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  • 孙雯雯,王茵,朱惠铭,毕珂,徐黎莎.超声造影引导下穿刺活组织检查对胸膜结核瘤的早期诊断价值[J].第二军医大学学报,2018,39(10):1077-1081    [点击复制]
  • SUN Wen-wen,WANG Yin,ZHU Hui-ming,BI Ke,XU Li-sha.Clinical value of contrast-enhanced ultrasound-guided biopsy in early diagnosis of pleural tuberculoma[J].Acad J Sec Mil Med Univ,2018,39(10):1077-1081   [点击复制]
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超声造影引导下穿刺活组织检查对胸膜结核瘤的早期诊断价值
孙雯雯1,王茵2,朱惠铭2,毕珂3,徐黎莎2*
0
(1. 同济大学附属上海市肺科医院结核病临床研究中心, 上海市结核病(肺)重点实验室, 上海 200433;
2. 同济大学附属上海市肺科医院超声科, 上海 200433;
3. 同济大学医学院, 上海 200092
*通信作者)
摘要:
目的 探讨超声造影引导下穿刺活组织检查对胸膜结核瘤的早期诊断价值。方法 选取同济大学附属上海市肺科医院于2017年1月至2018年1月收治入院且临床拟诊胸膜结核瘤的患者87例。所有患者均行超声造影及超声引导下穿刺活组织检查,标本进行病理、抗酸杆菌涂片培养和结核分枝杆菌聚合酶链反应检测。收集所有患者的临床资料,并对超声造影结果、最终诊断阳性率及不良反应发生情况进行分析。结果 87例患者取材成功率为100%,确诊结核病70例、恶性肿瘤7例、其他感染4例,未得到阳性结果的6例患者经诊断性抗结核治疗及胸腔镜活组织检查确诊为结核病5例、胸膜间皮瘤1例。87例患者中最终确诊为结核病者75例,其中直接通过超声造影引导下活组织检查确诊70例(93.33%)。超声造影病灶增强强度是胸膜结核瘤与恶性肿瘤的重要鉴别点,胸膜结核瘤以低增强为主(66/75),恶性肿瘤多为高增强(4/7)。5例患者在穿刺过程中发生出血和(或)咯血,3例发生胸膜反应,对症处理后均缓解。结论 超声造影引导下穿刺活组织检查对胸膜结核瘤的早期诊断具有较高价值,阳性率高、创伤小、重复性好,值得临床推广。
关键词:  超声造影检查  穿刺术  活组织检查  胸膜结核瘤  诊断
DOI:10.16781/j.0258-879x.2018.10.1077
投稿时间:2018-07-06修订日期:2018-09-25
基金项目:上海市科学技术委员会2018年度医学引导类(中、西医)科技支撑项目(18411966700).
Clinical value of contrast-enhanced ultrasound-guided biopsy in early diagnosis of pleural tuberculoma
SUN Wen-wen1,WANG Yin2,ZHU Hui-ming2,BI Ke3,XU Li-sha2*
(1. Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China;
2. Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China;
3. Tongji University School of Medicine, Shanghai 200092, China
*Corresponding author)
Abstract:
Objective To explore the clinical value of contrast-enhanced ultrasound-guided biopsy in the early diagnosis of pleural tuberculoma. Methods A total of 87 patients were recruited, who were admitted to Shanghai Pulmonary Hospital affiliated to Tongji University from Jan. 2017 to Jan. 2018 and were diagnosed to have pleural tuberculoma based on clinical indication and imaging. All patients underwent contrast-enhanced ultrasonography and ultrasound-guided biopsy, and then the samples were sent for pathological examination, acid-fast bacilli culture and polymerase chain reaction for Mycobacterium tuberculosis. The clinical data of the patients were collected and the results of contrast-enhanced ultrasound, final diagnostic positive rate and adverse reactions were statistically analyzed. Results The success rate of contrast-enhanced ultrasound-guided biopsy of 87 patients was 100%, among which 70 cases were diagnosed with tuberculosis, 7 with maligmant tumors, 4 with other infection diseases, and 6 cases obtained negative results (confirmed by diagnostic anti-tuberculosis and thoracoscopic biopsy, 5 with tuberculosis and 1 with pleural mesothelioma). Seventy-five of 87 cases were eventually diagnosed with tuberculosis, of which 70 (93.33%) were diagnosed by contrast-enhanced ultrasound-guided biopsy. The intensity of contrast-enhanced ultrasound was an important differential factor for pleural tuberculoma and malignant tumor; low enhancement mainly existed in the pleural tuberculoma (66/75), and high enhancement mainly existed in the malignant tumor (4/7). Hemorrhage and/or hemoptysis occurred in 5 cases during the puncture, pleural reaction occurred in 3 cases, and all of them was relieved after symptomatic treatment. Conclusion Contrast-enhanced ultrasound-guided biopsy has a high value for the early diagnosis of pleural tuberculoma, with high positive rate, small trauma and good reproducibility, and is worthy of clinical promotion.
Key words:  contrast-enhanced ultrasound  punctures  biopsy  pleural tuberculoma  diagnosis