老年患者胸部病变CT引导下穿刺活检临床研究［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)o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)o23例出现并发症，总发生率为18.0%o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［中图分类号］R446.8［文献标识码］A［文章编号］1673-9701(2009)23-08-04ClinicalAnalysisofCT-guidedBiopsyinElderlyPatientswithChestDiseaseZHENGXilDINGMingchaolCHENGGanglYANGMinghong21.DepartmentofRadiology,BeijingGeriatricsHospital,HaidianDistriet,Beijing100095,China；2.HubuHospital,Shandong262303,China[Abstract]ObjectiveTostudythevalueandsafetyofCT-guidedpercutaneoustransthoracicbiopsyintheelderlywithchestdiseases・MethodsWeusedCT-guidedbiopsyfor128elderlypatientswithchestdiseases,ofwhich115casesoflungdisease,8casesofmediastinaldiseaseand5casesofpleuraldiseases.ThewayofguidedpuncturewasdeterminedbyCTscanandwhentheneedlereachedthedesiredtarget,atissuespecimenwastaken.Thefinaldiagnosisneedtobeconfirmedbysurgery,andpathology.Thediagnosticaccuracyrateandtheincidenceofcomplicationswereanalyzed.Resultslnthe128elderlypatientswithchestdiseases,thefinaldiagnosisshowed106casesofmalignanttumorand22casesofbenign,withthecorrectdiagnosisrateofCT-guidedbiopsyas91.4%(117/128)・Thecorrectdiagnosisratesofbenignandmaligna.ntlesionswere75.0%(21/28),and90.6%(96/106),respectivelyandthediagnosticaccuracyforpathologicaltypingofthemalignantlesionswas91.7%(77/84).And23caseshadcomplications.Thetotalincidencewas18.0%,including17casesofpneumothorax(13.3%),6casesofsubcutaneousemphysema,1caseofmediastinalemphysemaand4casesofpulmonaryhemorrhage,withtheincidenceof13.3%,4.7%,0.8%and3.1%,respectively.Nocomplicationslikereversepulmonaryandairembolismwerefound.Drainagewasrequiredfor2casesofpneumothorax,andtheremainingpatientsneedednospecialtreatment.Cone1usionCT-guidedbiopsyintheelderlywithchestdiseasesisasafe,accurateandeffectivediagnostictechniquee,andcanalsobeusedinthedifferentialdiagnosis・[KeyWords]Chestdisease；Biopsyexamination；Tomography；X-raycomputerCT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lo单发结节或肿块病变78例，见图2O多发结节或弥漫性病变18例，见图3O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....
