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目的探讨超声造影(CEUS)对前中纵隔占位经皮穿刺活检的临床应用价值。方法拟行超声引导下穿刺活检的109例前中纵隔占位为研究对象。其中58例穿刺前行CEUS检查,5例不宜穿刺,余53例为造影组;同期51例未进行CEUS检查,为对照组。比较两组超声图像特点、穿刺活检次数、诊断准确率以及并发症等差异。分析CEUS组的灌注特征,探讨CEUS对提高纵隔穿刺活检成功率的应用价值。结果造影组5例CEUS显示大部分坏死或浅方大血管不宜穿刺。余53例CEUS对病灶内部坏死的显示率为37.7%(20/53),显著高于对照组的11.8%(6/51)(P=0.002)。两组穿刺次数分别为(2.35±0.73)次和(2.21±0.51)次,差异无统计学意义。诊断准确率比较,造影组为98.1%(52/53),显著高于对照组的84.3%(43/51)(P=0.012)。对照组发生2例纵隔出血(3.9%),造影组无严重并发症。结论 CEUS检查可对纵隔病灶浅表血管和内部结构进行有效评估,有助筛选适应证及提高诊断准确率,具有重要临床指导价值。
Objective To investigate the clinical value of CEUS in the treatment of anterior mediastinal mass percutaneous biopsy. Methods Totally 109 cases of anterior mediastinum space under biopsy guided by ultrasound were studied. Among them, 58 cases had CEUS before puncture, 5 cases not puncture and 53 cases as contrast group. In the same period, 51 cases were not CEUS, which was the control group. The characteristics of ultrasound images, the times of biopsy, diagnostic accuracy and complication were compared between the two groups. The perfusion characteristics of CEUS group were analyzed to explore the value of CEUS in improving the success rate of mediastinal biopsy. Results CEUS imaging showed that 5 cases of most of the necrotic or shallow large blood vessels should not be punctured. The remaining 53 cases of CEUS showed focal necrosis of the lesion was 37.7% (20/53), significantly higher than the control group of 11.8% (6/51) (P = 0.002). The number of puncture in the two groups was (2.35 ± 0.73) times and (2.21 ± 0.51) times, respectively, with no significant difference. The accuracy of diagnosis was 98.1% (52/53) in contrast group and 84.3% (43/51) in control group (P = 0.012). Two cases of mediastinal bleeding in the control group (3.9%), no serious complications in the angiography group. Conclusion The CEUS examination can effectively evaluate the superficial vessels and internal structures of mediastinal lesions, which can help to screen the indications and improve the diagnostic accuracy. It is of great clinical value.