自动切割针胸膜活检联合CA125、ADA检测在结核性胸膜炎中的应用

目的探讨超声引导下弹簧式自动切割针胸膜活检联合CA125、ADA检测在结核性胸膜炎中的应用价值。方法收集确诊结核性胸膜炎患者110例,非结核性胸腔积液患者56例,分析比较患者CA125、ADA及胸膜活检的结果。结果单独胸膜活检阳性率为80.91%,三种方法联合诊断阳性率为92.73%,两者有统计学差异(P0.05)。结论超声引导下弹簧式自动切割针胸膜活检联合CA125、ADA检测可提高结核性胸膜炎诊断率,在临床上有应用价值。     

多种技术联合应用对肺癌诊断的临床价值

目的评价多种技术联合应用对肺癌诊断的临床价值。方法 884例痰脱落细胞学、细菌学、常规支气管镜等检查均无阳性发现的疑似肺癌的患者行经支气管镜针吸活检术（TBNA）和活检刷检、经支气管镜超声引导针吸活检术（EBUS-TB-NA）、纵隔镜、超声或CT引导经皮肺穿刺活检术、PET-CT和内科电子胸腔镜胸膜活检术。结果 215例患者TBNA、刷检、活检的阳性率分别为81.58%、29.47%和16.84%。15例EBUS-TBNA的阳性率为91.67%,20例超声或CT引导经皮肺穿刺活检术阳性率为65%,10例PET-CT阳性率为80%,628例患者胸腔镜检查的总体阳性率为94.6%。结论多种技术联合应用可明显提高肺癌的早期诊断率。     

CT引导下经皮肺穿刺与活检针内径相关性的研究

目的探讨粗针（14G、16G）、细针（18G、20G）经皮穿刺活检肺部病变的阳性率及并发症的差异。方法对168例cT引导下经皮肺穿刺活检的病例资料进行回顾性分析，其中80例采用细针活检，88例采用粗针活检，比较两组穿刺结果的阳性率及并发症。结果粗针穿刺组中肺癌72例，阳性率为98．6％；良性病变16例，阳性率为81．3％。细针穿刺组中肺癌66例，阳性率81．8％；良性病变14例，阳性率64．3％。粗针穿刺组发生气胸9例，肺出血7例，并发症发生率18．2％；细针穿刺组发生气胸7例，肺出血4例，并发症发生率13．8％。结论粗针行CT引导下经皮穿刺活检阳性率有显著差异。     

胸膜活检标本行基因扩增对结核性胸膜炎的诊断价值

目的 评价胸膜活检组织行聚合酶链反应（ＰＣＲ）对结核性胸膜炎的诊断价值。方法 ＰＣＲ检测６５例胸膜活检组织中结核分枝杆菌ＤＮＡ,并与胸水检测及胸膜活检组织病检对比。结果 胸膜活检组织ＰＣＲ阳性率８３．１％,胸水ＰＣＲ阳性率为６３．１％,胸膜活检组织病检阳性率为６０．６％。前者较后两者更敏感。结论 胸膜活性组织ＰＣＲ检测对结核性胸膜炎有较高的诊断价值。     

胸膜活检和胸液培养分枝杆菌联合运用对结核性胸膜炎的诊断价值

目的探讨胸液培养分枝杆菌、胸膜活检及其联合运用对结核性胸膜炎的诊断价值。方法通过对270例结核性胸膜炎（合并肺结核141例）患者分别同时行胸液培养分枝杆菌、胸膜活检术检查,观察并比较它们的阳性率及其联合运用的阳性率。结果单独行胸液培养分枝杆菌检查,阳性率41.1%：单独行胸膜活检术,阳性率65.2%,2种方法联用阳性率80.0%。联用方法与单独胸液培养组之间的差异具有统计学意义（χ²＝85.476,P<0.01）;与单独胸膜活检组之间的差异也有统计学意义（χ²=14.892,P<0.01）。结论2项检查均较安全,准确,对结核性胸腔积液诊断有显著意义,联合运用能大大提高确诊率,并能知道结核性胸腔积液是否是耐多药结核病（MDR-TB）和非结核分枝杆菌病（NTM）。     

胸膜活检标本行基因扩增对结核性胸膜炎的诊断价值

目的 评价胸膜活检组织行聚合酶链反应(PCR)对结核性胸膜炎的诊断价值?方法 PCR检测65例胸膜活检组织中结核分枝杆菌DNA,并与胸水检测及胸膜活检组织病检对比?结果 胸膜活检组织PCR阳性率831%,胸水PCR阳性率为631%,胸膜活检组织病检阳性率为60.0%?前者较后两者更敏感?结论 胸膜活检组织PCR检测对结核性胸膜炎有较高的诊断价值?     

细针穿刺活检在肺部占位病变中的应用

目的探讨CT引导下细针经皮肺穿刺活检在肺部占位病变中的应用价值。方法CT扫描定位细针穿刺到病灶,穿刺物送细胞学检查。结果48例肺部占位性病变行CT引导下经皮细针肺穿刺活检,42例得到确诊,确诊率为87.5%,无并发症。结论CT引导下经皮细针肺穿刺活检对肺部占位病变的诊断阳性率高,创伤小,并发症少,值得推广。     

超声引导下胸膜活检、结核分枝杆菌-PCR及干扰素联合检测诊断结核性胸膜炎

目的探讨超声引导下胸膜活检、胸水结核分枝杆菌-PCR（TB-PCR）及干扰素（r-IFN）检测对结核性胸膜炎的诊断价值。方法对57例结核性胸腔积液患者行超声引导下胸膜活检,取壁层胸膜组织送病理检查,同时测定胸水中的TB-PCR、r-IFN。结果胸膜病理结果为干酪样坏死或肉芽肿病变46例,胸水TB-PCR阳性20例,r-IFN〉240pg/ml37例,胸膜病理结合胸水TB-PCR、r-IFN诊断结核性胸膜炎52例,较分别单独检查阳性率明显升高（P〈0.01）。结论超声引导下胸膜活检结合胸水TB-PCR、r-IFN的测定是结核性胸膜炎重要的内科确诊手段。     

超声定位下槽切式胸膜活检在老年结核性胸腔积液中的临床价值

目的探讨超声定位下槽切式胸膜活检对老年结核性胸腔积液的诊断价值。方法对58例老年结核性胸腔积液患者胸膜活检的取材成功率、病理诊断阳性率进行总结,分析胸膜活检的诊断价值、影响诊断阳性率的因素,以及胸膜活检的并发症。结果58例中取材成功率91.5%(75/82),病理结核确诊率70.7%(41/58)。增加活检次数可以提高诊断阳性率;并发症7例(8.5%)。结论超声定位下槽切式胸膜活检可作为诊断老年结核性胸腔积液安全有效的手段。     

超声引导下胸膜活检、干扰素联合检测诊断结核性胸膜炎

目的探讨超声引导下胸膜活检及胸水干扰素检测对结核性胸膜炎的诊断价值。方法对42例结核性胸腔积液患者行超声引导下胸膜活检,取壁层胸膜组织送病理检查,同时测定胸水中的干扰素。结果胸膜病理结果为干酪样坏死或肉芽肿病变34例,胸水IFN-r〉240pg/ml31例,胸膜病理结合胸水IFN-r诊断结核性胸膜炎40例,较分别单独检查阳性率明显升高（P〈0.01）。结论超声引导下胸膜活检结合胸水IFN-r的测定是结核性胸膜炎重要的内科确诊手段。     

187例结核性胸膜炎胸膜结核分枝杆菌药敏检测探讨

目的了解结核性胸膜炎患者结核分枝杆菌的耐药情况,为指导临床制定合理化疗方案提供科学依据。方法采用胸膜活检技术获取胸膜组织接种在改良罗氏培养基内进行结核分枝杆菌的培养及药物敏感性测定。结果306例结核性胸膜炎胸膜组织结核分枝杆菌培养阳性者187例,阳性率61.1%。187例药敏测定结果对6种抗结核药物均敏感者148例,敏感率79.1%;耐药39例,耐药率20.9%。结论结核性胸膜炎与肺结核都同样存在着初始耐药性和继发耐药性的问题,同样必须高度重视其化疗原则和管理水平。     

Pleural puncture needle biopsy]

Two hundred and thirty patients with pleurisy had pleural biopsy done by Castelain needle. This examination was positive in 85.7% of cases in tuberculous pleurisies and in 50% of cases in neoplastic pleurisies. The yield of needle pleural biopsy is higher in these two cases than in bacteriology and pleural cytology. The low rate of incidents and accidents (5.5%) widens the scope of needle pleural biopsy in non purulent pleurisy.     

Fine needle aspiration cytology of rectal masses.

This paper describes the results of transproctoscopic fine needle aspiration cytology in the diagnosis of rectal lesions. Fifty one consecutive patients referred with a presumptive diagnosis of rectal mass were subjected to proctoscopic examination when fine needle aspiration cytology, brush cytology and biopsy samples were taken. Of the 30 patients of malignancy of rectum in whom all the three sampling techniques were applied, the biopsy was positive in 27 (90%), brush cytology in 25 (83.3%) and fine needle aspiration cytology in 29 (96.6%). A combination of fine needle aspiration cytology with brush cytology gave a positive yield in 96.6% while that fine needle aspiration cytology with brush cytology gave a yield of 100%. Fine needle aspiration cytology was most helpful in infiltrative tumours. All 10 patients with secondaries in the pouch of Douglas or rectovesical pouch, and the single patient with submucosal rectal carcinoma were correctly diagnosed at fine needle aspiration cytology. There were no false positive results with fine needle aspiration cytology and no complications were encountered with the procedure.     

The role of thoracoscopy in pleural biopsy in cases with pleural effusion

Between April 1985 and July 1989, 125 cases with pleural effusion were admitted to our department. The causes of pleural effusion were carcinomatous pleurisy in 47 cases, infection without tuberculosis in 34 cases, tuberculous pleurisy in 17 cases, cardiac insufficiency and hypoproteinemia in 11 cases, trauma and pneumothorax in nine cases, collagen disease in two cases and unknown origin in five cases. Carcinomatous pleurisy and tuberculous pleurisy, the differential diagnosis of which is very important, comprised 37% and 14% of all cases, respectively. These diseases can be definitively diagnosed by pleural biopsy, effusion cytology and/or effusion culture. In July 1987, we introduced thoracoscopy to improve the ratio of definitive diagnoses. The ratio for carcinomatous pleurisy in the previous term, when thoracoscopy was not being used, was 59%, while that in the latter term, when it was used, was 73%. The ratio for all cases with tuberculous pleurisy was 47%. Prior to June 1987, pleural biopsies in our department were performed with a Cope needle. Using that procedure, a low positive ratio of 50% was obtained. For thoracoscopic pleural biopsies, a high positive ratio of 84% was achieved (in carcinomatous pleurisy, 13 out of 15 cases; in tuberculous pleurisy, three out of four cases). This procedure was performed with minimal patient discomfort and no serious complications. Therefore, thoracoscopic pleural biopsy is recommended as a diagnostic procedure for cases with pleural effusion.     

Diagnostic study of pulmonary mass under ultrasonography guided aspiration biopsy by four types of needle]

One hundred and thirty patients with pulmonary mass were studied under ultrasonography guided aspiration biopsy by four types of needle. The cytological positive cases were 57.1% in fine needle (22G), 79.6% in large needle (18G), 90.9% in canaliculated needle (18G) and 80.9% in cutting needle (14G), and the pathological positive cases were 0, 64.4%, 86.3% and 92.8% respectively. These data showed that the positive rate of fine needle puncture was the lowest one. Based on the pathological finding, canaliculated and cutting needle seem to be better than large one and it is the best choice to perform the pulmonary aspiration biopsy.     

超声引导下改良胸膜活检术对诊断原因不明胸腔积液的临床观察(附49例临床分析)

目的 观察超声引导下改良胸膜活检术对原因不明胸腔积液诊断中的价值.方法 使用改良胸膜活检术对49例不明原因胸腔积液患者进行胸膜活检术.结果 所有患者胸膜活检均成功,其中间皮瘤3例,低分化癌6例,腺癌7例,未分型4例,结核18例,慢性炎症11例(经治疗最终证实为结核),病理确诊率77.6％,仅2例出现胸膜反应,未出现局部出血及气胸.结论 超声引导下改良胸膜活检术安全、方便,对胸腔积液确诊率高、并发症少.     

多种抗结核分支杆菌抗体和胸膜活检对结核性胸膜炎诊断价值

目的　探讨多种抗结核分支杆菌抗体和胸膜活检术对结核性胸膜炎诊断价值。方法 对121例结核性胸膜炎(合并肺结核60例),44例癌性胸液患者进行血清、胸液四项抗结核抗体测定(抗PPD-IgG、LAM-IgG卡、TB-Dot卡、ICT-TB卡),对72例结核性胸膜炎病人进行胸膜活检病理检查。结果 血清四项抗体检测结核组阳性率分别为75.6%、30.7%、44.7%、35.1%;癌性组为43.2%、17.1%、11.4%、2.6%。胸液四项抗体检测结核组阳性率分别为81.7%、24.0%、27.1%、22.7%;癌性组为51.2%、14.7%、5.9%、2.8%。血清和胸液结核组均比癌性组高,合并肺结核高于单纯性胸膜炎组。敏感性以抗PPD-IgG为最高,但特异性差(血清56.8%,胸液48.8%),与癌性胸水存在明显交叉;LAM-IgG卡、TB-Dot卡、ICT-TB卡,特异性血清分别为82.9%、88.6%、97.4%,胸液为85.3%、94.1%、97.2%,比抗PPD-IgG高,但敏感性较低。胸液抗体检测阳性率除抗PPD-IgG外略低于血清。以抗PPD-IgG加TB-Dot卡(A组)或抗PPD-IgG与ICT-TB卡(B组)两项阳性组合,且两项均阳性时,特异性,血清可达94.3%～100%,胸液可达91.4%～97.2%。阳性率,血清为43.0%～42.98%,胸液为23.7%～17.2%,可提供临床鉴别诊断参考。胸膜活检72例,阳性34例（47.2%),活检阳性与病程密切相关,发病2个月内活检阳性率最高75.5%(25/34)。结论 胸膜活检病理学诊断在结核性胸膜炎诊断上有重要价值,多项抗体联合测定对结核性胸膜炎诊断有一定参考意义。     

超声定位下槽切式胸膜活检在老年结核性胸腔积液中的临床价值

目的　探讨超声定位下槽切式胸膜活检对老年结核性胸腔积液的诊断价值。方法 对58例老年结核性胸腔积液患者胸膜活检的取材成功率、病理诊断阳性率进行总结,分析胸膜活检的诊断价值、影响诊断阳性率的因素,以及胸膜活检的并发症。结果 58例中取材成功率91.5%(75/82),病理结核确诊率70.7%(41/58)。增加活检次数可以提高诊断阳性率;并发症7例(8.5%)。结论 超声定位下槽切式胸膜活检可作为诊断老年结核性胸腔积液安全有效的手段。