关键词：结核, 肺；体层摄影术，X线计算机；经皮肺穿刺活检；鉴别诊断

    摘要：目的 探讨难诊性肺结核CT引导下经皮肺穿刺活检(PCNB)的临床应用价值。 方法 回顾分析了2003年2月至2004年10月在我科行PCNB诊断的15例肺结核病人。活检前全部病例均经其他方法检查而无法明确诊断，其中10例痰涂片、12例纤支镜、13例胸片、15例CT扫描、1例PET-CT检查。 结果 痰涂片、纤支镜检查结果均为阴性；胸片、CT及PET-CT示肺内和/或纵隔肿物；15例肺穿刺活检物送病理组织学检查确诊为肺结核，穿刺术后发生气胸3例、咳血1例。 结论 对影像学和其他检查方法难于确诊的肺结核病例，PCNB是一种安全有效的确诊手段。

    CT-guided percutaneous needle biopsy for diagnosis of atypical pulmonary tuberculosis: analysis of clinical, imaging and pathological data in 15 cases

    LI Ji-gen, CHEN Long-hua, WU De-hua

    Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China

    Abstract: Objective To explore the clinical value of CT-guided percutancous needle biopsy (PCNB) for diagnosis of atypical pulmonary tuberculosis. Methods The data from 15 patients undergoing diagnostic PCNB for pulmonary tuberculosis were retrospectively analyzed. Prior to PCNB, definitive diagnosis failed to be obtained from other examinations including sputum smear in 10 cases, fiberoptic bronchoscopy in 12, chest X-ray in 13, CT scan in 15, and position emission tomography (PET) with CT examination in 1 case. Results Sputum smears and fiberoptic bronchoscopy both failed to produce positive results and pulmonary and/or mediastinal lesions were shown by chest X-ray, CT, and PET-CT. Pulmonary tuberculosis were diagnosed in the 15 cases by histopathological examination following PCNB, and pneumothorax in relation to PCNB occurred in 3 cases and hemoptysis in 1 case. Conclusion PCNB provides a safe and accurate means for diagnosis of pulmonary tuberculosis when imaging and other diagnostic modalities fail to result. ......