肺癌在支气管镜下的特征

The characteristics of bronchogenic carcinoma under fiberbronchoscopy

目的深入了解肺癌在支气管镜下的特征。方法采用纤维支气管镜、痰细胞学及病理学等方法对１１０５例患者进行了观察。结果经纤维支气管镜确诊支气管肺癌１１０５例，占同期支气管镜检查的２５５％。其中６３８例（５７７％）可见肿瘤直接征象，即新生肿物；４１２（３７３％）例可见肿瘤的间接征象。２７例（２４％）镜下符合黏膜炎性改变，但黏膜病理活检确诊为肺癌。此外，２８例（２５％）镜下未见明显异常，但支气管黏膜盲目活检得到肺癌的病理诊断。在可见肿瘤直接和间接征象的１０５０例中鳞癌４２１例（４０１％），小细胞癌３２２例（３０７％），腺癌１７６例（１６８％），大细胞未分化癌２０例（１９％），肺泡细胞癌１７例（１６％）。此外还有鳞腺癌４例（０４％），细胞类型不明确者９０例（８６％）。然而，１０５０例中３２例镜下虽显示新生物肿块，５４例可见癌的间接征象，但第一次支气管镜下病理活检报告为急性和慢性炎症。结论（１）肺腺癌患者中男性仍稍多于女性；（２）绝大部分肺泡细胞癌在支气管镜下仅显示管腔狭窄、黏膜肿胀等非特异的间接征象；（３）各肺叶前侧段支气管癌的发生率与后侧段没有显著差别。

Objective The characteristics of bronchogenic carcinoma under fiberbronchoscopy. Methods Fiberbronchoscopy, sputum smear and pathological examination of biopsy specimens. Results 1 105 of bronchogenic carcinoma proved by fiberbronchoscopy and biopsy were reported. Direct signs of cancer i.e. neoplastic masses of bronchogenic carcinoma were found in 638 patients (57 7%) and indirect signs in 412 cases (37.3%). The bronchoscopic findings accorded with inflammation of bronchial membrane in 27 cases (2.4%), but evidences of bronchogenic carcinoma were found in the random specimens of mucosa. However, 32 subjects with neoplastic masses and 54 with indirect signs presented pathological findings indicaing acute or chronic inflammation in the first bronchoscopy and biopsy. In the 1 050 cases showing direct or indirect signs of cancer, squamous cell carcinoma was confirmed in 421 cases (40.1%), small cell lung cancer in 322 patients (30.7%) and adenocarcinoma in 176 subjects (16.8%). Large cell undifferentiated carcinoma, pulmonary alveolar carcinoma, mixed squamo adenocarcinoma were confirmed in 20(1.9%), 17(1.6%) and 4 cases (0.4%) respectively. In addition, the pathological findings in 90 patients did not conform to any cell type of the lung cancer.Conclusion (1) Male cases were more than female in pulmonary adenocarcinoma; (2) Incidence of bronchial carcinoma was not markedly different between anterolateral segments and posterolateral segments of the various lobes of lung; (3) Most of the cases with pulmonary alveolar carcinoma showed only atypical findings of bronchial stenosis and edema of bronchial mucosa under bronchoscopy.