对胸部CT未确诊的咯血行支气管镜检查的价值探讨

Bronchoscopy on determination of etiology in patients with hemoptysis undiagnosed by computed tomography (CT)

目的评价纤维支气管镜检查(FOB)在胸部CT未能确诊病因的咯血诊断中的价值。方法回顾近5年来我科收治的82例胸部CT未确诊病因的咯血病人临床资料,所有病人在胸部CT检查后1周内行FOB检查,并选择性使用了冲洗,剧检,活检,支气管肺泡灌洗(BAL),CT定位下经支气管镜肺活检(TBLB),经支气管镜针吸活检(TBNA)。获取的标本进行细菌学、细胞学或病理学检查。结果71例(87%)咯血病因确诊,其中肺结核25例,肺癌18例,支气管炎9例,肺炎10例,其他9例。11例(13%)仍未确诊。确诊方法:恻检18例(阳性率54%),冲洗21例(46%),BAL12例(63%),活检22例(71%),TBLB7例(54%),TBNA4例(40%)。采用两种以上支气管镜检查技术的阳性率(85.5%)高于单一技术(53.3%)。结论对于胸部CT未确诊病因的咯血病人,FOB检查是明确病因的有效手段。联合使用两种或以上FOB检查技术可以提高确诊率。

Objective To assess the value of fiberoptic bronchoscopy （FOB） in diagnosis of etiology in patient with hemoptysis undiagnosed by CT. Methods We reviewed 82 patients with hemoptysis and a normal/nondiagnostic chest CT in our hospital during the past 5 years, Subsequently after CT examinations, all patients were performed FOB combined with selective brushings, washings, bronehoalveolar lavages （BAL）, endobronehial or transbronehial lung biopsies under CT guidance （TBLB）, and transbronchial needle aspirations （TBNA） as indicated, Specimens obtained from FOB were sent to lab for further testing in bacteriology, cytology or pathology. Results A definite etiologic diagnosis was established in 71 （87%） patients. The etiologies included tuberculosis in 25 （31%）, lung cancer in 18 （23%）, bronchitis in 9 （11%）, pneumonia in 10 （12%） and the others in 9 （10%）. Another 11 （13%） were still undiagnoaed. The diagnosis was made by brushings in 28 （positive rate of 54%） cases, washing in 21 （46%）, BAL in 12 （63%）, endobronchial biopsy in 22 （71%）, TBLB in 7 （54%）, and TBNA in 4 （40%）. The diagnostic rate made by no less than two techniques of bronchoscopy was higher than that by only one （83.5% vs 53.3%）. Conclusion FOB is an effective measure in determination of etiology in hemoptysis patients undiagnosed by CT. Combination of two or more techniques of bronchoscopy may increase the diagnostic rate of accuracy.