CT引导下经皮肺活检诊断周围性病变21例分析

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

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。

Objective To explore the value of CT-gnided percutaneous transthoracie needle biopsy in early diagnosis of lung peripheral diseases. Methods The clinical data of 21 patients with lung peripheral diseases undergoing CT-gnided percutaneous transthoracie needle biopsy were retrospectively analysed. The biopsy by fiberbronehoscopy was performed on 15 patients. Thoracic operation was carried out in 8 eases for further dignosis or treatment. The pathologic tissues were detected by histological and microbiological assay. Results The pathological accuracy of CT-gnided pereutaneous transthoraeie needle biopsy was 90.4% （19/21）. The diagnosis was clarified in 19 patients （malignant tumor： t0 eases, tuberculosis： 3 eases, pulmonary infection： 2 eases, metastatic carcinoma： 3 eases, sarcoidosis： 1 ease）. The diagnosis was unclear in 2 patient （the liver tissue was obtained in one ease, no abnormality was found in the other ease）. Only 2 out of 15 patients showed patients showed positive findings （adenocarcinoma） after the fiberbronehoscopy and the confirmed diagnosis rate was only 13.3 %. The diagnosis was elarifled in 8 eases after the thoracic operation （malignant tumor： 5 eases, chronic pulmonary infection： 1 ease, eryptoeoceosis of lungs： 1 ease, benign hamartoma of lungs： 1 ease）. The complication after CT-gnided pereutaneous transthoraeie needle biopsy occurred in 2 eases （2/21, incidence rate was 9.52%）. One ease with mild pneumatothorax recovered without special treatment. By going astray the liver tissue instead of lung tissue was obtained in the other ease. Conclusion CT-gnided pereutaneous 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.