术前行可弯曲支气管镜在孤立性肺结节患者中的应用价值

The value of flexible bronchoscopy in the preoperative workup of patients with solitary pulmonary nodules

目的研究孤立性肺结节(solitary pulmonary nodule,SPN)患者术前行可弯曲支气管镜检查的价值,评估其对治疗策略的影响。方法回顾性纳入2016年1月—6月111例拟行胸外手术前已完成支气管镜检查的SPN患者。收集其临床信息、支气管镜检查结果、手术治疗策略,分析支气管镜在SPN患者中的术前评估价值及活检阳性率。结果 111例SPN中共79例恶性结节,32例良性病变,恶性结节平均直径[(2.04±0.58)cm]大于良性结节[(1.70±0.75)cm],差异有统计学意义(P<0.05)。经可弯曲支气管镜发现管腔异常病变9例(8.1%),3例(2.7%)患者因检查结果而调整手术方式或取消手术。26例患者经支气管活检,其中9例肺癌患者术前经支气管镜确诊,灵敏度为45%(9/20),特异度为100%(6/6)。结论 SPN患者术前行可弯曲支气管镜可协助术前诊断,判断患者治疗策略的调整,建议作为术前的常规检查。

Objective To evaluate the diagnostic value and utility of flexible bronchoscopy in the preoperative assessment in patients with solitary pulmonary nodules （SPNs）. Methods A total of 111 patients with SPNs of unknown origin treated between January and June 2016 were retrospectively enrolled. The clinical characteristics, bronchoscopy findings and surgical strategies were collected. Results In the total 111 cases, malignant and benign SPNs were 79 and 32 cases, respectively. The mean diameter of malignant SPNs was larger than that of benign SPNs [（2.04_＋0.58） vs. （1.70＋0.75） cm, P〈0.05]. Bronchoscopy identified 9 cases （8.1%） unsuspected findings. Surgeries were modified or cancelled in 3 patients （2.7%） because ofbronchoscopy findings. Transbronchoscopy biopsies were performed in 26 patients, 9 of whom were diagnosed lung cancer preoperatively, with a sensitivity of 45% （9/20） and a specificity of 100% （6/6）. Conclusions Flexible bronchoscopy can be contributed to diagnosis of SPN before surgery and determination of surgical strategies. It is suggested that flexible bronchoscopy could be included in the routine preoperative work-up of SPN.