471例肺不张纤维支气管镜下诊断及治疗

Diagnosis and treatment of 471 cases with atelectasis by branchofiberoscope

目的探讨肺不张的好发部位和病因。方法收集该院呼吸内科471例肺不张的影像学(X线或CT检查)、纤维支气管镜检查和病理检查等临床资料,分析肺不张的发生部位和病因。结果右中叶肺不张141例,约占29.9%,右上叶肺不张114例,约占24.2%,右下叶肺不张47例,约占10%,左上叶肺不张70例,约占14.9%,左下叶肺不张53例,占11.3%。左全肺肺不张42例,占8.9%。右全肺肺不张4例,约占0.9%;普通炎症120例,占25.5%,结核98例,占20.8%,癌肿145例,占30.8%,新生物45例,占9.6%,异物28例,占5.9%,未见异常28例,占5.9%,其他7例,为5血凝块,韦氏肉芽肿2例;右中叶肺不张病因中炎症63例,占44.7%,右上叶肺不张病因中,癌肿54例,占47.4%,右下叶肺不张病因中,癌肿22例,占46.8%,左上叶肺不张的病因中癌肿27例,占38.6%,左下叶肺不张病因中炎症20例,占37.7%,左全肺肺不张病因中新生物14例,占33.3%。结论以右中叶肺不张为多见,其次是右上叶肺不张、左上叶肺不张、左下叶肺不张、右下叶肺不张、左全肺肺不张,右全肺肺不张最少见;肺不张的病因以癌肿最为多见,其次是炎症,在我国结核仍然是引起肺不张很重要的原因;右中叶肺不张、左下叶肺不张以炎症最为多见。而右上叶肺不张、左上叶肺不张、右下叶肺不张以肿瘤多见。

[Objective] To analysis the clinic characteristic of atelectasis. [Methods] 471 cases with atelectasis were collected from department of respiratory medicine in our hospital to analyse the location and causes of atelectasis, [Results] There were 141 cases of right-middle lobe atelectasis, including 114 cases of right-upper lobe atelectasis, 47 cases of right-lower lobe atelectasis, 70 cases of left-upper lobe atelectasis, 53 cases of left-lower lobe atelectasis, 42 cases of whole left lobe atelectasis and 4 cases of whole right lobe atelectasis, which were approximate 29.9%, 24.2%, 10%, 14.9%,11.3%, 8.9% and 0.9% respectively. There were 120 cases of inflammation, 98 cases of tuberculosis,145 cases of cancer, 45 cases of neoplasm, 28 cases of foreign body,28 cases of normal observation under branchofiberoscope and 5 cases of blood blot, which were 25.3%, 20.8%, 30.8%, 9.6%, 5.9%, 5.9% and 1.5% respectively, There were 63 cases of inflammation in right-middle lobe atelectasis （approximate 44.7%）, 54 cases of cancer in right-upper lobe atelectasis （approximate 47.4%）, 22 cases of cancer in right-lower lobe atelectasis （approximate 46.8%）, 27 cases of cancer in left-upper lobe atelectasis （approximate 38.6%）, 20 cases of inflammation in left-lower lobe atelectasis （approximate37.3%） and 14 case of neoplasm in whole left lobe atelectasis （approximate 33.3%）. [Conclusions] The more common atelectasis is in right-middle lobe, then in right-upper lobe atelectasis, left-upper lobe atelectasis, left-lower lobe atelectasis, right-lower lobe atelectasis. The least common atelectasis is in whole left lobe. Cancer is the most common cause of atelectasis, then inflammation. Tuberculosis is still an important cause of atelectasis. Inflammation is the more common cause of right-middle lobe atelectasis and left-lower lobe atelectasis, while cancer is the more common cause of right-upper lobe atelectasis, left-upper lobe atelectasis and right-lower lobe atelectasis. Neoplasm is the principle cause of whole left lobe atelectasis.