肺组织不同活检术在肺部块影诊断中的比较研究

目的探讨肺组织不同活检术在肺部块影诊断中的应用价值。方法对１５７例临床上疑为肺肿瘤的住院病人,依据胸片上肺部块影部位及形态分为中央型、周围型和其它型。对经纤维支气管镜（简称纤支镜）直视下肺组织活检（简称肺活检）阴性者,分别选用Ｘ线引导下经皮肺活检和Ｃ...     

CT引导经皮肺穿刺活检术在肺部肿物中的临床应用

目的探讨CT引导经皮肺穿刺活检术对肺部肿物的诊断价值。方法采用CT引导经皮肺穿刺活检术197例肺部肿物进行穿刺活检,病灶直径2～10 cm（平均4.2 cm）,病灶距胸膜深度0～8cm（平均3.4 cm）。结果诊断恶性病变133例,良性病变（炎症、结核、结节病）54例,诊断率94.9%（187/197）,病理不能确诊10例,其中6例手术确诊为肺鳞癌,4例随访2年无变化。术后并发症气胸28例,胸腔出血2例,咯血6例。结论 CT引导经皮肺活检术是一种安全、诊断率高的诊断方法,尤其适用于距离胸膜较近病灶。     

CT引导下经皮肺穿刺活检在肺部占位病变中的诊断价值

目的探讨CT引导下经皮肺穿刺活检对肺部占位病变的诊断价值。方法CT扫描确定最佳的穿刺点、局麻后CT引导下组织切割针经皮刺入到病灶,切割组织行病理检查。结果56例肺占位病变行CT引导下经皮肺穿刺活检,53例得到确诊,阳性率为94.6%。并发症包括少量气胸11例,肺出血9例,少量咯血5例,均不需特殊处理。结论CT引导下经皮肺穿刺活检对肺占位病变的诊断阳性率高、并发症轻,值得临床推广。     

纤维支气管镜在肺部浸润影病因诊断中的作用

临床常常见到肺部呈浸润影像的表现,其病因众多,常规无创检查方法有时难以确立诊断,往往需要借助有创性检查手段来加以帮助,支气管镜检查技术的应用就是其中之一。其中的纤维支气管镜因其设备成     

细针穿刺活检在肺部占位病变中的应用

目的探讨CT引导下细针经皮肺穿刺活检在肺部占位病变中的应用价值。方法CT扫描定位细针穿刺到病灶,穿刺物送细胞学检查。结果48例肺部占位性病变行CT引导下经皮细针肺穿刺活检,42例得到确诊,确诊率为87.5%,无并发症。结论CT引导下经皮细针肺穿刺活检对肺部占位病变的诊断阳性率高,创伤小,并发症少,值得推广。     

CT引导下肺部穿刺活检176例

CT引导下肺部穿刺活检是一种非血管性介入技术。在CT引导下 ,经皮穿刺到达肺内病灶 ,进行针吸、活检 ,从而取得病变组织 ,可进行病理学、细胞学等方面检查 ,为临床诊断、鉴别诊断提供了最有力的证据。 1997年 6月至 2 0 0 3年 2月我们共实施了 176例肺穿刺 ,分析其临床价值及应用体会如下。1. 176例均为肺周边组织出现块形影或占位性病灶 (即支气管镜之检查盲区 ) ,病灶最大直径 7.2 cm ,最小直径 1.6 cm,平均直径 4 .0 1cm。其中男性 114例 ,女性 6 2例 ;年龄 31～ 79岁 ,平均 6 2 .4岁。右肺病灶 98例 ,右上 4 1例 ,右中 19例 ,右下88例…     

CT引导下经皮肺穿刺活检术在肺部占位性病变中的应用研究

目的:探讨CT引导下经皮肺穿刺活检术在肺部占位性病变中的诊断效率及并发症发生情况、原因及预防等。方法:回顾性分析2016年1月至2019年4月在应急总医院肿瘤内科CT引导下经皮肺穿刺活检术的134例患者临床资料。SPSS 20.0统计软件分析诊断效率及其与性别、年龄、病灶位置、病灶长径、穿刺体位及针道深度等的相关性,同...     

超声自动活检枪在肺结节及块影活检的临床应用

目的 评价采用超声引导下自动活检枪对肺结节或块影活检的临床应用价值。方法 将临床常规检查不能确诊的31例肺周边性结节或块影患，超声引导下用自动活检枪对肺结节或块影活检，计算其取材成功率、病理诊断率及并发症等。结果 超声引导自动活检枪对肺结节或块影活检取材成功率96．9％，组织病理确诊率96．8％，并发症极少。结论 超声自动活检枪对肺结节或块影活检具有取材成功率高、诊断率高、安全实用，是肺部周边性结节或块影确诊的重要手段。     

CT引导下经皮穿刺肺活检术围手术期护理

肺部疾病不同的病理学改变有时会出现相似的影象表现，肺活体组织检查是肺部疾病诊断和鉴别诊断的最好方法，随着诊疗技术的发展，CT引导下经皮穿刺肺活检术已广泛应用于临床，从诊断的准确性来说，CT引导下经皮肺穿刺要高于纤维支气管镜肺活检但是由于肺脏结构和功能的特殊性，决定了手术难度相对较大，并且存在一定的危险和术后并发症，因此掌握并加强其护理要点非常重要，我科自2001年6月至今已开展此项技术30例，经过不断对穿刺方法，围手术期的处理及护理方法进行规范，获得了较好的临床效果。     

肺部块影纤维支气管镜活检的诊断价值

肺部块影形态单凭影像学往往易漏诊或误诊。经纤支镜肺活检对块影定位、定性诊断提供了重要依据。本文总结了经纤支镜肺活检对临床诊断不明的228例肺部块影,89.5%获得明确诊断。     

两种不同类型的穿刺针在经皮肺穿刺中的应用比较

目的比较两种穿刺针诊断肺周围性病变的性质及造成的并发症的差别。方法收集本院五年期间的患者资料,比较两种穿刺针的准确性及造成的并发症。结果Bard18G和Angiotech18G穿刺针的准确性分别为96．03％和94％;其中分别有2l例和6例患者发生了气胸;12例和6例发生了咳血或痰中带血;6例和5例发生了肺内渗血。结论两种穿刺针诊断肺周围性病变的准确性及造成的并发症无明显差别。     

CT定位后经支气管镜肺活检对周围型肺癌的诊断价值

目的 探讨CT肺段定位后经支气管镜肺活检(TBLB)对周围型肺癌的诊断价值.方法 对35例疑似周围型肺癌患者参照CT肺段定位行TBLB.结果 确诊周围型肺癌18例(51.4％),腺癌8例,腺鳞癌2例,鳞癌6例,未定型2例;肺良性病变11例,其中非特异性炎7例(20％)、坏死性炎3例(8.5％),结核1例(2.8％),阴性6例(17.1％),总确诊率82.9％.结论 CT肺段定位后TBLB能显著提高周围型肺癌的诊断阳性率,安全且并发症少.     

The optimal sequence for bronchial brushing and forceps biopsy in lung cancer diagnosis: a random control study

Background

Optimizing basic techniques in diagnostic bronchoscopy is important for improving medical services in developing countries. In this study, the optimal sequence of bronchial brushing relative to bronchial biopsy for lung cancer diagnosis was evaluated.

Methods

A total of 420 patients with visible endobronchial tumors were prospectively and randomly enrolled in two groups: a pre-biopsy brushing group, receiving two brushings before biopsy; two brushings which performed afterwards; were set as self-control and compared with the pre-biopsy brushings as the intra-group comparison; and a post-biopsy brushing group, only receiving two brushings after biopsy, which were compared with the pre-biopsy brushings as the inter-group comparison. Diagnostic yield of brushing was compared before and after biopsy, and as well as for different tumor pathologies and bronchoscopic morphologies. The occurrence of treated bleeding which defined as bleeding needed further intervention with argon plasma coagulation and/or anti-coagulation drugs in two groups was also compared.

Results

Only patients with a definitive cytological or histological diagnosis of lung cancer based on bronchoscopy or other confirmatory techniques were included. Patients were excluded if they had submucosal lesions, extrinsic compressions, pulmonary metastasis of extrapulmonary malignancies or uncommon non-small cell lung carcinoma (NSCLC). A total of 362 patients who met the inclusion criteria were analyzed. Diagnostic yield for pre-biopsy brushing (49.2%, 88/179) was significantly higher than for post-biopsy brushing within the same pre–biopsy brushing group (31.8%, 57/179) (P=0.007) as the intra-group comparison, and significantly higher than for post-biopsy brushing in the post group (30.6%, 56/183) (P<0.001) as the inter-group comparison. No difference in occurrence of treated bleeding for pre- vs. post-biopsy bronchial brushing was found.

Conclusions

Supplementing bronchoscopic forceps biopsy with brushing improves diagnostic yield in lung cancer. In cases of endobronchial exophytic tumors, pre-biopsy brushing appears to be superior to post-biopsy brushing.     

经纤维支气管镜肺活检对弥漫性间质性肺疾病的诊断价值

目的探讨经纤维支气管镜肺活检（TBLB）对弥漫性间质性肺疾病（D ILD）的诊断价值。方法报道168例D ILD患者,其中行TBLB病理检查确诊45例（26.79%）,分析患者性别、病理诊断构成比及误诊情况等。结果 45例患者中,误诊为非特异性肺炎8例,肺结核6例,肺癌5例,肺淋巴瘤4例,肺动脉高压3例,气道中心纤维化2例;女性患者明显多于男性（27 vs 18,P〈0.01）。D ILD患者中特发性间质性肺炎最多（32例）,其次是结缔组织病相关D ILD（8例）、结节病（5例）。结论 TBLB是诊断D ILD的有效手段,对D ILD的鉴别诊断和分类诊断有重要意义。     

多种活检在周围型肺癌诊断中的应用

目的研究CT引导下经皮肺活检（CT-PLB）与经支气管镜肺活检（TBLB）或经支气管针吸活检（TBNA）在周围型肺癌诊断中的应用。方法对143例周围型肺癌患者的诊断方法进行分析,其中137例通过单用或联合采用CT-PLB、TBLB、TBNA等检查手段取得病理学诊断,6例为术后病理学诊断。结果 CT-PLB确诊率为85.4%,TBLB确诊率为68.4%,TBNA确诊率为80%,联合应用总确诊率为95.8%。结论对于肺周围型病变,根据病灶大小、位置、与胸壁距离、有否纵隔淋巴结转移等具体情况选择合适的活检方式可取得病理学诊断,多种方法联合应用可提高检出率。     

纤支镜与胸部CT对周围型肺肿瘤的诊断价值评估

目的 论述纤支镜与胸部CT在周围型肺癌诊断和分期中的价值。方法 分析24例周围型肺癌的胸部CT纤支镜及经皮穿刺活检。结果 CT支气管征（＋）7例中5例纤支镜（＋）,阳性率70％,24例CT（－）中有2例纤支镜（＋）。结论 纤支镜对周围型肺癌的诊断价值不能忽视。     

Pulmonary sarcoidosis in a 14-year-old boy diagnosed by low-dose CT-guided transthoracic lung biopsy

Pulmonary sarcoidosis is a rare disease in the pediatric age group, characterized by the presence of epitheloid-cell granulomas. In stage 3 sarcoidosis, pulmonary infiltrates without hilar lymphadenopathy occur. Definitive diagnosis requires a histopathological specimen, which might be difficult to obtain by transbronchial biopsy. Multidetector computed tomography (MDCT)-guided transthoracic lung biopsy (TLB) is a well-established procedure in adults, but has only rarely been applied in children.A 14-year-old boy was admitted to hospital for evaluation of a chronic systemic disease with severe pulmonary manifestation. All investigations, including bronchosopy and bronchoalveolar lavage with microbiological and virological testing, had been negative. MDCT-guided TLB was performed on a 16-section scanner with a low-dose protocol (single slices, 120 kV, 20 mAs), using a 16-gauge biopsy device. The total effective dose was 0.4 mSv for the biopsy procedure. Histopathological examination revealed multiple epitheloid-cell granulomas with giant cells in the absence of microbiological or virological abnormalities. A diagnosis of stage 3 pulmonary sarcoidosis was made and systemic anti-inflammatory therapy was administered, which led to complete remission within weeks. MDCT-guided TLB can be a valuable instrument in assessing pulmonary manifestations of pediatric sarcoidosis, enabling precise histopathological diagnosis and adequate therapy. The use of low-dose protocols can substantially reduce radiation exposure without relevant loss of image information. MDCT-guided lung biopsy should be considered prior to open-lung surgery in selected patients with unclear pulmonary disease.