CT引导下经皮穿刺活检对肺部疾病的诊断价值

目的探讨CT引导下经皮切割针肺活检在影像学上表现为肺占位性疾病诊断中的作用和应用范围。方法选择2008年11月—2011年11月安徽省阜阳市人民医院呼吸内科CT引导下经皮肺穿刺活检,胸部CT表现为占位性病例48例,回顾分析所有病例的病史、肿瘤标记物、气管镜、胸部CT及肺活检病理。结果男性33例,女性15例,年龄22-79岁,平均57岁。48例均穿刺活检成功,37例确诊为恶性肿瘤,其中鳞癌18例,有一例肺穿刺活检结果为浆细胞性肉芽肿,术后标本病理为中分化鳞状细胞癌,此例患者以术后病理结果统计;腺癌12例,包括1例细支气管肺泡癌,现称肺原位腺癌;小细胞癌4例;低分化非小细胞癌2例;转移癌1例,该病例原发为左侧肾脏;硬化性血管瘤1例;结核2例;机化性肺炎1例;真菌2例,但未区分出曲霉和隐球菌;炎性假瘤1例;未确诊4例,穿刺结果为肺组织内较多炎性细胞浸润、增生的纤维组织或者坏死组织。术中或者术后发生气胸4例,咳血3例,肺部并发症14.6%,明确诊断率91.7%。结论 CT引导下经皮肺穿刺活检对肺部占位性疾病确诊率高,并发症少,具有重要临床应用价值。但对于特发性间质性肺炎诊断价值有限,为减少假阴性率,对CT引导下经皮肺活检不能明确诊断但可见较多炎性细胞浸润、增生的纤维组织或者坏死组织者,需结合临床及其他辅助检查,综合诊断。

The clinical value of CT-guided percutanous biophy in diagnosis of lung diseases

Objective This study was to evaluate the efficacy and limitation of CT-guided percutaneous cutting needle lung biopsy in the diagnosis of pulmonary disease. Methods A total of 48 patients admitted in the respiratory department of Respiratory Fuyang of Anhui Hospital from November 2008 to November 2011 underwent CT-guided percutaneous cutting needle lung biopsy. The patients were evaluated by clinical history,lung CT,tumor marker and bronchoscopy.Results The study patients included 33 males and 15 females,and the mean age at diagnosis was 57（ range from 22-79） years. All the 48 punctures were successful,37 cases were diagnosed as malignant tumor,18 cases squamous cell carcinous,one case of lung biopsy results was plasma cell granuloma,but postoperative pathology specimens was differentiated squamous cell carcinoma,and statistics of the patients were according to the pathological results; 12 cases adeno carcinoma,including one case of bronchioloalveolar carcinoma,which was known as lung adenocarcinoma; 4 cases of small cell carcinoma,low differentiated,nonsmall cell carcinoma in 2 cases,metastatic carcinoma 1 case,primary tumor from the left kidney; sclerosing hemangioma 1 case,2 cases were tuberculosis,machine pneumonia in 1case,funji in 2 cases,inflammatory pseudotumor in 1 case. 4 cases were not confirmed,lung tissue biopsy results for more inflammatory cell infiltration,fibrosis or necrosis. Four cases had pneumothorax,3 cases had hemoptysis,pneumonic complication was at the rate of14. 6%. The diagnosis rate was 91. 7%. Conclusion The diagnosis on pneumonic diseases by CT-guided percutaneous biopsy was high in accuracy with less complication,which had important clinical value,but it was not a good method for diagnosis of interstitial lung diseases such as NSIP and UIP,in order to reduce false negative rate,in the cases with many inflammatory infiltrating cells,clinic and other secondary inspections should be combined as diagnosis means.