经皮肺穿刺活检术对影像学表现不典型的肺结核患者的诊断意义及安全性临床分析

Clinical Analysis of the Diagnostic Significance and Safety of Percutaneous Lung Biopsy in Pulmonary Tuberculosis Patients with Atypical Imaging Findings

目的分析经皮肺穿刺活检术对影像学表现不典型的肺结核患者诊断的意义及该检查在该类患者中的安全性。方法回顾性分析23例经经皮肺穿刺活检术后确诊的影像学表现不典型的肺结核患者临床特征,术中术后的并发症,追踪观察患者治疗前后的影像学变化。结果 23例患者影像学表现分别为结节8例(34.9%)、片团影6例(26.1%)、占位9例(39.1%),初诊均疑诊为肺部肿瘤,20例行支气管镜检查无阳性发现,经CT引导下经皮肺穿后经病理学检查确诊结核,两例患者抗酸杆菌涂片阳性,术中无咯血等并发症,术后出现气胸4例,无严重不良事件。结论对临床表现及影像学表现不典型的肺结核患者,经皮肺穿为一种较好的检查方式,检查安全性高。

Objective To analyze the significance of percutaneous lung biopsy in the diagnosis of pulmonary tuberculosis patients with atypical imaging findings and the safety of the examination in this type of patients. Methods The clinical features,intraoperative and postoperative complications of 23 patients with atypical pulmonary tuberculosis confirmed by percutaneous lung bi- opsy were retrospectively analyzed. The imaging changes before and after treatment were observed and followed up. Results The ima- ging findings of 23 patients were nodular in 8 cases （34.9%）, mass shadow in 6 cases （26. 1% ）, occupying in 9 cases （39. 1% ）, respectively. All patients were initially diagnosed as suspected lung cancer. 20 cases had no positive findings by bronchoscopy, and were diagnosed as tuberculosis confirmed by CT guided pereutaneous lung biopsy after pathological examination. Two cases were posi- tive for acid fast bacilli smear. There were no complications such as hemoptysis,pneumothorax occurred in 4 cases, and no serious ad- verse events occurred. Conclusion For patients with pulmonary tuberculosis with atypical clinical manifestations and imaging find- ings, percutaneous lung biopsy is a better method of examination,with high safety.