25G活检针对有COPD等合并症肺肿块的诊断作用  

Spiral CT-guided 25-gauge needle biopsy in the diagnosis of thoracic tumor associated with COPD or other concurrent disease

作　　者：张立安 贺静 葛林阜[2] 周宏超 王东 胡加寿 孙秋德 朱媛 肖林 

机构地区：[1]107医院影像中心,山东烟台264002 [2]济南军区总医院血液科,山东济南250022

出　　处：《实用医药杂志》2007年第10期1166-1168,1171,共4页Practical Journal of Medicine & Pharmacy

摘　　要：目的探讨25G活检针在诊断胸部肿块及肿块合并严重的慢性阻塞肺疾病(COPD)中的可行性及安全性。方法27例疑似胸部肿瘤患者,CT显示病灶直径为0.7～4.8cm,平均1.8cm,均在螺旋CT立体定位导引下取活检。其中15例患有严重的慢性阻塞肺疾病(COPD),1例伴有胸膜炎及陈旧肺结核,1例患凝血疾病。穿刺采用25G活检针,外面套以同轴套管行经皮取活检。标本取出后首先确定数量是否合格,然后行快速染色病理学检查。结果27例中有24例获得足够的组织学标本(88.9%),达到诊断要求者23例(95.8%),细胞学快速染色诊断17例恶性、6例良性,其中1例初始怀疑恶性者最终确定组织胞浆菌病。改用较大号活检针补充穿刺者4例,只有1例提供更进一步的诊断信息。3例出现气胸(11.1%),2例为单纯应用25G活检针者,1例为较大号针所致。结论25G活检针在诊断胸部肿瘤时具有较高的可行性和安全性,尤其对胸部肿块合并COPD患者更具有潜力。Objective To evaluate the clinical value and safety of 25-gauge needles for biopsy of thoracic tumor and thoracic tumor associated with severe chronic obstructive pulmonary disease （COPD）. Methods Twenty-seven patients with thoracic tumor were suspected by CT which the diameter of their lesion were 0.7-4.8 cm （mean,1.8cm）. All the patients then underwent biopsy with spiral-CT guidance. Five of them had COPD,one had a pleurisy and a obsolete pulmonary tuberculosis, and one had a eoagulopathy. Biopsy with an inner 25-gauge needle traversing an outer extrapleural coaxial cannula was performed in all the patients. Cytologic quick staining was performed routinely to determine specimen adequacy and to establish a preliminary diagnosis. Results Adequate specimens （as determined by eytopathologists）were obtained in 24 of 27 patients （88.9%）,with a definitive diagnosis achieved in 23 （95.8%） patients during initial quick staining （17 malignant and six benign）.One case initially considered suspicious for malignancy were reclassified as benign （histoplasmosis）.At the request of eytopathologists, a larger needle was alternatively used to supplement of the 25-gauge needle in four patients,among them in one patient, it provided further diagnostic information,3 patients developed a small pneumothorax （11.1%）, which 2 patiens with use of the 25-gauge needle alone, other one received larger needles.Conclusion The 25-gauge needle biopsy with spiral CT -guided is both feasible and safe,especially for the tumor associated with COPD it has more potentiality.

关 键 词：活检 胸部肿块 慢性阻塞性肺疾病(COPD) 诊断 

分 类 号：R446.8[医药卫生—诊断学]