X线透视引导下经纤维支气管镜检查对肺孤立性病变的诊断价值  

Diagnostic value of fiberoptic bronchoscopy with fluoroscopic guidance in the evaluation of solitary pulmonary nodules and lung masses

作　　者：李坚[1] 张蓝石[1] 杭建明[1] 张德厚[1] 陈萍[1] 施潮[1] 

机构地区：[1]江苏大学附属医院呼吸科,江苏镇江212001

出　　处：《江苏大学学报（医学版）》2008年第3期234-237,共4页Journal of Jiangsu University：Medicine Edition

摘　　要：目的：比较有和无X线透视引导下经纤维支气管镜（纤支镜）检查对肺孤立性病灶的诊断率。方法：236例有孤立性肺结节和肿块（SPN/M）的患者分为两组：Ⅰ组（166例）在X线透视引导下行经纤支镜肺活检,Ⅱ组（70例）根据影像学解剖定位,无X线透视引导下行经纤支镜肺活检,比较两组的诊断阳性率,分析影响阳性率的相关因素。结果：Ⅰ组和Ⅱ组经纤支镜检查的阳性率分别为71.1%和52.9%（χ^23.96,P〈0.05）。两组中病灶直径〉4cm亚组患者纤支镜诊断阳性率均明显高于直径〈2 cm亚组（χ^26.76,P〈0.01和χ^29.08,P〈0.005）。在直径≤2cm和2.1~4 cm的肺恶性病灶患者中,Ⅰ组纤支镜检查的阳性率均明显高于Ⅱ组（χ^24.06,P〈0.05和χ^24.72,P〈0.05）。位于距离肺门较远的肺外周区和中间区的恶性和良性病灶,Ⅰ组的阳性率要明显高于Ⅱ组（χ^24.67,P〈0.05和χ^28.28,P〈0.005）。结论：对于直径在2~4 cm范围,位于肺外周和中间区的SPN/M,选用X线透视引导下经纤支镜肺活检有助于提高诊断阳性率。Objective： To compare diagnostic yield of fiberoptic bronchoscopy （FB）with and without the use of fluoroscopic guidance in evaluating solitary pulmonary nodules and masses （ SPN/M ）. Methods： Two hundreds and thirty six patients with SPN/M were divided into two groups： group Ⅰ , 166 patients underwent FB procedure with fluroscopic guidance; group Ⅱ , 70 patients taken FB examination without the use of fluroscopic guidance. To compare diagnostic positive rate of FB in group Ⅰ and Ⅱ and analyze factors effecting the diagnostec yield of FB for SPN/M. Results： Diagnostic positive rate of FB in group I were 71.1% （118/166） , as compared with group 11 52.9% （37/70） （P 〈 0. 05 ）. The diagnostic positive rate from FB in patients with lesion 〉 4 cm was higher than that in those with lesion 〈 2 cm for two groups （ P 〈0. 01 and P 〈 0. 005, respectively）. Among patients with malignant lesion 2 - 4 cm in size, diagnostic yield from FB in group I patients was significantly higher than that in group 11 patients （ P 〈 0. 05）. For malignant and benign lesion located in the outer and middle third area around the hilum, diagnostic yield of FB in group I patients was markedly higher than that in group Ⅱ patients （P 〈 0.05 and P 〈 0. 005, respectively）. Conclusion： For SPN/M of lesion 2 - 4 cm in size and located in outer and middle third area around hilum, FB procedure with the use of fluoroscopic guidance can improve diagnostic yield.

关 键 词：纤维支气管镜检查 活检 X线透视引导 孤立性肺结节 肿块 

分 类 号：R563[医药卫生—呼吸系统]