纤维支气管镜检查在肺不张病因诊断中的临床应用

The Clinical Application of Bronchofiberoscope Examination on Pathogeny of Ateletasis

目的探讨肺不张的病因及纤维支气管镜的诊断价值。方法用纤维支气管镜(纤支镜)对126例经胸片及/或胸部CT诊断为肺不张的患者作常规检查,结合活检、刷检、抗酸染色等。结果126例患者中确诊为肺癌82例(65%)、慢性炎症27例(21.4%)、结核14例(11.1%)、其他病变3例,纤支镜检查诊断率依次为86.6%,96.3%,65.0%,纤支镜下主要表现为肿块病变,浸润型病变,外压性改变等。中老年肺不张以恶性肿瘤(78.7%)为主,炎症(12.2%)次之,结核(7.1%)较少见;中青年组以炎症(53.5%)为主,结核(25%)、肿瘤(17.8%)次之。结论肺不张的常见原因仍为肺癌,慢性炎症,结核。中老年肺不张多数由肺癌所致,鳞癌居首位,中青年肺不张以炎症为主。应重视活检技术,采取活检、刷检等方法取材,必要时纤支镜复查及经纤支镜CT诱导下作针吸活检,提高诊断率。

Objective To investigate the etiology of atelectasis with bronchoscopy. Methods 126 patients with CT diagnosed atelectasis were examined with bronchoscopy. Bronchial biopsy, bronchial brush, anti-acid stain was performed as necessary. Results Of all patients, 82（65%） of them were lung cancer, followed by chronic Inflammation 27（21.4%）, tuberculosis（TB）14（11.1%）,other causes3. The diagnostic rate with bronchoscopy for lung cancer, chronic inflammation, TB was 86.6%,96.3%,65% respectively. The main findings under bronchoscopy was tumor, infiltration and tissue shift with external push. The main case for atelectasis in middle to old age patients was malignant tumor （78.7%i, inflammation（12.2%） and TB（7.1%）;while in young patients, It was inflammation（53.5%）, TB（25%） and tumor（17.8%）.Conclusiona The main causes for atelectasis were tumor . TB and inflammation. Bronchoscopy was useful in the etiology of atelectasis. Fine needle biopsy under CT or Bronchoscppy maybe a good method to improve the diagnosis.