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目的 :分析CT引导下经皮肺穿刺与纤维支气管镜在慢性阻塞性肺疾病中的诊断价值。方法 :选取自2012年8月至2014年11月本院住院患者69例(其中男性45例、女性24例),釆用CT引导下经皮肺穿刺、纤维支气管镜,确诊为慢性阻塞性肺疾病,比较二者灵敏度和特异度,并进行X2检验,观察各自疗效。结果 :(1)33例纤维支镜检查患者有1例出现气胸,1例检查过程中发生大出血,无其他明显并发症,并发症总发生率为6.1%。36例CT引导下经皮肺穿刺活检患者中有5例患者出现并发症,总发生率为13.9%。其中气胸3例,咯血例1,血胸1例。比较两组方法,经皮肺穿刺活检并发症显著高于纤维支气管镜检查,差异具有统计学意义。(2)以病理检查结果定为金标准诊断为大量脓痰阻塞35例、痰栓形成及堵塞33例,诊断后总确诊率为95.55%(确诊例数/总例数100%)。纤维支气管镜诊断灵敏度,特异性,阳性预测值,阴性预测值(NPV)和准确率分别为90.0%,100%,100%,96.7%,和97.4%。经皮肺穿刺,其值分别为70.0%,59.8%,37.5%,85.2%,和62.4%(P=0.052;P<0.001,P<0.001;P=0.011;P<0.001)。大量脓痰阻塞(35例)诊断准确率,纤维支气管镜准确率高于经皮肺穿刺(94.6%比77.8%;P=0.044)。痰栓形成及堵塞(33例)诊断准确率,纤维支气管镜和经皮肺穿刺的同样高(97.9%比96.3%;P=0.689)。结论 :两种检查手段在肺部疾病的诊断上有不同的临床价值,临床上经有机地结合它们,能最大程度地减少漏诊率和误诊率,并且能获取良好的治疗效果。
Objective: To analyze the diagnostic value of CT guided percutaneous pulmonary puncture and bronchoscopy in chronic obstructive pulmonary disease. Methods: Totally 69 inpatients (45 males and 24 females) were selected from August 2012 to November 2014 in our hospital. Percutaneous pulmonary puncture and fiberoptic bronchoscopy were used to diagnose chronic obstructive Lung disease, the sensitivity and specificity of the two were compared and X2 test was performed to observe their curative effect. Results: (1) One case of pneumothorax was found in 33 cases of fiberoptic bronchoscopy, one case of hemorrhage occurred in the course of examination, and no other obvious complication. The total complication rate was 6.1%. Complications were found in 5 of 36 patients who underwent CT-guided percutaneous lung biopsy, with a total incidence of 13.9%. Among them, 3 cases of pneumothorax, 1 case of hemoptysis, 1 case of hemothorax. Comparing the two methods, the complication of percutaneous pulmonary biopsy was significantly higher than that of bronchoscopy, the difference was statistically significant. (2) According to the results of pathological examination, gold was diagnosed as a large number of purulent sputum obstruction in 35 cases, sputum thrombosis and occlusion in 33 cases. The total diagnosis rate was 95.55% (the number of confirmed cases / 100% of the total cases). The diagnostic sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy of fiberoptic bronchoscopy were 90.0%, 100%, 100%, 96.7%, and 97.4%, respectively. Percutaneous pulmonary puncture had values of 70.0%, 59.8%, 37.5%, 85.2%, and 62.4%, respectively (P = 0.052; P <0.001, P <0.001; P = 0.011; P <0.001). The diagnosis accuracy of massive purulent sputum obstruction (35 cases) was higher than that of percutaneous pulmonary puncture (94.6% vs 77.8%; P = 0.044). The diagnostic accuracy of sputum formation and occlusion (33 cases) was the same (97.9% versus 96.3%; P = 0.689) for the diagnostic accuracy of bronchoscopy and percutaneous lung biopsy. Conclusion: The two methods have different clinical value in the diagnosis of pulmonary diseases. Combined with them organically, they can minimize the rate of misdiagnosis and misdiagnosis, and can obtain good therapeutic effect.