针型胸腔镜在晚期肺癌病理学诊断和分期中的价值  

The application of needle video-assisted thoracoscopic biopsy in pathologic diagnosis and staging for advanced lung cancer

作　　者：谷力加[1] 吴一龙[1] 冯卫能[1] 翁毅敏[1] 程超[1] 钟文昭[1] 黄绍洪[1] 

机构地区：[1]中山大学附属第三医院胸心外科,广州510630

出　　处：《中华结核和呼吸杂志》2003年第7期396-399,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的　探讨针型胸腔镜活检术在晚期肺癌病理学诊断和分期中的临床应用价值。方法　对经胸部螺旋CT和磁共振 (MRI)检查临床诊断为Ⅲa～Ⅳ期肺癌 ,行痰、胸液细胞学和纤维支气管镜等检查 ,未能获得病理诊断的 94例患者 ,施行针型胸腔镜肺内原发病灶、纵隔淋巴结、肺内和胸壁转移病灶组织活检术。结果　 94例患者中 89例经针型胸腔镜取得病理学标本 ,成功率为 95 % ;术后病理均诊断为肺癌 ,其中腺癌 4 7例 ,鳞癌 2 3例 ,腺鳞癌 1 2例 ,小细胞肺癌 7例。经胸腔镜活检病理检查后 ,1 5例 (1 7% )肺癌患者病理分期得到更正 ;4例发生气胸 ,1 1例出现轻度皮下气肿 ,2例出现少量咯血 ;89例患者术后 8～ 1 8个月均获随访并行螺旋CT检查 ,无胸壁针道的肺癌种植性转移。结论　对常规检查方法不能明确病理诊断和病理分期的晚期肺癌患者 。Objective To study the clinical application of needle video assisted thoracoscopic biopsy in the pathologic diagnosis and staging for advanced lung cancer. Methods Ninety four patients were diagnosed as having advanced lung cancer staged Ⅲa Ⅳ by chest X ray, computed tomography and magnetic resonance imaging, for which a pathologic diagnosis was not made by sputum and pleural effusion cytology or bronchoscopic examination Needle video assisted thoracoscopic biopsy was performed for primary lesions, mediastinal lymph nodes, metastatic lesions in the lungs and the chest wall Results Pathologic samples were obtained in 89 of the 94 patients by needle video assisted thoracoscopic surgery The successful rate was 95% After operation, the pathologic diagnosis was confirmed to be lung cancer in all the 89 patients Adenocarcinoma was found in 47 patients,squamous carcinoma in 23,adenosquamous carcinoma in 12,and small cell lung cancer in 7. Compared to the clinical diagnosis before operation, the pathologic diagnosis post operation was changed in 15 patients Pneumothorax and mild haemoptysis occurred in 4 patients and 2 of the cases respectively All the patients were followed for 8 18 months with computed tomography and physical examination No implantation metastasis was found Conclusion Needle video assisted thoracoscopic biopsy is an effective diagnostic measure for patients with advanced lung cancer for which pathologic diagnosis, typing and staging are not determined by routine examinations

关 键 词：针型胸腔镜 晚期肺癌 病理学诊断 分期 

分 类 号：R734.2[医药卫生—肿瘤]