白光气管镜联合荧光气管镜在肺癌诊断中的作用

目的探讨荧光气管镜(AFB)和白光气管镜(WLB)用于气道粘膜癌变的早期识别和术后残端复发检查的应用研究。方法对40例肺癌病人同时进行AFB和WLB检查。采用局部麻醉,经鼻进镜,先普通白光气管镜检查,然后切换至荧光,对每一处的可疑病变部位进行活组织病理检查。结果 40例病人共进行气管镜检查44次,活检组织检查144处,均获明确病理诊断,58处恶性病变,AFB无漏诊,WLB漏诊12处,漏诊率20.68%。初诊患者30例,共发现46处恶性病变,而AFB无漏诊,而WLB漏诊10处,其中6例患者肿瘤范围超过WLB,AFB发现4例患者气道内多发癌变。20例患者AFB和WLB检查结果相符。术后复查10例,发现6处恶性病变,WLB漏诊2处,AFB和WLB在肺癌患者气管镜检查中的敏感性分别为100%和79.3%,(P<0.001),阴性预测值分别为100%和87.7%,(P<0.005)。结论 AFB应用于支气管肺癌的气道粘膜癌变的早期识别和术后残端复发检查显著优于WLB。

The role of white bronchoscope and autofluorescence bronchoscope in diagnosis of lung cancer

Objective To investigate the examination result of autofluorescence bronchoscope(AFB) and white bronchoscope(WLB) to identify mucosal carcinoma of airway and postoperative stump recurrence.Methods 40 patients were examinated by AFB and WLB procedures.After local anaesthesia of glottis and airway,all patients underwent WLB examination followed by AFB procedure,and all suspicious visual findings were recorded for biopsy and pathological examination.Results 40 patients were performed 44 times for bronchoscope,and 144 tissues of suspicious sites were taken out for biopsy and pathologic examination.In 58 malignancies,AFB found all,but WLB missed 10 sites with missed-rate 20.68%;in 46 sites of malignancy,AFB found all,while WLB missed 10 sites for 30 preliminary diagnostic cases.The size of malignancy found by AFB were larger than WLB,and 4 cases of multi-site malignancy were found by AFB;the results of AFB and WLB were same for 20 patients,6 sites of malignancy were found by AFB for postoperative patients,but WLB missed 2 sites in 2 cases.The sensitivity of AFB and WLB was 100.0% and 79.3%(P<0.001);and the negative predictive value of AFB and WLB was 100.0% and 87.7%(P<0.005).Conclusion AFB is better than WLB in detection of early mucosal carcinoma lesions and postoperative stump recurrence.