支气管倾斜分层和纤维支气管镜检查诊断肺癌的评价——附100例分析

本文收集我院病理确诊为肺癌100例,对其平片和支气管分层片所见与纤支镜资料进行对照分析,比较各自在诊断肺癌方面的作用和限度。结果认为,鳞癌多发生在段以上大支气管,管腔内常见块影,病变多为局部扩散和转移;未分化癌表现为广泛性支气管狭窄及淋巴结转移,少数可见腔内肿块;腺癌多发生于肺段或亚肺段支气管,并向近端蔓延,以管腔狭窄、浸润及粘膜肥厚为主,有早期淋巴结转移。根据这些特征,支气管分层可初步估计肺癌的病理类型。纤支镜可见到管腔内肿物及管壁病理改变,通过活检能明确细胞类型,但对肺段以远癌瘤,也难确诊。作者认为支气管分层引导下进行镜检和活检,可进一步提高肺癌诊断的正确率。

EVALUATION OF BRONCHO-TOMOGRAPHY AND FIBEROPTIC BRONCHOSCOPY IN THE DIAGNOSIS OF LUNG CANCER

The broncho-tomographic and fiberoptic bronchoscopic findings of 100 confirmed cases of lung cancer were studied and analyzed to compare the diagnostic value and the limitations of the two procedures. It was found that certain features shown on a bronchogram could be characteristic of the pathological nature. A squamous carcinoma was usually located in a bronchial branch larger than a segmental bronchiole. An intraluminal mass was often found, and the lesion usually grew locally and metastasized to the regional lymph nodes. Undifferentiated cancers manifested themselves by extensive narrowing of the involved bronchial branch with lymphatic metastasis, and an intraluminal mass could only be seen in a few cases. Adenocarcinomas were often found in the segmental or subsegmental bronchioles and spread proximally. Their main features were narrowing of the bronchial lumen, cancer cell infiltration, and thickening of the mucous membrane, and there was early lymphatic metastasis.On the basis of the findings mentioned above, it can be concluded that broncho-tomography serves only to disclose primarily the pathological nature of a lung lesion, while with the aid of fiberoptic bron- choscopy one can visualize the intraluminal mass and the pathological changes of the bronchial wall directly, and to ascertain the definite pathology of the lesion through biopsy. But for those lesions occurring distal to the segmental bronchioles, it can still be difficult to reach a correct pathological diagnosis even with fiberoptic bronchoscopy. It is suggested that fiberoptic brochoscopy with biopsy under the guide of broncho-tomographic findings be practised to improve further the diagnostic accuracy of lung cancers.