多排螺旋CT扫描及多平面重建和曲面重建对周围型肺癌纤维支气管镜取材导引作用探讨

Study on the directing role of multi-slice spiral CT and multiplanar reformation(MPR)in bronchoscopy.

目的探讨多排螺旋CT（MSCT）及多平面重建（MPR）和曲面重建（CPR）对纤维支气管镜取材的导引作用，提高周围型肺癌（PPC）的阳性检出率。方法选择苏州大学附属第一医院2002-2005年收治的60例PPC患者，行MSCT扫描后行MPR及CPR，评价支气管与肿瘤结节之间的关系，确定支气管征（BS）的分型，将BS分型与纤维支气管镜各种取材方式的检测结果相对照。结果（1）全部病例的3～7级支气管均能清晰完整的显示、BS分为4型（Ⅰ～Ⅳ型）。（2）25例腺癌中BS阳性者有22例，17例鳞癌中有13例，6例小细胞肺癌中有4例，8例支气管肺泡癌中有4例，4例其他类型肺癌中有2例．（3）BSⅠ型发生率最高，为31.3％（15／48），BSⅡ型为14．6％（7／48），BSⅢ型为25％（12／48），BSⅣ型为29．2％（14／48）（4）纤维支气管镜的总阳性率为58．3％，BS阳性的检出率为73.3％，高于BS阴性的检出率（13．3％）．BS类型与纤维支气管镜取材的阳性率密切相关。结论横断面联合MPR、CPR能更好地显示肿瘤与支气管之间的关系在不同BS征的导引下，指导纤维支气管镜取材，可提高周围型肺癌的检出率，

Objective To study on the directing role of multi - slice spiral CT and muhiplanar reformation （MPR） in bronehoscopy and enhance the yield of peripheral pulmonary carcinoma （PPC）. Methods This study was carried in 60 PPC patients from Respiratory Department in the First Hospital Affilliated to Suzhou University during 2002-2005. They underwent MSCT. Images were reconstructed with MPR （CPR） to evaluate the relationship between PPC and bronchi and the type of BS was identified. Compare the diagnosed yields of bronehoscopie muhiple diagnostic procedure （ BM- DPs） with types of BS. Results （ 1 ） in all patients the third to the seventh level branches of the bronchi were clearly shown. The tumor - bronchus relationship was identified as four types on MSCT. （2） MSCT demonstrated the BS in 22 of 25 adenoearcinomas and 13 of 17 squamous - cell carcinomas and 4 of 6 small cell lung carcinomas and 4 of 8 bronchi olo - alveolar carcinomas. （3） BS type Ⅰ was shown in 15of 48 （31. 3% ）. Type Ⅱ was seen in 7 of 48 （ 14.6% ）. Type m was shown in 12 of 48 （25%） squamous tumors. Type 1W was seen in 14 of 48 （29. 2%）. （4） Total positive rate of bronehoseopy was 58.3% , 73.3% with BS and 13.3% without BS. Type of BS was closely associated with positive rate of BMDPs. Conclusion Axial CT and MPR can show the relationship between PPC and bronchi better. BS can direct fiberoptic bronchoscopy （FOB） diagnosis procedure and enhance the yield of PPC.