肺癌术前纤维支气管镜检查的诊断价值

Clinical Value of Preoperative Fiberoptic Bronchoscopy in the Diagnosis of Lung Cancer

目的探讨肺癌术前纤维支气管镜检查的重要性。方法回顾性分析2007年1月～2010年10月200例肺癌患者手术前进行纤维支气管镜检查的临床资料。使用钳检、刷检、支气管肺泡灌洗3种方法。结果 140例经纤维支气管镜检查发现肿物或异常(包括X线胸片及胸部CT检查未见异常的早期肺癌12例),敏感性70.0%;60例经纤维支气管镜检查未发现异常,假阴性率30.0%。手术187例,13例因纤维支气管镜检查发现异常,包括双侧支气管病变3例,病灶浸润至同侧相邻叶支气管病人不能耐受全肺切除6例,侵及隆突2例,侵及对侧支气管腔1例,双源癌1例,临床分期变为Ⅲb或Ⅳ期,放弃手术。结论肺癌患者手术前进行纤维支气管镜检查,不仅可以明确病灶形态和病理诊断,而且可以发现早期隐性肺癌及发现气管、支气管等的异常情况,对提高肺癌早期阳性诊断率和选择正确治疗方式提供重要依据。

Objective To examine the clinical value of preoperative fiberoptic bronchoscopy in the diagnosis of lung cancer. Methods Clinical diagnosis data of 200 patients with lung cancer who received preoperative fiberoptic bronchoscopy were analyzed retrospectively from January 2007 to October 2010. Forceps holder, brushing,and bronchoalveolar lavage were used. Results 140 cases examined by fiberoptic bronchoscope were found to have goitre or abnormal signs（ including 12 cases of early lung cancer which were shown normal by chest X-ray and CT examination） , with a sensitivity of 70.0% ; No abnormality was found among 60 cases by fiberoptic bronchoscope examination, with a false negative rate of 30.0%. 187 cases were given surgical treatments, and 13 cases gave up surgery because of abnormal bronchoscopy findings, including 3 cases of bilateral bronchial lesions, 6 cases who could not tolerate total pneumonectomy due to tumor infiltration into the adjacent ipsilateral lobe bronchus, 2 cases of invading carina, 1 case of heterolateral bronchus invasion, and 1 case of double source of primary carcinoma. The clinical stage of the 13 cases was m b or IV. Conclusion By preoperative fiberoptic bronchoscopy, the preoperative morphologic and pathological diagnosis of the lesions can be confirmed, and early hidden lung cancer and trachea, bronchus and other abnormalities can be detected at an early stage. It provides an important basis for early diagnosis and proper treatment of lung cancer.