中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2012年
3期
171-175
,共5页
彭敏%许文兵%施举红%蔡柏蔷%田欣伦%柳涛%张弘%肖教%刘巍%冯瑞娥%刘鸿瑞%朱元珏
彭敏%許文兵%施舉紅%蔡柏薔%田訢倫%柳濤%張弘%肖教%劉巍%馮瑞娥%劉鴻瑞%硃元玨
팽민%허문병%시거홍%채백장%전흔륜%류도%장홍%초교%류외%풍서아%류홍서%주원각
体层摄影术,X线计算机%活组织检查,针吸%肺疾病,间质性%弥漫性实质性肺疾病
體層攝影術,X線計算機%活組織檢查,針吸%肺疾病,間質性%瀰漫性實質性肺疾病
체층섭영술,X선계산궤%활조직검사,침흡%폐질병,간질성%미만성실질성폐질병
Tomography,X-ray computed%Biopsy,needle%Lung diseases,interstitial%Diffuse parenchymal lung disease
目的 探讨CT引导下经皮切割针肺活检在影像学表现为弥漫性实质性肺疾病诊断中的作用和应用范围.方法 选择2000年1月至2008年12月北京协和医院行CT引导下经皮肺活检、胸部CT表现为双肺弥漫病变且临床资料完整的弥漫性实质性肺疾病患者248例.排除胸部CT为单发病变及单肺病变的病例.回顾分析所有病例的病史、血免疫学、支气管镜、胸部高分辨CT及肺活检病理等检查结果.结果 男114例,女134例,年龄13～78岁,平均年龄(50±16)岁.248例中经皮肺活检获得病理形态学诊断130例(52.4％),确诊疾病分别为肺部感染性疾病46例(35.4％),肺部肿瘤33例(25.4％),闭塞型细支气管炎伴机化性肺炎/机化性肺炎(BOOP/OP) 29例(22.3％),血管炎8例(6.2％),肉芽肿病变6例(4.6％),结节病3例(2.3％),弥漫性肺泡损伤和肺淀粉样变各2例(1.5％),以及肺泡蛋白沉积症(PAP)1例(0.7％).经皮肺活检未确定诊断的118例患者中有37例进行了开胸或胸腔镜肺活检,36例确定诊断,分别为非特异性间质性肺炎(NSIP) 12例,寻常型间质性肺炎(UIP)3例,感染6例,肿瘤3例,淋巴细胞间质性肺炎(LIp)、肺血管炎和过敏性肺炎(HP)各2例,结节病、ABPA、肺透明样肉芽肿病、肺尘埃沉积症、Castleman病及淋巴增殖性疾病各1例.经皮肺活检未确定诊断的118例患者中有69例结合临床及其他检查获得诊断.结论 约半数弥漫性实质性肺疾病患者通过CT引导下经皮肺活检能够获得特定的病理形态学诊断,尤其是影像学表现为双肺弥漫病变的感染及肿瘤病例确诊阳性率较高,但对于特发性间质性肺炎诊断价值有限,应结合患者的临床实际情况选择应用.
目的 探討CT引導下經皮切割針肺活檢在影像學錶現為瀰漫性實質性肺疾病診斷中的作用和應用範圍.方法 選擇2000年1月至2008年12月北京協和醫院行CT引導下經皮肺活檢、胸部CT錶現為雙肺瀰漫病變且臨床資料完整的瀰漫性實質性肺疾病患者248例.排除胸部CT為單髮病變及單肺病變的病例.迴顧分析所有病例的病史、血免疫學、支氣管鏡、胸部高分辨CT及肺活檢病理等檢查結果.結果 男114例,女134例,年齡13～78歲,平均年齡(50±16)歲.248例中經皮肺活檢穫得病理形態學診斷130例(52.4％),確診疾病分彆為肺部感染性疾病46例(35.4％),肺部腫瘤33例(25.4％),閉塞型細支氣管炎伴機化性肺炎/機化性肺炎(BOOP/OP) 29例(22.3％),血管炎8例(6.2％),肉芽腫病變6例(4.6％),結節病3例(2.3％),瀰漫性肺泡損傷和肺澱粉樣變各2例(1.5％),以及肺泡蛋白沉積癥(PAP)1例(0.7％).經皮肺活檢未確定診斷的118例患者中有37例進行瞭開胸或胸腔鏡肺活檢,36例確定診斷,分彆為非特異性間質性肺炎(NSIP) 12例,尋常型間質性肺炎(UIP)3例,感染6例,腫瘤3例,淋巴細胞間質性肺炎(LIp)、肺血管炎和過敏性肺炎(HP)各2例,結節病、ABPA、肺透明樣肉芽腫病、肺塵埃沉積癥、Castleman病及淋巴增殖性疾病各1例.經皮肺活檢未確定診斷的118例患者中有69例結閤臨床及其他檢查穫得診斷.結論 約半數瀰漫性實質性肺疾病患者通過CT引導下經皮肺活檢能夠穫得特定的病理形態學診斷,尤其是影像學錶現為雙肺瀰漫病變的感染及腫瘤病例確診暘性率較高,但對于特髮性間質性肺炎診斷價值有限,應結閤患者的臨床實際情況選擇應用.
목적 탐토CT인도하경피절할침폐활검재영상학표현위미만성실질성폐질병진단중적작용화응용범위.방법 선택2000년1월지2008년12월북경협화의원행CT인도하경피폐활검、흉부CT표현위쌍폐미만병변차림상자료완정적미만성실질성폐질병환자248례.배제흉부CT위단발병변급단폐병변적병례.회고분석소유병례적병사、혈면역학、지기관경、흉부고분변CT급폐활검병리등검사결과.결과 남114례,녀134례,년령13～78세,평균년령(50±16)세.248례중경피폐활검획득병리형태학진단130례(52.4％),학진질병분별위폐부감염성질병46례(35.4％),폐부종류33례(25.4％),폐새형세지기관염반궤화성폐염/궤화성폐염(BOOP/OP) 29례(22.3％),혈관염8례(6.2％),육아종병변6례(4.6％),결절병3례(2.3％),미만성폐포손상화폐정분양변각2례(1.5％),이급폐포단백침적증(PAP)1례(0.7％).경피폐활검미학정진단적118례환자중유37례진행료개흉혹흉강경폐활검,36례학정진단,분별위비특이성간질성폐염(NSIP) 12례,심상형간질성폐염(UIP)3례,감염6례,종류3례,림파세포간질성폐염(LIp)、폐혈관염화과민성폐염(HP)각2례,결절병、ABPA、폐투명양육아종병、폐진애침적증、Castleman병급림파증식성질병각1례.경피폐활검미학정진단적118례환자중유69례결합림상급기타검사획득진단.결론 약반수미만성실질성폐질병환자통과CT인도하경피폐활검능구획득특정적병리형태학진단,우기시영상학표현위쌍폐미만병변적감염급종류병례학진양성솔교고,단대우특발성간질성폐염진단개치유한,응결합환자적림상실제정황선택응용.
Objective This study was to evaluate the efficacy and limitation of CT-guided percutaneous cutting needle lung biopsy in the diagnosis of diffuse parenchymal lung diseases (DPLD).Methods A total of 481 patients admitted in Peking Union Medical College Hospital from January 2000 to December 2008 underwent CT-guided percutaneous cutting needle lung biopsy.The patients were evaluated by clinical history,physical examination and lung HRCT.Those with localized opacity or lesions in a single lung in the CT scan were excluded.Finally,248 patients with DPLD in HRCT were enrolled for this study.Results The study patients included 114 males and 134 females,and the mean ( ± SD) age at diagnosis was 50 ± 16 ( range from 13 - 78 ) years.Confirmed diagnosis by percutaneous needle lung biopsy was obtained in 130 patients ( 52.4％ ),including pulmonary infection ( 35.4％,46/130 ),pulmonary malignant diseases (25.4％,33/130),bronchiolitis obliterans organizing pneumonia/organizing pneumonia (22.3％,29/130 ),pulmonary vasculitis ( 6.2％,8/130 ),granulomatous lesions ( 4.6％,6/130 ),pulmonary sarcoidosis ( 2.3％,3/130 ),acute interstitial pneumonia ( 1.5％,2/130 ) ,pulmonary amyloidosis ( 1.5％,2/130),and pulmonary alveolar proteinosis (0.8％,1/130).Open lung biopsy/video-assisted thoracoscopic surgery was performed in 37 out of 118 cases for which the diagnosis was undetermined by percutaneous lung biopsy.Confirmed diagnosis was obtained in 36 patients,including nonspecific interstitial pneumonia ( NSIP,33.3％,12/36 ),usual interstitial pneumonia ( UIP,8.3％,3/36 ),pulmonary infection (16.7％,6/36),neoplasm (8.3％,3/36),lymphoid interstitial pneumonia,pulmonary vasculitis ( 5.6％ 2/36 ), hypersensitivity pneumonitis ( 5.6％,2/36 ), and pulmonary sarcoidosis,allergic bronchopulmonary aspergillosis,pulmonary hyalinizing granuloma,pneumoconiosis,Castleman' s disease,and lymphoproliferative disorder (1 case respectively ).Conclusion CT-guided percutaneous cutting needle lung biopsy can provide confirmed diagnosis in half of patients with DPLD,and has a high diagnostic yield in patients with infectious or neoplastic diseases,but it is not a good method for diagnosis of interstitial lung diseases such as NS1P and UIP.
