纤维支气管镜对早期诊断菌阴肺结核合并肺癌的临床意义  

Clinical significance of earl diagnosis for negative bacteria pulmonary tuberculosis with lung cancer by fiber bronchoscope

作　　者：陈红梅[1] 傅满姣[1] 

机构地区：[1]长沙市中心医院胸6科,湖南长沙410007

出　　处：《临床肺科杂志》2016年第9期1661-1663,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨通过纤维支气管镜(纤支镜)检查提高对菌阴肺结核合并肺癌的早期诊断率。方法40例临床诊断为菌阴肺结核的患者均接受诊断性抗结核治疗1月后,临床症状部分好转,仍不能排除肺部肿瘤的患者,同时进行纤支镜检查行病理活检、刷检、支气管肺泡灌洗液(BALF)找癌细胞、BALF涂片、BALF结核菌培养、BALF的TB-DNA。结果 40例患者中肺癌与菌阴肺结核共存25例(62.5%),肺癌4例(10%),菌阴肺结核11例(27.5%),40例患者进行BALF检查,其中36例患者的BALF的TB-DNA≥1.14×103,13例BALF结核菌培养阳性,2例发现癌细胞;40例患者中的16例纤支镜下有异常改变者,进行病理活检和刷检,其中13例患者病理为典型结核和肺癌并存,3例为典型结核结节;24例在病变部位行刷检,其中10例病理证实肺癌。结论纤维支气管镜检查操作简单,镜下多种联合检测可提高菌阴肺结核合并肺癌的早期诊断率,避免漏诊及误诊。Objective To improve early diagnosis rate of negative bacteria pulmonary tuberculosis and lung cancer by fiber bronchoscope .Methods 40 cases of negative pulmonary tuberculosis received diagnostic anti-tuber-culosis treatment for 1month, and some of their clinical symptoms made partially improvement .For a accurate diagno-sis, all these patients accepted fiber bronchoscope and biopsy , brush, lavage for pathological cell , tuberculosis bacte-ria cultivation and lavage TB-DNA at the same time.Results 25 cases （62.5%） had negative bacteria pulmonary tu-berculosis and lung cancer co-existed, 4 cases （10%） had lung cancer, 11 cases （27.5%） had negative bacteria pulmonary tuberculosis .36 cases of 40 BALF （ bronchoalveolar Lavage Fluid ） of TB-DNA were higher than 1.14 × 10^3 , of which 13 case showed tuberculosis bacterium culture positive , and 2 cases found cancer cells .16 cases of 40 found abnormal changes under bronchoscope , of which 13 cases with pathological for typical tuberculosis and lung cancer co-existed, 3 cases had typical tuberculosis .24 cases of 40 brush the lesion site, of which 10 cases of patho-logical proved lung cancer .Conclusion Fiber bronchoscope operation is simple , and the joint detection can improve early diagnostic rate of negative bacteria pulmonary tuberculosis and lung cancer , which can avoid missed diagnosis and misdiagnosis .

关 键 词：菌阴肺结核 肺癌 纤维支气管镜 早期诊断 

分 类 号：R521[医药卫生—内科学] R734.2[医药卫生—临床医学]