[CT-guided Percutaneous Lung Puncture for the Diagnosis of Solid Pulmonary Nodules: A Single-center Experience Summary]

背景与目的

探究经皮肺穿刺对于实性肺小结节（直径≤15 mm）的诊断价值。

方法

本研究回顾性地纳入了2014年1月-2018年12月于本中心行经皮肺穿刺的20例实性肺小结节患者，其中男性11例，女性9例。病灶最大直径介于0.5 cm-1.5 cm之间，排除严重脏器功能不全，有凝血障碍患者。

结果

20例患者全部取材成功，19例患者均获得明确的病理诊断，其中11例患者找到恶性肿瘤细胞，明确为肺恶性肿瘤，5例为肺慢性炎，2例纤维组织增生，1例找到肺软骨组织，1例未见肿瘤细胞。穿刺后少量气胸1例，穿刺侧少量胸腔积液患者1例。

结论

经皮肺穿刺对于实性肺小结节的诊断具有较高的有效性以及安全性。

Perfusing chemotherapy by percutaneous lung puncture "holing" for pulmonary tuberculoma-a ten-year single center experience

BACKGROUND

Pulmonary tuberculoma is a special form of secondary pulmonary tuberculosis, with a poor response to drug treatment. We used the method of drug administration via percutaneous lung puncture "holing" to treat pulmonary tuberculoma and observe its short- and long-term efficacy, summing up our 10-year clinical experience.

METHODS

A total of 54 patients with pulmonary tuberculoma were included in this study. They themselves were taken as the control group. Three to six months of conventional anti-tuberculosis treatment was conducted firstly. Then those patients with no changes of sizes in tuberculoma were recommended to receive drug administration via percutaneous lung puncture. Isoniazid (INH, 0.1 g) and amikacin (AMK, 0.2 g) were injected into tuberculoma (once or twice per week, 10 times as a course of treatment).

RESULTS

After two months of drug treatment by lung puncture, the sputum smear test showed the negative conversion rate of tubercle bacillus was 87% (13/15), and the positive conversion rate was 8% (3/39). The tuberculosis bacillus culture indicated that the negative conversion rate was 100% (7/7). The reexamination after one year showed the negative conversion rate of tubercle bacillus in the sputum smear test was 80% (4/5). About 58% (31/54) of tuberculoma disappeared or significantly reduced, in which, 40% (21/54) of tuberculoma disappeared. The tuberculoma diameter reduced from 3.6 cm × 2.8 cm to 1.7 cm × 1.1 cm on average. Side-effects included postoperative pneumothorax 9% (5/54), hemoptysis 7% (4/54) and fever 11% (6/54). A total of 34 patients were followed up for five years, and the disappearance rate of tuberculoma was up to 47% (16/34), with no recurrence.

CONCLUSIONS

The drug administration via percutaneous lung puncture-"holing" in pulmonary tuberculoma takes a significant effect obviously, good short- and long-term effects and less side effects.