纤维支气管镜检查对右肺中叶不张的诊断价值的再评价

A STUDY ON RE-EVALUATING THE DIAGNOSTIC VALUE OF FIBROBRONCHOSCOPIC FINDINGS FOR RIGHT MIDDLE LOBE ATELECTASIS

目的 :进一步探讨右肺中叶不张的原因及纤维支气管镜的诊断价值。方法 :对 2 62例经胸部X片或胸部CT诊断右肺中叶不张的患者进行纤维支气管镜检查。结果 :纤维支气管镜下发现新生肿物 75例 ( 2 8.62 % ) ,5 2例 ( 19.85 % )可见管腔明显狭窄 ,非特异性改变占 5 3例 ( 2 0 .2 3 % ) ,82例 ( 3 1.2 9% )镜下未见明显异常。经纤支镜确诊为肺癌 78例 ( 2 9.77% ) ,4 5岁以上患者 62例占同年龄右肺中叶不张患者的 4 0 .2 6% ( 62 /15 4 ) ;肺结核占 12 .60 % ( 3 3 /2 62 ) ;肺部慢性炎症为最常见病因 ( 5 6.4 9% )。结论 :右肺中叶不张的常见原因仍为肺部慢性炎症、肺癌、肺结核 ,4 5岁以上的患者中肺癌的发病率可高达 4 0 .2 6% ,纤维支气管镜检查是重要的诊断方法。由于右肺中叶的解剖结构的异常易造成右肺中叶慢性炎症 ,纤支镜对这种情况的诊断价值有限。

Objective: To follow up the causes of right middle lobe atelectasis and the diagnostic value of bronchoscopic findings for this disease. Methods: 262 cases of right middle lobe atelectasis proved by chest radiography or computerized tomography (CT) were examined with bronchoscopy. Results: Specific endoscopic findings of neoplastic masses were seen in 75 cases (28.62%) and bronchial stenosis in 52 cases (19.85%). Abnormal but nonspecific changes were presented in 54 cases (20.23%) while normal endoscopic findings were presented in 82 cases (31.29%) of these patients. Chronic inflammatory disease was the most common etiological factor (56.49%). Tumors diagnosed by branchofiberoscope accounted for 29.77% (78/262). Conclusions: Benign inflammatory disease, tumors and tuberculosis are still the common causes of right middle lobe atelectasis. Tumors account for a high percent in the patients more than 45 years old. Bronchoscopy is vital in rational approach to right middle lobe atelectasis. The diagnostic value of Bronchoscopy for this disease appears to be almost 50%.