CT引导经皮肺穿刺结核空洞介入治疗的临床应用

CT guided percutaneous lung biopsy in clinical application

目的探讨CT引导下经皮肺穿刺结核的介入方法,总结其临床应用效果。方法选患者舒适且利于穿刺的体位仰卧、俯卧或侧卧等,在CT引导下经皮肺结核空洞穿刺,先活检,留标本,后根据不同病情,采用不同介入治疗方法,局部药物高浓度,结合全身联合抗痨治疗,疗效显著。结果所有在CT引导下经皮穿刺肺结核空洞介入治疗的患者,不论是初治、复治(耐药),均能达到:(1)临床症状有效率为100%,尤其是初治的18例肺结核空洞患者。(2)痰菌阴转情况:6个月复查对照:介入+全身抗痨治疗痰菌阴转率达81.9%;单纯联合抗痨治疗为33.3%。(3)空洞缩合情况:6月观察:介入+全身抗痨治疗:缩合率达63.6%;单纯联合抗痨治疗为23.8%。结论经介入治疗加全身联合抗痨结果表明:初治肺结核空洞患者治疗效果最明显。复治空洞患者疗效差于初治结核空洞患者,但通过穿刺抽出空洞内的分泌液及活检组织,做培养及药敏实验,可指导临床抗痨治疗,该方法的临床应用是极有价值的。

objective Study of CT guided percutaneous needle lung tuberculosis interventional. Methods summarize its clinical application effect. Method. Selected patients comfortable and conducive to the puncture position, prone or supine position, in CT guided percutaneous puncture biopsy of pulmonary tuberculous cavity, first, leaving specimens after, according to the different condition, using different intervention methods, locally high concentrations of the drug, combined with systemic combination anti-tuberculosis treatment, the curative effect remarkable. Results In all the CT guided percutaneous interventional treatment of pulmonary tuberculosis cavity of patients, regardless of initial treatment, retreatment （resistance）, can be reached： （1） clinical efficiency of 100%, especially in the early treatment of 18 cases of cavitary pulmonary tuberculosis patients. （2） sputum conversion： 6 months control： intervention therapy and systemic antitubereulosis therapy of sputum negative conversion rate： 81.9%; herpes combination anti-tuberculosis treatment： 33.3%. （3） hollow condensation： June observation： intervention therapy and systemic antitubereulosis therapy： condensation rate reached 63.6%; herpes combination anti-tuberculosis treatment： 23.8%. Conclusion Transcatheter interventional therapy plus systemic antituberculosis results show that： the initial treatment of pulmonary tuberculosis patients with the most obvious effect of empty.Retreatment of patients with untreated cavities for cavitary TB patients, but through the needle extraction cavities within the fluid secretion and biopsies, as culture and susceptibility test, can guide clinical anti-tuberculosis treatment, clinical aDlalieation of the method is very valuable.