支气管镜及相关检查对血液肿瘤肺部并发症的诊断价值

Diagnostic value of bronchoscopy and related examination in pulmonary complication of hematologic malignancies

目的:探讨纤维支气管镜(FB)及相关检查对血液肿瘤移植及化疗后肺部并发症的病因诊断价值。方法:回顾分析经胸部CT、血、痰病原学检查不能明确诊断的38例肺部并发症患者,接受FB检查、支气管肺泡灌洗(BAL)、刷片,部分经支气管镜肺活检(TBLB)的确诊情况。结果:38例患者中26例经FB确诊,总诊断率68.42%。其中,肺部感染25例,有19例(76%)通过FB确诊。非感染肺部并发症13例,有7例(53.85%)通过FB确诊,而这7例中有6例直接通过TBLB确诊。另外,有2例感染、5例非感染肺部并发症是经FB及临床综合判断确诊。所有患者中8例(21.05%)出现轻微FB相关并发症(发热、出血),均在24h内消失。结论:血液肿瘤移植及化疗后肺部并发症病因复杂,部分难以确诊。FB联合BAL、刷片、TBLB明显提高了诊断率,TBLB对非感染肺部并发症诊断尤为重要。FB检查创伤小,安全性好,有较高临床应用价值。

Objective：To discuss the etiological diagnostic value of fibroptic bronchoscope （FB） and related examination in pulmonary complication of hematologic malignancies post transplantation or chemotherapy.Method：To retrospectivly analyze the diagnosis of pulmonary complications of 38 cases who couldn＇t be diagnosed by chest CT,blood and sputum etiology examination. FB examination,bronchoalveolar lavage （BAL）,brushing and also partly transbronchial lung biopsy （TBLB） were carried out.Result：Twenty-six of 38 cases were diagnosed by FB. The overall diagnostic rate was 68.42%. In 25 cases with pulmonary infection,19 cases （76%） were diagnosed by FB. In 13 cases with noninfectious pulmonary complication,7 cases （53.85%） were diagnosed by FB. Of them,6 cases were diagnosed directly by TBLB. In addition,2 cases of infectious and 5 cases of noninfectious pulmonary complication were diagnosed by comprehensive analysis of FB and clinical manifestation. In all cases,8 cases （21.05%） suffered from minor complication （fever,bleeding） which disappeared within 24 h.Conclusion：The causes of pulmonary complication of hematologic malignancies post transplantation or chemotherapy are complicated and some of them are difficult to diagnose. FB combined with BAL,brushing,TBLB increased the diagnostic rate obviously. TBLB is very important in the diagnosis of noninfectious pulmonary complication. FB examination is safe with mild trauma and has a high clinical value.