CT引导下经皮肺活检诊断周围性病变21例分析

目的 评价CT下引导下经皮肺活检,对肺周围性病变早期诊断的意义.方法 回顾21例肺周围性病变患者的临床资料.21例均行CT引导下经皮肺活检,其中15例经纤维支气管镜检查并行活检或刷检.8例因诊断不明确或为进一步治疗,行胸科手术,取病理做组织学及微生物学检查.结果 CT引导下经皮肺活检,病理准确率为90.4%（19/21）.21例中明确诊断,肺肿瘤者10例,肺结核3例,肺部感染2例,肺转移癌3例,结节病1例,未能明确诊断2例（1例误穿至肝脏未获得肺组织,诊断为轻度脂肪肝;另1例病理未见异常）15例行支气管检查,有阳性结果者仅为2例,诊断为腺癌,确诊率为13.3%.经开胸手术诊断者共8例（肿瘤切除者为5例,另外3例,1例为肺部慢性炎症,1例为肺隐球菌感染,1例为良性错构瘤）.CT引导下经皮肺活检并发症有1例发生少量气胸,未做特殊处理而自愈,1例误穿至肝脏未获得肺组织,发生率为9.52%（2/21）.结论 CT引导下经皮肺活检是肺部周围性病变的一种重要诊断措施,其安全性可靠,诊断的准确率较高,并发症少和侵袭性小的方法,可以在较短的时间内得到周围性病变的诊断结果.

CT-guided percutaneous transthoracic needle biopsy in 21 cases with peripheral disease of lungs

Objective To explore the value of CT-guided percutaneous transthoracic needle biopsy in early diagnosis of lung peripheral diseases.Methods The clinical data of 21 patients with lung peripheral diseases undergoing CT-guided percutaneous transthoracic needle biopsy were retrospectively analysed.The biopsy by fiberbronchoscopy was performed on 15 patients.Thoracic operation was carried out in 8 cases for further dignosis or treatment.The pathologic tissues were detected by histological and microbiological assay.Results The pathological accuracy of CT-guided percutaneous transthoracic needle biopsy was 90.4%(19/21).The diagnosis was clarified in 19 patients(malignant tumor: 10 cases,tuberculosis: 3 cases,pulmonary infection: 2 cases,metastatic carcinoma: 3 cases,sarcoidosis: 1 case).The diagnosis was unclear in 2 patient(the liver tissue was obtained in one case,no abnormality was found in the other case).Only 2 out of 15 patients showed patients showed positive findings(adenocarcinoma) after the fiberbronchoscopy and the confirmed diagnosis rate was only 13.3%.The diagnosis was clarified in 8 cases after the thoracic operation(malignant tumor: 5 cases,chronic pulmonary infection: 1 case,cryptococcosis of lungs: 1 case,benign hamartoma of lungs: 1 case).The complication after CT-guided percutaneous transthoracic needle biopsy occurred in 2 cases(2/21,incidence rate was 9.52%).One case with mild pneumatothorax recovered without special treatment.By going astray the liver tissue instead of lung tissue was obtained in the other case.Conclusion CT-guided percutaneous needle biopsy provides an important method for diagnosis of peripheral disease in lungs.It is helpful to clarify the diagnosis quickly and safely with few complications and little damage.