CT引导下经皮肺穿刺活检诊断艾滋病合并肺部病变的应用

Application of CT guided percutaneous lung biopsy in diagnosisof AIDS-related puhmonary disease

目的探讨CT引导下经皮肺穿刺活检术在艾滋病合并肺部病变诊断中的准确性与安全性。方法对6例艾滋病合并肺部病变病例及其在CI＇引导下经皮肺穿刺活检术病理结果进行分析。结果6例患者术前均有不同程度胸闷，4例咳白色泡沫痰，3例高热（〉39．5℃）。WBC升高2例，降低4例；血沉增快3例；1例癌胚抗原明显升高达52．20ng／mL。6例病例胸部CT均显示肺内片状或团块状病灶。6例患者活检术病理显示，5例为炎性改变，其中肉芽肿改变2例，肺癌1例；确诊马尔尼菲青霉菌感染2例，马红球菌感染1例，肺结核2例，肺腺样囊性癌1例；仅1例患者术后出现少量气胸；除肺癌患者放弃治疗外，其余5例根据确诊病因给予治疗，患者病灶明显吸收。结论CT能清晰地显示脏器内部的病变，同时又能明确病灶与周围组织结构关系，因此在CT引导下经皮肺穿刺活检术是一种安全、有效的获取病理资料的方法，可为各种肺部病变的病因诊断提供重要依据，对提高患者存活率具有十分重要的临床意义。

Objective To discuss the accuracy and safety of CT guided pereutaneous lung biopsy in the diagnosis of AIDS-rehted pulmonary disease. Methods The clinical and the pathological＇ results of cr guided pereutaneous lung biopsy d 6 cases with AIDS-related lung disease were analyzed. Results 6 patients had various degrees d chest tightness, white foam sputum occurred in 4 cases and high fever in 3 cases （ 〉 39.5 ℃ ） before lung biopsy. The WBC were increased in 2 cases, decreased in 4 cases; ESR were increased in 3 patients,CEA was increased to 52.20 ng/mL in 1 cases. The chest cr showed lung flake or crumb lesions in all the patients. The pathology for biopsy revealed that 5 cases developed infoammatory change （including granuloma change in 2 cases） and 1 case with lung cancer. Penicillium marneffe was detected in 2 cases and rhodococcus equn in one case. Tuberculosis occurred in 2 cases and pulmonary adenoid cystic carcinoma in I case. Only 1 patient developed a little pneumothorax postoperation. All the patients were treated according to the pathological results of lung biopsy and received good treatment expect 1 patient with lung cancer. Conclusions CT can clearly show the viscera internal lesions and the relation between the lesions and the surrounding tissue structure,so CT guided percutaneous lung biopsy is a safe and effective method for obtaining pathological data of pulmonary disease, it can provide important basis for the etiological diagnosis and help to raise the survival rate of the patients.