目的：探讨CT引导下经皮肺活检对肺曲霉病的诊断价值。方法：对34例接受CT引导下肺活检的肺曲霉病患者的临床资料进行回顾性分析。结果：穿刺活检病理确诊30例,4例未确诊病例后经手术病理证实为肺曲霉病。临床表现：咳嗽25例,咳痰20例,发热18例,咯血6例,胸痛5例,胸闷、呼吸困难5例,无症状者(体检发现肺部病变)3例。影像学表现：结节15例(单发6例,多发9例),肿块7例,实变灶5例,斑片影4例及新月征3例。血半乳甘露聚糖试验阳性率67.6%(23/34)。病理学改变以坏死性炎症为主。并发症：气胸17.6%(6/34),1例需放置胸腔引流管,其余自行吸收；针道出血5例,少量咯血1例,均未特殊处理,症状自行缓解。结论：CT引导下经皮肺活检是确诊肺曲霉病的一种安全、有效的方法。%Objective:To explore the clinical value of the percutaneous biopsy guided by CT in the diagnosis of pulmonary aspergillosis. Methods:The clinical data of 34 patients with pulmonary aspergillosis treated with percutaneous paracentesis guided by CT were retrospectively analyzed. Results:Thirty cases with pulmonary aspergillosis were diagnosed by biopsy,4 cases with undiagnosed pulmonary aspergillosis were identified by the surgical pathology. The clinical manifestation showed cough in 25 cases,expectoration in 20 cases,fever in 18 cases,emptysis in 6 cases,chest pain in 5 cases,dyspnea in 5cases and no symptom in 3 cases. The imaging showed nodule in 15 cases( single in 6 cases and multiple in 9 cases) ,lump in 7 cases,consolidation in 5 cases,infiltrate in 4 cases and air-crescent sign in 3 cases. The positive rate of galactomannan test was 67. 6%(23/34). The necrotizing inflammation was the mainly pathological characteristics. The pneumothorax rate was 17. 6%(6/34),only one patient was treated with intrathoracic drain,and the others were automatically absorbed. Both 5 cases of needle passage hemorrhage and 1 case of hemoptysis alleviated without treatment. Conclusions:The percutaneous biopsy guided by CT is a safe and effective means in diagnosing pulmonary aspergillosis.
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