超细支气管镜在周围型肺癌诊断中的应用  

Application of ultrathin fibreoptic bronchoscope in diagnosis of peripheral lung cancer

作　　者：廉海容[1] 张芳[1] 蔡礼鸣[1] 游庆军[2] 

机构地区：[1]无锡市第四人民医院呼吸内科,214062 [2]无锡市第四人民医院胸外科,214062

出　　处：《国际呼吸杂志》2013年第4期261-264,F0003,共5页International Journal of Respiration

摘　　要：目的评价超细支气管镜检查在周围型肺癌诊断中的应用价值。方法回顾性分析32例行超细支气管镜检查的周围型肺癌患者，常规支气管镜检查未发现病灶，再次行超细支气管镜检查。结果活检25处，刷检40处。确诊16例肺癌，腺癌8例，鳞癌4例，小细胞癌2例，未分类癌2例，诊断阳性率为50．0％（16／32）。其中肺内带75．0％（12／16），肺外带25．0％（4／16）。超细支气管镜对肺不同部位的肿块诊断阳性率差异有统计学意义（P=0．017），其对肺内带肿块诊断阳性率较肺外带及胸膜高。常规气管镜总检查时间9～32min，平均17．6min；超细支气管镜总检查时间25～65min，平均38．9min，超细支气管镜检查时间较常规气管镜检查时间长（P=0．013）。所有患者均顺利完成检查，未发生气胸和致命性大出血，且咳嗽反应较普通支气管镜检查明显小。结论超细支气管镜作为常规气管镜的补充，能探测更远的支气管腔并获得病理，是一种有效的诊断周围型肺癌的方法，且安全微创。Objective To evaluate the application value of ultrathin fibreoptic bronchoscopy in the diagnosis of peripheral lung cancer. Methods The data of 32 peripheral lung cancer patients who had performed ultrathin fibreoptic bronchoscopy were retrospectively analyzed. They were firstly diagnosed by conventional bronchoscope and found nothing. Secondly, ultrathin fibreoptic bronchoscopy had been done to them. Results 25 times were biopsy, 40 times were brush biopsy. 16 patients were identified lung cancer, eight cases were pulmonary adenocarcinoma, four cases were squamous lung carcinoma, two cases were small cell lung cancer, two cases were unclassified lung cancer, the positive rate was 50.0% （16/ 32）. There were 12 cases （75.0%） located in inner zone of the lung,four cases （25.0%） located in outer zone of the lung. With ultrathin bronchoscopy, the positive diagnosis rate was different in different parts of the lung tumor （ P =0. 017）. The positive diagnosis rate in inner zone of the lung was higher than that in outer zone of the lung and pleura. The total operation time of conventional bronchoscopy was 9-32 minutes, mean 17.6 minutes, while the total time of ultrathin bronchoscopy was 25-65 minutes, mean 38.9 minutes. The total operation time of ultrathin bronchoscopy was longer than that of conventional bronchoscopy （ P =0. 013）. All patients successfully completed the examination, pneumothorax and fatal bleeding did not happen, and the cough response by ultrathin bronchoscopy was significantly smaller than that by ordinary bronchoscopy. Conclusions As a supplement of conventional bronchoscopy, ultrathin bronchoscopy can probe farther bronchial lumen to get pathology. It is an effective method for the diagnosis of peripheral lung cancer,and it is safe and micro-invasive.

关 键 词：支气管镜 超细 肺癌 活检 

分 类 号：R734.2[医药卫生—肿瘤]