肺活检及支气管镜检查在弥漫性肺疾患和尘肺诊断中的价值

Bioptic and bronchoscopic examination in diagnosis of diffuse pulmonary disorders and pneumoconioses

目的 探讨对弥漫性肺疾患和尘肺的较好的诊断方法。方法 通过纤维支气管镜检查、BALF分析及肺活体组织检查 ,综合分析诊断。结果 经纤维支气管镜检查、BALF分析检出粉尘颗粒、石棉纤维、石棉小体以及在肺活体组织检查中发现石英、氧化铝粉尘颗粒、石棉纤维或石棉小体 ,肺间质纤维化及肺组织结构破坏等改变而明确了矽肺、氧化铝尘肺和石棉肺的诊断。结论 在BALF及肺组织中检出病源性粉尘颗粒或石棉小体、肺间质纤维化或矽结节、肺泡结构破坏等改变即可确立尘肺或其他弥漫性肺疾患的诊断。

Subjective To explore the value of bronchoscopic examination,BALF constituents and the bioptic findings of lungs in diagnosis of diffuse lung pulmonary disorders and pneumoconioses.Method On the basis of bronchoscopic examination,BALF analysis and the results of transbronchial lung biopsy,the diagnosis of pneumoconiosis or other diffuse lung disorders were confirmed.Results In an old patient with diffuse pulmonary fibrosis,the idiopathic pulmonary interstitial fibrosis was confirmed by bioptic examination of lung tissue;a young man was suffering from coughing,expectoration and short breath for a month,with a history of pigeon breeding for 2 years.The signs:Crepitant rales,increadsed markings and reticular opacities in the both lung bases,and increased cell count and lymphocytes in BALF.Diagnosis:extrinsic allergic alveolitis(pigeon Breeders lung).In the workers exposed to silica,alumina dusts or asbestos fibers,the pathogenic particles or asbestos bodies were found in the BALF and lung tissue,the diagnosis of silicosis,aluminosis or asbestosis was confirmed respectively.Conclusion The pathogenic particles or asbestos bodies in BALF and/or in lung tissues;interstitial fibrosis or silicotic nodules,disturbed alveolar structure are found,the pneumoconiosis or other diffuse pulmonary disorders might be confirmed.