经皮穿刺肺活检术在尘肺病诊断与鉴别诊断中的应用:4例报道  

Application of percutaneous lung biopsy to diagnosis and differential diagnosis of pneumoconiosis: Four case reports

作　　者：戴伟荣 李莉 占扬清 刘浪 李欣 刘文峰 杨中兴 谢雷 DAI Wei-rong;LI Li;ZHAN Yang-qing;LIU Lang;LI Xin;LIU Wen-feng;YANG Zhong-xing;XIE Lei(Department of Occupational Diseases, Hunan Prevention and Treatment Center for Occupational Diseases, Changsha, Hunan 410007, China;The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China)

机构地区：[1]湖南省职业病防治院职业病科,湖南长沙410007 [2]广州医科大学附属第一医院,广东广州510120

出　　处：《环境与职业医学》2019年第3期282-286,共5页Journal of Environmental and Occupational Medicine

基　　金：湖南省职业病防治院自选项目(Y2015-009)

摘　　要：4例病例为尘肺病诊断过程中难以确诊的病例,通过经皮穿刺肺活检术取得肺组织标本进行病理检查,找到致病粉尘的存在以及肺组织对这些粉尘反应的特征性改变,或找到结核、肿瘤等其他肺部疾病的病理证据。最终,1例病例为职业史明确,但肺部影像学改变无特异性,通过病理检查发现巨细胞间质性肺炎改变,最后确诊为硬金属肺病;1例病例为职业史与影像学改变不符,通过病理检查发现尘肺典型玻璃样改变,最后确诊为矽肺叁期;1例为职业史不明确,通过病理检查发现肺结核的改变,最后确诊为肺结核;1例为在尘肺基础上出现团块影,通过病理检查发现肿瘤样改变,最后确诊为尘肺合并肺癌。因此,在CT引导下经皮穿刺肺活检取得病理标本,对于辅助尘肺病的诊断及鉴别诊断上具有肯定意义。Percutaneous lung biopsy was ordered for four silicosis-suspected cases to obtain lung tissues for pathological examination and to confirm the presence of pathogenic dust and corresponding characteristic changes in lung tissues or the pathological evidence of other pulmonary diseases such as tuberculosis and tumor. Finally, 1 case with definite occupational history, who did not show any specific alterations in pulmonary image but features of giant cell interstitial pneumonia by pathological examination, was diagnosed as hard metal lung disease;1 case whose occupational history was incompatible with image changes and who showed typical hyaline changes by pathological examination was diagnosed as the third phase of silicosis;1 case without definite occupational history, who showed features of tuberculosis by pathological examination, was diagnosed as tuberculosis;and 1 case with lung mass shadow and silicosis, who showed tumor-like changes by pathological examination, was diagnosed as silicosis combined with lung cancer. Therefore, obtaining pathological specimens through CT-guided percutaneous lung biopsy has positive significance in the diagnosis and differential diagnosis of pneumoconiosis.

关 键 词：CT引导 经皮穿刺肺活检 尘肺病 诊断 鉴别诊断 

分 类 号：R135.2[医药卫生—劳动卫生]