超声定位下穿刺活检诊断肺周围型占位性病变的临床应用价值

目的评价超声引导下经皮肺穿刺活检在肺周围型占位性病变中的临床应用价值。方法对胸部CT检查示外周型肺占位病变的128例患者行胸部超声检查,在超声引导下使用一次性自动活检针行经皮肺穿刺活检术,留取标本,行组织病理学检查,与肺癌切除术后病理结果对照,评价组织学诊断正确率,观察穿刺活检术后的并发症情况。结果 128例经皮肺穿刺活检患者中5例因取材少或未取到病变处组织未能明确诊断,123例取材满意,其活检与术后病理结果对照,组织学诊断正确率为95.1%（117/123）,其中良性病变25例、恶性病变92例,肺癌伴感染误诊为肺脓肿6例。经皮穿刺肺活检术后并发症发生率为12.9%（15/123）,包括气胸6例、胸腔积液3例、发热2例和痰中带血4例。结论超声引导下经皮肺穿刺活检适用于纤支镜检查未发现明显异常的肺周围型占位性病变患者,具有创伤小、确诊率高、安全、操作简便、并发症少等优点。     

CT引导经皮肺穿刺活检诊断肺占位的应用价值

目的探讨CT引导下经皮肺穿刺活检联合针吸活检术对肺内肿块病变的诊断价值及安全性。方法对临床气管镜检查、痰检,不能确诊的58例肺部占位性病变给予CT引导下经皮肺穿刺活检联合针吸术。结果 58例患者中55例获得满意的组织标本,明确了定性诊断,诊断成功率94.83%,恶性病变49例,良性病变6例,不能明确诊断3例。并发症:气胸7例,肺出血12例,胸痛10例。结论 CT引导下经皮肺穿刺活检联合针吸活检术成功率高,并发症轻微,对胸部占位性病变的定性诊断具有重要意义,值得临床普遍推广应用。     

CT引导下经皮肺穿刺活检的临床体会

目的 探讨CT引导下经皮肺穿刺活检对肺内病灶的诊断价值.提高肺部占位病变取材成功率和临床诊断准确率.方法 本组43例肺部占位患者,行CT引导下经皮肺穿刺活检,分别行组织学检查及细胞学涂片检查,以术后病理为标准,分析肺穿刺活检的阳性率、成功率以及并发症的发生率.结果 43例全部取得有效标本,穿刺成功率100%,穿刺病理结果恶性肿瘤阳性率76.7%(33/43).并发症:气胸2例(4.7%),痰中带血3例(7.0%),均较轻微,无严重并发症.结论 CT引导下经皮肺穿刺活检是一种安全、快捷准确的诊断方法.     

CT引导下经皮肺活检临床价值

目的明确CT引导下经皮肺穿刺活检对肺部占位病变的确诊价值及安全性。方法 44例患者行CT引导下经皮肺穿刺活检术,穿刺活检组织做病理学检查。结果 44例病例中41例得到明确诊断,其中恶性病变32例,良性病变9例,穿刺活检确诊率93%。l例出现需要相应处理的并发症。结论 CT引导下经皮肺穿刺活检是明确肺部占位性病变的性质的安全有效检查方法。     

CT引导下经皮肺活检40例临床分析

目的探讨CT引导下经皮肺穿刺活检对肺部周围性病变的诊断价值及安全性。方法 40例肺部周围性病变患者行CT引导下经皮肺穿刺活检术。结果 40例病例中38例得到明确诊断,其中恶性病变25例,良性病变13例,穿刺活检确诊率95%。仅1例出现轻微并发症。结论 CT引导下经皮肺穿刺活检是一种诊断准确性高,安全的检查方法 。     

CT引导下经皮肺穿刺活检术在肺外周病变的临床价值探讨

目的探讨CT引导下经皮肺穿刺活检术在肺外周病变的临床价值。方法收集2013~2016年期间行CT引导下经皮肺穿刺活检术病例60例。结果 60例均获得病理结果,51例(85.0%)经病理证实为恶性肿瘤。并发气胸7例,发生率为11.7%,无咯血病例。结论 CT引导下经皮肺穿刺活检术具有较高的诊断效率及相对较低的并发症发生率,取活体组织时定位准确,创口小,活检成功率高,更适用于肺外周病变的诊断。     

CT引导下经皮肺穿刺活检在肺部占位性病变诊断中的诊断价值

目的探讨cT引导下经皮肺穿刺活检在肺部占位性病变诊断价值。方法分析62例CT引导下经皮肺穿刺活检术的临床资料,评价其临床应用价值,对并发症进行分析。结果62例肺占位病变中,穿刺病理诊断56例,准确率达90．3％,并发肺出血19．34％,气胸16．13％。结论CT引导下经皮肺穿刺活检是一种微创、安全、准确、简便的获得组织病理的诊断方法,具有重要的临床诊断意义。     

胰腺占位经皮Trucut针穿刺活检的临床应用

目的 探讨超声或CT引导下经皮Trucut活检针穿刺活检对胰腺占位的诊断价值.方法 对124例临床诊断胰腺癌但无病理诊断的患者在超声或CT引导下行经皮Trucut针穿刺活检检查.结果 超声引导下穿刺109例,CT引导下穿刺15例.平均每例穿刺2.3次.124例患者均获取组织标本,病理诊断与临床符合率95.2％,其中腺癌115例,囊腺瘤5例,转移癌2例,来源不明癌1例,1例未见癌细胞.诊断敏感性99.2％,特异性100％,准确率99.2％.3例术后出现一过性血清淀粉酶升高;5例术后腹痛加重,均经对症处理后症状减轻;1例术后34 d发现原穿刺部位皮下种植转移.无其他严重并发症.结论 超声或CT引导下经皮胰腺肿物16～18G Trucut针穿刺活检是一种安全、简便、诊断准确率高的方法.     

53例CT引导下经皮肺穿刺活检临床分析

目的 探讨CT引导下经皮肺穿刺活检对肺部占位性病变的诊断价值和安全性。方法 回顾性分析我科行CT引导下经皮肺穿刺活检术53例肺部占位性病变的患者的术后资料。结果 53例患者中明确诊断46例,诊断率为86.8%,诊断准确率为97.8%。其中恶性病变34例(腺癌17例,鳞癌14例,小细胞癌1例,神经鞘瘤1例,胸腺恶性肿瘤1例);良性疾病12例(炎性包块4例,结核3例,矽肺2例,肺炎2例,炎性假瘤1例)。6例并发症中中-少量气胸4例(7.5%),咯血2例(3.8%)。结果 CT引导下经皮肺穿刺活检术定位准确,操作简单,创伤小,并发症少,确诊率高,是肺部占位性病变安全可靠的确诊手段。     

CT引导下经皮肺细针抽吸活检对肺周围性病变的诊断价值

目的 评价CT引导下经皮肺细针抽吸活检术在肺内病变中的诊断价值.方法 回顾性分析165例行CT引导下经皮肺细针抽吸活检术的肺内周围性病变资料.结果 经手术、病理及临床随访证实恶性肿瘤114例,良性病变51例.穿刺病理恶性108例,准确率为94.7%,假阴性6例,无假阳性;良性病变41例,准确率为80.4%,穿刺总准确率为90.0%.发生并发症11例,发生率为7.0%,其中气胸4例,少量肺出血2例,肋间神经痛1例.结论 CT引导经皮肺细针抽吸活检术是一种微创、准确度较高、并发症较少的有效检查方法,有助于肺部病变的诊断与鉴别诊断,具有较高的临床价值.     

间质性肺疾病与肺癌

间质性肺疾病(ILD)患者中肺癌的发病率增高,特别是特发性肺纤维化合并肺癌的报道最多.ILD合并肺癌的病理类型以鳞状细胞癌最多,好发于肺下叶和外周部位.ILD的一些肿瘤标记物增高,与疾病的活动程度、严重程度、肺纤维化程度和病情预后等有关,并且具有一定的诊断价值.ILD的肿瘤标记物增高可能是其合并肺癌的危险因素.本文对I...     

肺癌和癌旁正常肺组织中5种肿瘤标志物比较研究

目的 探讨肺癌组织及癌旁正常肺组织中心钠素、分泌型IgA、铁蛋白、DNA聚合酶、血管内皮生长因子的含量。方法 应用放射免疫法测定39例肺癌和癌旁正常肺组织中心钠素、分泌型IgA、铁蛋白、DNA聚合酶、血管内皮生长因子5种肿瘤标志物含量。结果 5种肿瘤标志物在肺癌组织中的含量均高于癌旁正常肺组织，差异有统计学意义（P均〈0．001）。结论 肺癌细胞具有产生物质的作用。     

Quantitative lung perfusion following single lung transplantation

BACKGROUND: Following successful lung transplantation, most of the lung perfusion, as well as ventilation, is shifted towards the transplanted lung. We investigated the changes in perfusion during exercise in lung transplant recipients. PATIENTS AND METHODS: Twelve patients were included in the study. Six patients had emphysema and 6 patients had idiopathic pulmonary fibrosis (IPF). Patients underwent two upright lung perfusion scans: the first at rest and the second during a maximal cardiopulmonary exercise test. Lung perfusion was assessed in each lung and regionally. RESULTS: At rest, patients with emphysema had 83.3 +/- 8 % of total perfusion to the transplanted side and 16.7 +/- 8 % to the native lung, while in the IPF patients, it was 68.7 +/- 12 and 32.7 +/- 10 %, respectively ( P = 0.028). At peak exercise, perfusion shifted from the transplanted lung to the native lung ( P = 0.0095) both in emphysema and IPF patients. CONCLUSIONS: Following successful lung transplantation, most of the perfusion is directed towards the transplanted lung. During exercise, there was a small but significant shift towards the native lung. These findings highlighted the important role of the native lung during maximal exercise.     

The effect of lung biopsy on lung function in diffuse lung disease.

The aim of this study was to investigate the effect on lung function of lung biopsy used in the diagnosis of diffuse lung disease carried out by an open procedure or by video-assisted thoracoscopy. One hundred and sixteen patients with diffuse lung disease who attended the Royal Brompton Hospital were studied retrospectively. Thirty five patients underwent open lung biopsy, and 33 video-assisted thoracoscopic biopsy and 48 had their diagnosis made without biopsy. All patients underwent lung function tests before and after surgery, or at an interval of 3-6 months in those who did not undergo biopsy. No significant differences were found in changes in lung function between those who had and had not undergone biopsy, and the proportions of patients whose lung function improved or deteriorated were similar. Lung biopsy by an open procedure or by video-assisted thoracoscopy did not differ in its effects on lung function. The results for older patients, those with severe disease and those with fibrosing alveolitis were the same as for the whole group. Open lung biopsy for the diagnosis of diffuse lung disease does not deleteriously affect lung function whether carried out by an open or a minimally invasive procedure.     

Successful lung transplantation following lung volume reduction surgery

BACKGROUND: Lung volume reduction surgery (LVRS) is an accepted treatment modality for patients with advanced emphysema. Recently, successful lung transplantation (LTX) has been reported following LVRS. We assess the pulmonary functions in lung transplant recipients after LVRS. METHODS: 8 patients - 5 males and 3 women--aged 53-66 years with advanced emphysema underwent LVRS. Following clinical deterioration and decline of pulmonary function, patients underwent single LTX. Post transplantation follow-up included pulmonary function, 6 minute walk distance (6 MWD) and recording perioperative complications. RESULTS: Median forced expiratory in one second (FEV 1) before and after LVRS were 24 % with 31 % predicted, respectively. All but one showed improvement in lung function and 6 MWD following LVRS. Median maximal 6 MWD before and after LVRS was 222 and 316 meters, respectively. Median time from LVRS to LTX was 46 months (range 10-83). All patients survived and were discharged after LTX. Median FEV1 before and after LTX was 23 % with 57 % predicted, respectively. Median 6MWD before and after LTX was 240 and 462 meters, respectively. NYHA classes improved from 3-4 to 1-2 in 7 surviving patients. At transplantation, bleeding due to pleural adhesions was observed in 4 patients; two required blood transfusions. One patient developed acute respiratory distress syndrome and one had unilateral vocal cord paralysis. At nine-month follow-up, 7 patients are doing remarkably well, while one patient died 6 months after LTX due to bronchiolitis obliterans syndrome (BOS). CONCLUSIONS: LVRS is a therapeutic option in patients with end-stage emphysema. When emphysema deteriorates, LTX can be successfully performed with significant improvement of quality of life without significant additional risk.