纤维支气管镜检查和经皮肺穿刺活检对菌阴不典型肺结核的诊断价值

目的探讨纤维支气管镜检查和CT引导下经皮肺穿刺2种途径对菌阴不典型肺结核的诊断价值。方法行纤维支气管镜检查516例,根据胸部X线片或CT确定病变部位,在纤维支气管镜下经支气管黏膜活检和肺活检(TBLB)192例。行CT引导下经皮肺穿刺活检(PNLB)147例,包括纤维支气管镜检查未能确诊71例及直接行PNLB检查76例。结果 516例经纤维支气管镜检查肺结核确诊445例,阳性率86.2%,147例经皮肺穿刺活检肺结核确诊140例,阳性率95.2%,两者差异有统计学意义(P<0.01)。2种方法均未出现严重不良反应。结论纤维支气管镜检查和PNLB对菌阴不典型肺结核的诊断均有很重要的价值,合理地选用这2种方法可提高其确诊率。

Diagnostic value of fiberoptic bronchoscopy and trans-thoracic needle lung biopsy in atypical pulmonary tuberculosis with negative sputum smear

Objective To evaluate the diagnostic value of fiberoptic bronchoscopy and CT-rguided percutaneous needle lung biopsy＇（PNLB） in atypical pulmonary tuberculosis with negative sputum smear.Methods According to the lesion location on chest X ray or CT images,516 patients were selected to operate the fiberoptie bronchoscopy and 192 with trans-bronchial mucosa tissue biopsy and tons-bronchial lung biopsy（TBLB）;147 patients were selected to operate the CT-guided percutaneous needle biopsy,including 71 patients who failed to make a definite diagnosis by fiberoptic bronchoscopic.Results The positive rates of fiberoptic bronchoscopy and PNLB were 86.2%（445/516） and 95.2%（140/147）,there was statistically significant between them（P 0.01）.No severe adverse effect was encountered.Conclusion Diagnostic rate eculd be improved by using two methods rationally which are both important to the diagnosis of atypical pulmonary tuberculosis with negative sputum smear.