CT结节支气管征在周围型肺癌诊断中的价值

CT bronchus sign-guided bronchoscopic multiple diagnostic procedures in the diagnosis of peripheral lung cancer.

目的 探讨CT结节支气管征对纤支镜取材的导引作用,及其对周围型肺癌的诊断价值。方法 CT表现为2～6 cm的孤立性结节的肺癌患者63例作为研究对象,通过分析支气管与结节间的关系,确定支气管征(BS)分型,并给予纤支镜刷检(BR)、活检(TBB)、针吸活检(TBNA)、经支气管镜冲洗(BW),然后将BS分型、纤支镜检测结果与最后组织学诊断相对照,得出阳性检出率。结果 纤支镜的总阳性率为59％。BS阳性检出率为79％,高于BS阴性检出率34％(P<0.05)。BS类型与各纤支镜取材的阳性率密切相关。BS Ⅰ型和BSⅡ型的TBB和BR的阳性率显著高于TBNA(P<0.05);BSⅢ型和BSⅣ型中,TBNA的阳性率显著高于BR和TBB(P<0.05);肿瘤的直径越大,诊断的阳性率越高。结论 薄层CT较好地反应了肿瘤和引流支气管之间的关系,BS征导引下纤支镜多种取材方法的联合检测,能有效提高周围型肺癌的检出率。

Objective To evaluate the contribution of bronchus sign(BS)-guided bronchoscopic multiple diagnostic proceduresC BMDPs) in diagnosis of peripheral lung cancer. Methods A prospective study was carried out on 63 lung cancer patients with a 2-6 cm diameter solitary nodules or masses. Bronchial brushing (BR), transbronchial lung biopsy (TBB), transbronchial needle aspiration (TBNA)and bronchial washing (BW) were done for each patient. Results The combined diagnosed yield of BMDPs reached 59%. In 27 of 34(79%)with BS and in 10 of 29 without BS(P<0. 05). The diagnostic yield of TBB and BR was significantly higher in nodules characterized by BS type I and type Ⅱ. While TBNA was higher in BS type Ⅲ and type Ⅳ than TBB and BR in BS type I and type Ⅱ (P<0. 05%). The larger the diameter of nodules was, the higher the diagnostic yield was(P< 0. 05). Conclusion These results confirmed CT BS can be utilized as a guiding sign to direct FB diagnostic procedures and enhanced the yield of peripheral lung cancer.