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中华危重症医学杂志(电子版) ›› 2020, Vol. 13 ›› Issue (04) : 264 -269. doi: 10.3877/cma.j.issn.1674-6880.2020.04.005

所属专题： 总编推荐； 文献；

论著

IG4电磁导航系统辅助CT引导下肺穿刺活检术在肺占位病变诊断中的临床价值
曾晖1, 章浙伟1, 严兴2, 邵国良1,†()   
  1. 1. 310022　杭州，浙江省肿瘤医院介入科
    2. 310022　杭州，浙江省肿瘤医院放射科
  • 收稿日期:2020-02-25 出版日期:2020-08-01
  • 通信作者: 邵国良
  • 基金资助:
    浙江省医药卫生科技计划项目(2019KY043)

Clinical value of CT-guided percutaneous needle biopsy assisted by IG4 electromagnetic navigation system in diagnosing pulmonary lesions

Hui Zeng1, Zhewei Zhang1, Xing Yan2, Guoliang Shao1,†()   

  1. 1. Department of Intervention, Zhejiang Cancer Hospital, 310022 Hangzhou, China
    2. Department of Radiology, Zhejiang Cancer Hospital, 310022 Hangzhou, China
  • Received:2020-02-25 Published:2020-08-01
  • Corresponding author: Guoliang Shao
  • About author:
    Corresponding author: Shao Guoliang, Email:
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曾晖, 章浙伟, 严兴, 邵国良. IG4电磁导航系统辅助CT引导下肺穿刺活检术在肺占位病变诊断中的临床价值[J]. 中华危重症医学杂志(电子版), 2020, 13(04): 264-269.

Hui Zeng, Zhewei Zhang, Xing Yan, Guoliang Shao. Clinical value of CT-guided percutaneous needle biopsy assisted by IG4 electromagnetic navigation system in diagnosing pulmonary lesions[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(04): 264-269.

目的

评估IG4电磁导航系统辅助CT引导下经皮肺穿刺活检术在肺占位病变中的应用价值。

方法

将125例拟行肺穿刺活检术的肺占位患者分为对照组（62例）及磁导组（63例）。对照组患者采用普通CT引导下肺穿刺活检术，磁导组采用IG4电磁导航系统辅助CT引导下肺穿刺活检术。记录所有患者的临床基础资料包括白细胞计数，血小板计数（PLT），国际标准化比值（INR），活化部分凝血活酶时间（APTT），凝血酶原时间（PT），丙氨酸转氨酶（ALT），血肌酐，肌酸激酶同工酶（CK-MB），C反应蛋白质（CRP）以及肺癌相关标志物神经元特异性烯醇化酶（NSE）、血清鳞状细胞癌抗原（SCCA），并对两组患者间肺穿刺活检术中定位时间、穿刺针调整次数、扫描次数、接受辐射剂量[剂量长度乘积（DLP）]、病理诊断敏感度以及气胸、出血等并发症发生率进行比较。

结果

两组患者穿刺前白细胞计数、PLT、INR、APTT、PT、ALT、血肌酐、CK-MB、CRP、NSE、SCCA的比较，差异均无统计学意义（P均> 0.05）。同时，磁导组患者在穿刺术中定位时间[（9.5 ± 2.6）min vs.（13.6 ± 4.1）min，t = 6.584，P < 0.001]、调针次数[（3.0 ± 1.3）次vs.（3.8 ± 1.8）次，t = 2.662，P = 0.009]、扫描次数[（3.9 ± 1.2）次vs.（5.8 ± 1.8）次，t = 6.853，P < 0.001]、DLP[（291 ± 167）mGy × cm vs.（407 ± 307）mGy × cm，t = 2.622，P = 0.010]方面均明显优于对照组；且磁导组患者气胸发生率[15.87%（10/63）vs. 33.87%（21/62），χ2 = 5.204，P = 0.023]及出血发生率[20.63%（13/63）vs. 38.71%（24/62），χ2 = 4.899，P = 0.027]均明显低于对照组患者。而两组患者病理诊断的敏感度比较，差异无统计学意义[89.66%（52/58）vs. 96.36%（53/55），χ2 = 1.931，P = 0.165]。

结论

IG4电磁导航系统辅助CT引导下肺穿刺活检术在安全性及对患者的伤害程度等方面明显优于常规CT引导下的肺穿刺活检术，具有较高的临床应用价值。

关键词: IG4电磁导航系统, CT引导下经皮肺穿刺术, 肺占位, 肺肿瘤
Objective

To explore the application value of CT-guided percutaneous needle biopsy assisted by the IG4 electromagnetic navigation system in diagnosing pulmonary lesions.

Methods

A total of 125 patients with pulmonary lesions to undergo CT-guided percutaneous needle biopsy were randomly divided into a control group (62 patients) and a magnetic group (63 patients). Patients in the control group were performed conventional CT-guided percutaneous needle biopsy, and patients in the magnetic group received CT-guided percutaneous needle biopsy assisted by the IG4 electromagnetic navigation system. The white blood cell count, platelet count (PLT), international normalized ratio (INR), activated partial thromboplastin time (APTT), prothrombin time (PT), alanine aminotransferase (ALT), serum creatinine, creatine kinase-MB (CK-MB), C-reactive protein (CRP), and lung cancer related markers of neuronspecific enolase (NSE) and serum squamous cell carcinoma antigen (SCCA) before the piercing were recorded. The positioning time, needle adjustment times, scanning times, radiation dose [dose length product (DLP)], pathological diagnosis sensitivity and incidence of complications such as pneumothorax and bleeding were compared between the two groups.

Results

The levels of white blood cell count, PLT, INR, APTT, PT, ALT, serum creatinine, CK-MB, CRP, NSE and SCCA before puncture all showed no significant differences between the two groups (all P > 0.05). Meanwhile, the positioning time [(9.5 ± 2.6) min vs. (13.6 ± 4.1) min, t = 6.584, P < 0.001], needle adjustment times [(3.0 ± 1.3) times vs. (3.8 ± 1.8) times, t = 2.662, P = 0.009], scanning times [(3.9 ± 1.2) times vs. (5.8 ± 1.8) times, t = 6.853, P < 0.001] and DLP [(291 ± 167) mGy × cm vs. (407 ± 307) mGy × cm, t = 2.622, P = 0.010] in the magnetic group were significantly better than those in the control group. The incidence of pneumothorax [15.87% (10/63) vs. 33.87% (21/62), χ2 = 5.204, P = 0.023] and bleeding [20.63% (13/63) vs. 38.71% (24/62), χ2 = 4.899, P = 0.027] in the magnetic group was significantly lower than that in the control group. However, there was no statistically significant difference in the pathological diagnosis sensitivity between the two groups [89.66% (52/58) vs. 96.36% (53/55), χ2 = 1.931, P = 0.165].

Conclusion

The CT-guided percutaneous needle biopsy assisted by the IG4 electromagnetic navigation system is significantly superior to conventional CT-guided lung biopsy in terms of safety and degree of injury to patients, and has high clinical application value.

Key words: IG4 electromagnetic navigation system, CT-guided percutaneous lung puncture, pulmonary lesions, Lung neoplasms
表1 两组肺占位患者一般资料的比较（例）
组别 例数 性别（男/女） 年龄（岁， ± s） 病灶大小（cm） 病灶距皮肤距离（cm）
<1 ≥1~<2 ≥2~<3 ≥3~<4 ≥4~<5 ≥5 >0 ~ ≤ 5 >5 ~ ≤ 10
对照组 62 39/23 64 ± 11 3 11 23 13 7 5 25 37
磁导组 63 40/23 62 ± 8 1 15 11 19 9 8 20 43
t/χ2值   0.005 0.683 7.910 0.998
P值   0.946 0.496 0.161 0.318
表2 两组肺占位患者肺穿刺前实验室指标的比较[M（P25，P75）]
组别 例数 白细胞计数（× 109/L， ± s） PLT（× 109/L， ± s） INR APTT（s， ± s） PT（s， ± s） ALT（U/L） 血肌酐（μmol/L） CK-MB（μmol/L， ± s） CRP（mg/L） NSE（mg/L， ± s） SCCA（μg/L）
对照组 62 6.6 ± 1.2 248 ± 62 0.96（0.93，1.02） 27.8 ± 3.3 11.6 ± 0.8 16.5（9.0，30.5） 69.5（61.5，78.8） 19 ± 6 6.4（3.1，20.1） 19 ± 6 1.2（0.9，1.5）
磁导组 63 6.3 ± 1.7 217 ± 90 1.02（0.96，1.05） 28.2 ± 2.8 11.9 ± 0.8 14.0（12.2，22.0） 66.5（60.2，75.8） 19 ± 8 3.1（0.7，24.0） 18 ± 10 1.1（0.8，2.3）
t/H值   0.779 1.268 1.737 0.393 1.172 0.420 0.244 0.287 0.765 0.352 0.250
P值   0.441 0.212 0.086 0.696 0.248 0.678 0.820 0.775 0.451 0.727 0.806
表3 两组肺占位患者肺穿刺术相关指数的比较（ ± s）
组别 例数 定位时间（min） 调针次数（次） 扫描次数（次） DLP（mGy × cm）
对照组 62 13.6 ± 4.1 3.8 ± 1.8 5.8 ± 1.8 407 ± 307
磁导组 63 9.5 ± 2.6 3.0 ± 1.3 3.9 ± 1.2 291 ± 167
t值   6.584 2.662 6.853 2.622
P值   <0.001 0.009 <0.001 0.010
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