CT引导下经皮肺穿刺术在高原地区肺结核诊断中的应用

Clinical application of CT-guided percutaneous lung biopsy in the diagnosis of pulmonary tuberculosis in high altitude area

目的评价CT引导下经皮肺穿刺术在高原地区肺结核的诊断价值。方法回顾性分析2016年10月—2017年3月期间接受CT引导下经皮肺穿刺并最终确诊的22例患者的临床资料。结果 22例患者中,男性15例,女性7例,年龄28~71岁,平均年龄(44.7±14.8)岁。合并COPD病史11例(50.0%),高原性心脏病10例(45.5%),2型糖尿病9例(40.9%),高血压病7例(31.8%)。发热7例(31.8%),咳嗽、咳痰12例(54.5%),咯血8例(36.4%),胸痛8例(36.4%),盗汗7例(31.8%),消瘦10例(45.5%),纳差8例(36.4%),无症状(体检发现)9例(40.9%)。22例患者全部穿刺成功,CT引导下经皮肺穿刺活检成功率为100%(22/22),CT穿刺共确诊20例,穿刺物病理阳性率90.90%(20/22),穿刺物抗酸染色阳性率为18.2%(4/22),二者相比差异有统计学意义(χ~2=20.625,P<0.05)。本组共有5例患者出现轻微不良反应。气胸发生率9.1%(2/22),吸氧休息后自行吸收。咯血发生率13.6%(3/22),无大咯血发生。结论 CT引导下经皮肺活检操作简单、安全性高,对高原地区肺结核的诊断具有重要应用价值。

Objective To explore the clinical value of CT-guided percutaneous lung biopsy in the diagnosis of pulmonary tuberculosis in high altitude area. Methods The clinical data of 22 cases of pulmonary tuberculosis confirmed by CT- guided percutaneous lung biopsy between October,2016 and March,2017 were retrospectively analyzed. Results There were 15 males and 7 females,aged 28 -71 years,with an average age of （44.7 ± 14.8） years. 11 cases complicated with the history of COPD（50% ）, 10 cases with high altitude heart disease （45.5%）,9 cases with type 2 diabetes mellitus （40.9%）, and 7 cases with hypertension（ 31.8% ）. The clinical manifestation included 7 cases of fever（ 31.8% ）, 12 cases of cough and sputum （ 54.5% ）, 8 cases of hemoptysis （ 36.4% ）, 8 cases of chest pain （ 36.4% ） ,7 cases of night sweats（31.8% ） , 10 cases of loss of weight （45.5%）, 8 cases of loss of appetite （ 36.4% ）, 9 cases without symptoms （physical examination found,40.9% ）. All the 22 patients had successful puncture, and the success rate of CT-guided percutaneous lung biopsy was 100% （22/22）. The positive rate of pathologic diagnosis was 90.90% （20/22）. The positive rate of acid-fast staining for puncture fluid was 18.2% （4/22）. There was significant difference between the two groups （ Х^2 = 20. 625, P 〈 0.05 ）. A total of 5 patients with mild complication were observed. The incidence of pneumothorax was 9.1% （ 2/22）, pneumothorax were automatically absorbed after oxygen uptake and rest. The incidence of hemop- tysis was 13.6% （3/22）, and no fatal hemoptysis occurred. Conclusion The CT-guided percutaneous lung biopsy is a safe and effective means in the diagnosis of pulmonary tuberculosis in high altitude area.