conventional group and the CEUS group

项目	常规组 (229例)	CEUS组 (132例)	统计量	P值
年龄(x±s, 岁)	66.9±12.3	67.0± 9.8	0.087^a	0.931
性别[例(%)]			0.973^b	0.324
男性	164(71.6)	88(66.7)
女性	65(28.4)	44(33.3)
病变位置[例(%)]			8.611^b	0.072
左肺上叶	58(25.3)	18(13.6)
左肺下叶	43(18.8)	32(24.2)
右肺上叶	62(27.1)	36(27.3)
右肺中叶	16(7.0)	15(11.4)
右肺下叶	50(21.8)	31(23.5)
穿刺次数(x±s, 次)	3.6±1.1	3.5±0.9	1.061^a	0.289
是否有坏死[例(%)]			55.484^b	< 0.001
是	25(10.9)	60(45.5)
否	204(89.1)	72(54.5)
病灶及周围是否可见大血管[例(%)]			12.118^b	< 0.001
是	48(21.0)	50(37.9)
否	181(79.0)	82(62.1)
是否有并发症[例(%)]			2.206^b	0.138
是	31(13.5)	11(8.3)
否	198(86.5)	121(91.7)
穿刺是否成功[例(%)]			10.171^b	0.001
是	193(84.3)	126(95.5)
否	36(15.7)	6(4.5)
注：^a为t值，^b为χ²值。

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表 3 A组肺周围型病变患者活检相关指标比较(%)

Table 3. Comparison of biopsy related indicators in patients with peripheral pulmonary lesions in group A (%)

组别	例数	内部坏死区显示率	病灶及周围大血管显示率	穿刺成功率	并发症发生率
常规组	61	6.6(4/61)	18.0(11/61)	83.6(51/61)	13.1(8/61)
CEUS组	27	11.1(3/27)	25.9(7/27)	88.9(24/27)	11.1(3/27)
χ²值			0.717
P值		0.671^a	0.397	0.747^a	0.999^a
注：^a为采用Fisher精确检验。

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表 4 B组肺周围型病变患者活检相关指标比较(%)

Table 4. Comparison of biopsy related indicators in patients with peripheral pulmonary lesions in group B (%)

组别	例数	内部坏死区显示率	病灶及周围大血管显示率	穿刺成功率	并发症发生率
常规组	86	8.1(7/86)	23.3(20/86)	81.4(70/86)	14.0(12/86)
CEUS组	37	24.3(9/37)	29.7(11/37)	97.3(36/37)	8.1(3/37)
χ²值			0.575	5.492
P值		0.020^a	0.448	0.019	0.549^a
注：^a为采用Fisher精确检验。

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表 5 C组肺周围型病变患者活检相关指标比较(%)

Table 5. Comparison of biopsy related indicators in patients with peripheral pulmonary lesions in group C (%)

组别	例数	内部坏死区显示率	病灶及周围大血管显示率	穿刺成功率	并发症发生率
常规组	82	17.1(14/82)	20.7(17/82)	87.8(72/82)	13.4(11/82)
CEUS组	68	70.6(48/68)	47.1(32/68)	97.1(66/68)	7.3(5/68)
χ²值		43.903	11.714	4.325	1.433
P值		< 0.001	0.001	0.038	0.231

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