摘要
目的探讨CT引导下经皮肺穿刺组织病理学检查联合组织培养在肺部感染性疾病中的诊断及鉴别诊断的价值。方法选取2015年1月1日至2019年5月1日清华大学附属北京清华长庚医院41例行CT引导下经皮肺穿刺活检的患者,术前临床诊断不除外肺部感染。穿刺活检标本分别送病理检查及组织培养。收集患者临床特征、病理及微生物学资料,按照肺部影像学表现分为肿块组、结节组及实变影组,分析肺穿刺活检病理检查联合组织培养对肺部感染性疾病的诊断价值。结果41例患者中,男30例,女11例,全部穿刺成功。经病理检查和组织培养,结合临床表现,其中23例(56.1%)诊为肺部感染性疾病,16例(39.0%)诊为恶性病变,2例(4.8%)未能明确诊断。感染性病变的镜下特征性表现有大量炎细胞浸润、发现菌团、特殊染色阳性等。总体病理诊断阳性率82.9%(34/41)。组织培养结果,41例标本共鉴定出19种微生物,总体组织培养阳性率31.7%(13/41),临床判定11例(11/41,29.2%)组织培养所得微生物有临床意义,其中6例为特殊感染(结核分枝杆菌感染3例,非结核分枝杆菌1例,真菌感染2例)。组织病理和组织培养联合诊断率为95.1%(39/41)。87.8%的患者治疗方案因联合诊断而改变(36/41)。肿块组的病理检查诊断率最高(88.2%),结节组的组织培养阳性率最高(40%)。术后并发症包括气胸、出血,总发生率为14.6%,均为1~2级不良反应,无操作相关死亡。结论对CT引导下肺穿刺活检组织,行病理检查联合组织培养能够提高肺部感染性疾病的早期诊断率,且安全有效,尤其有助于对结核、真菌等特殊病原体感染的早期诊断。
Objective To explore the diagnostic value of CT-guided percutaneous lung biopsy combined with specimen tissue culture in pulmonary infectious disease.Methods Patients with undetermined pulmonary lesions and poor response to empirical anti-infection therapy,from January 1 st 2015 to May 1 st 2019,underwent CT-guided percutaneous lung biopsy.All the specimens were sent to pathological examination and tissue culture,respectively.The clinical features,radiology data,pathology and microbiology profile were collected.Based on the imaging findings,the patients were divided into three groups:mass group,nodule group and solidification group.The positive rate of tissue pathology,tissue culture,and the combining of both were evaluated.The diagnostic value of combining histopathological investigation with microbiological cultivation were analyzed.Results A total of 41 patients,30 males and 11 females,were enrolled.All the procedures were performed successfully.After pathological examination and tissue culture,combined with clinical manifestations,23 cases(56.1%)were diagnosed as lung infectious diseases,16 cases(39.0%)were diagnosed as malignant lesions,and two cases(4.8%)were not definitively diagnosed.The pathology characteristic of infected lesions were massive infiltrated inflammatory cells,visible bacteria,or special staining positive,etc.The histopathological,microbiological and the combined diagnostic rates were 82.9%(34/41),31.7%(13/41)and 95.1%(39/41),respectively.Treatments changed in 36 of 41 patients(87.8%).The pathological diagnostic rate in mass group(>3 cm)was 88.2%,which was higher than the other groups.The culture positive rate in nodule group(≤3 cm)was 40%,which was higher than the other groups.The culture results showed that19 strains of microorganisms identified in 41 specimens,with a overall positive rate of 31.7%(13/41),among them 11(11/41,29.2%)were of clinically significant.Among the 11 confirmed infective cases,six were special infections(three cases of tuberculosis,one case of non-tuberculosis,two cases of fungal infection).The incidence of pneumothorax and hemorrhage was 14.6%and all were grade 1~2 complications without intensive intervention.No procedure related death occurred.Conclusions For CT-guided pulmonary puncture biopsy tissue,the joint of tissue culture can improve the early diagnositic rate of infectious diseases in the lungs,and is a safe and effective way,especially helpful for special pathogens infection such as tuberculosis and fungi.
作者
蔡存良
张明强
赵景全
安宇林
肖楠
马永强
尹洪芳
郭军
牟向东
Cai Cunliang;Zhang Mingqiang;Zhao Jingquan;An Yulin;Xiao Nan;Ma Yongqiang;Yin Hongfang;Guo Jun;Mu Xiangdong(Department of Resipiratory and Critical Care Medicine,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)
出处
《北京医学》
CAS
2020年第6期504-509,共6页
Beijing Medical Journal
关键词
经皮肺穿刺活检
组织病理
组织培养
percutaneous lung biopsy
histopathology
tissue culture
