纤维支气管镜刷检细胞学检查诊断肺癌的价值及影响因素分析

目的探讨纤维支气管镜（纤支镜）刷检细胞学检查诊断肺癌的敏感性、特异性及相关影响因素。方法以手术切除和（或）经纤支镜钳取活检组织病理学诊断结果为标准,对143例可疑肺癌患者的纤支镜刷检细胞学检查结果、涂片质量及纤支镜下表现等进行分析。结果以高级别异型增生及以上级别报告为阳性结果,纤支镜刷检细胞学检查诊断肺癌的敏感性为66．7％、特异性为96．6％;纤支镜活检和刷检结合肺癌检出率为89．3％,显著高于单纯刷检（P〈0．01）、显著低于组织病理学检查（P〈0．05）;纤支镜刷检肺癌检出率退变标本和未退变标本分别为25．0％．72．0％（P〈0．05）,中央型肺癌和非中央型肺癌分别为72．1％、43．8％（P〈0．05）,增生型、管壁浸润型、管外压迫型和正常型分别为81．4％、70．0％、22．2％、41．7％（P〈0．01）。结论纤支镜刷检细胞学检查简便、快捷,诊断肺癌特异性及敏感性均较高,与纤支镜钳取活检联用可提高肺癌检出率;但纤支镜刷检结果受标本质量、肺癌部位和纤支镜下分型等影响,临床医师要综合分析临床资料、排除假阴性。     

纤维支气管镜吸痰治疗肺癌术后肺不张6例报告

纤维支气管镜吸痰治疗肺癌术后肺不张６例报告江苏省宜兴市人民医院（２１４２００）谈永飞肺癌术后余肺不张为常见并发症之一。如病人痰液粘稠，单一用纤维支气管镜行气管、支气管内吸痰难以奏效。我们对此作一改进，在镜管并行捆绑一吸痰管，达到了理想的效果，介绍如下...     

纤维支气管镜下联合取材对肺癌的诊断价值

目的　探讨纤维支气管镜下联合取材对肺癌的诊断价值。方法　采用回顾性分析法 ,分别统计钳检、刷检、冲洗及针吸活检 4种不同取材方法对肺癌的检出情况。结果　确诊的 2 60例肺癌患者镜下分为四型 :增生型、浸润型、外压型、正常型 ;钳检、刷检、冲洗、针吸活检的阳性率分别为 83 7%、72 3 %、65 0 %、62 3 % ,联合后总阳性率为 93 8%。结论　纤维支气管镜对肺癌的诊断有重要价值 ;不同取材方法对镜下不同类型肺癌的诊断价值不同 ;4种取材方法中钳检的检出率最高 ,联合运用多种取材方法可明显提高肺癌的诊断准确率     

支气管镜活检技术对肺癌的诊断意义

目的：对肺癌患者采用活检、刷检和支气管肺泡灌洗三项技术的诊断意义进行分析评价。方法：６０例进行纤支镜检查的肺癌患者，按照肺灌洗、活检和刷检顺序进行。三项技术检查阳性率进行比较，统计学处理采用ｘ２检验。结果：纤支镜检查总阳性率为９３．３３％，活检、刷检和肺灌洗阳性率分别为８３．３３％、５３．３３％和２２％。同时做三项检查的５０例中，４７例（９４％）阳性，其中单纯活检阳性２２例，单纯刷检阳性３例，余２２例两项以上检查技术阳性，无单纯灌洗阳性者。结论：纤支镜诊断肺癌有重要意义，三种检查技术以活检阳性率最高，刷检次之，灌洗最低，活检和刷检联合应用能提高阳性率。灌洗意义不大。     

痰细胞学联合支气管镜DNA倍体检测对肺癌的诊断意义

目的探讨痰细胞学联合支气管镜DNA倍体检测对肺癌的诊断价值。方法 80例患者行痰细胞学、支气管镜DNA倍体检测。结果 54例确诊为肺癌,痰细胞学检测阳性率29.92%,支气管镜DNA倍体检测阳性率69.87%,两者联合检测阳性率为95.18%;DNA倍体分析与细胞学联合检测灵敏度为98.38%,明显高于DNA倍体分析91.85%及细胞学78.58%(P0.05)。结论痰细胞学联合支气管镜DNA倍体检测能有效的提高肺癌检测的灵敏度。     

纤支镜下液基细胞学检查对肺癌患者的诊断效果

目的探讨纤支镜下液基细胞学检查对肺癌患者的诊断效果。方法选择本院临床怀疑和诊断肺癌患者288例为研究对象,所有患者的纤支镜刷检标本同时送液基细胞学和传统细胞学检测,并与组织病理诊断结果比较。结果液基细胞学诊断的特异性为97.3%(36/37),敏感性为75.3%(189/251),准确性为78.1%(225/288)。传统细胞学诊断的特异性为91.9%(34/37),敏感性为59.0%(148/251),准确性为63.2%(182/288)。液基细胞学诊断的敏感性和准确性高于传统细胞学诊断(P0.005)。结论纤支镜下液基细胞学检查有较高的特异性和分析准确性,优于传统细胞学检查,在临床中有较高的应用价值。     

纤维支气管镜联合取材对肺癌诊断的临床价值

目的评价纤维支气管镜检查对肺癌的诊断价值,探讨纤维支气管镜下联合采用多种取材方法对肺癌诊断的临床意义。方法回顾性分析109例肺癌患者,经纤支镜检查采用钳夹、刷检、灌洗联合取材方法,获取标本,经病理学检查或细胞学检查确诊为肺癌,比较三种不同取材方法及联合取材方法获取肺癌诊断阳性率。结果钳夹、刷检、灌洗对肺癌诊断的阳性率分别是82.02%、69.44%、55.96%,三种方法联合后总阳性率为98.86%,联合取材与单一方法取材比较差异有显著性（P〈0.05）。结论纤支镜检查是确诊肺癌的重要手段之一,联合取材可以提高肺癌诊断的阳性率。     

经纤维支气管镜不同取材方法对肺癌的诊断价值

目的评价纤维支气管镜(纤支镜)下不同取材方法对肺癌诊断的价值,探讨纤支镜下联合采用多种取材方法对肺癌诊断的临床意义。方法分析130例肺癌患者的纤支镜检查结果,比较钳检、刷检、经纤支镜肺活检(TBLB)、单纯经纤支镜针吸活检(TBNA)、支气管肺泡灌洗(BAL)及联合取材方法诊断肺癌的阳性率。结果 130例肺癌经纤支镜确诊122例,镜下分为六型:中央增生型、中央浸润型、中央外压型、中央正常型、周围增生浸润型、周围外压正常型;钳检、刷检、TBLB、TBNA、BAL的阳性率分别为83.33%、56.92%、50.00%、67.35%、42.31%,钳检阳性率明显高于另4种单一方法取材(P0.05);不同镜下类型分别采用刷检联合其他4种方法检查的总阳性率为93.85%(122/130),平均阳性率为89.99%;不同取材方法对不同镜下类型肺癌的检出不同。结论根据镜下特点的不同采取不同经纤支镜取材方法、重视钳检、积极开展TBLB、TBNA、联合多种取材方法可提高肺癌的病理学诊断率。     

纤维支气管镜检查对肺癌的诊断价值

本文报告了经纤支镜检确诊肺癌５０２例，描述了肺癌的组织学类型与纤支镜下的独特表现。着重分析了鳞癌、腺癌、未分化癌纤支镜下表现与病理类型的关联，并对如何提高镜下取材阳性率以及纤支镜检对肺癌手术根治有何指导意义进行分析。     

纤维支气管镜对肺癌的诊断价值

早期肺癌的治疗效果显优于进展期肺癌，努力提高早期肺癌的确诊率是临床工作的一项重要措施。纤支镜的临床应用大大提高了肺癌的诊断水平。现将纤支镜检查(镜检)并取得病理确诊的60例肺癌临床及镜柱资料分析并加以讨论；     

Diagnostic value of bronchoalveolar lavage and postbronchoscopic sputum cytology in peripheral lung cancer

Abstract The objective of this study was to evaluate the value of bronchoalveolar lavage (BAL) and postbronchoscopic sputum cytology in diagnosing peripheral lung cancer. We performed a prospective study in 55 patients with lesions on chest radiographs who were suspected of having lung cancer and had non-endoscopically visible lesions on fiberoptic bronchoscopy. The sequence of procedures in all cases was BAL and transbronchial forceps biopsy. The final diagnosis of these patients were primary lung cancer in 30 patients, metatastic lung cancer in five and benign diseases in 20. In the primary lung cancer group, BAL was positive for malignant cells in 14 of the 30 patients (46.7%). In seven (50%) of these patients, the cell type diagnosed by BAL agreed with the final diagnosis. The diagnostic yield of BAL was influenced by the size and segmental location of the lesion. Bronchoalveolar lavage provided a higher diagnostic yield (46.7%) than transbronchial biopsy (16.7%). In five patients with metastatic lung cancer and 20 patients with benign disease, BAL gave negative results in all. Postbronchoscopic sputum cytology was positive in only two of the 26 patients (7.7%) from whom samples could be obtained. Bronchoalveolar lavage cytology proved to be a valuable diagnostic tool in detecting peripheral, primary lung cancer. Postbronchoscopic sputum cytology provided no significant additional information.     

纤维支气管镜与常规吸痰治疗在预防呼吸机相关性肺炎患者中的应用

目的比较分析纤维支气管镜与常规吸痰治疗在预防呼吸机相关性肺炎(VAP)患者中的应用价值及对VAP病原学的诊断价值。方法将70例呼吸衰竭并行呼吸机辅助呼吸的患者按照随机数字表法分为观察组和对照组,各35例,对照组患者采用常规吸痰管吸痰,观察组患者采用纤维支气管镜吸痰,观察两组行呼吸机辅助呼吸后VAP发生率、机械通气情况、住院时间、活动状态和生活质量,并进行痰中病原学分析。结果每例患者各进行2次痰细菌培养,观察组检出阳性率82.86%,对照组检出阳性率57.14%,比较差异有统计学意义(P0.05);观察组患者行辅助呼吸后3、5、7d肺部感染评分(CPIS)明显低于对照组,比较差异有统计学意义(P0.05);观察组VAP发生例数、机械通气时间、VAP治愈时间、总住院时间均明显低于对照组,比较差异有统计学意义(P0.05);治疗后3个月,观察组卡氏评分(KPS)及日常生活能力评分(ADL)均明显优于对照组(P0.05)。结论对呼吸衰竭机械通气患者行纤维支气管镜吸痰进行痰培养可以有效的进行病原菌监测,及早采取措施防止肺感染,可以解除呼吸道的阻塞、直接去除引起呼吸衰竭的诱因,缩短患者住院时间,改善预后,值得临床推广使用。     

荧光支气管镜在中央型肺癌诊断中的价值

目的评价荧光支气管镜在中央型肺癌诊断中的价值。方法将患者随机分为白光组和荧光组,对可疑病变部位进行活检和/或刷检,比较两组检查结果的差异。结果入组患者86例,白光组和荧光组分别为44例和42例,肺癌一次性检出率分别为52.3%和78.6%,有统计学差异(χ2=6.54,P=0.038)。镜下呈增生型病变的肺癌检出率两组无统计学差异(χ2=0.34,P=0.84)。对于镜下呈非增生型病变,白光组检出率15.4%,荧光组为77.8%,两组有统计学差异(P=0.0138)。对中、重度不典型增生和原位癌检出率,白光组和荧光组分别为8.7%和24.2%,两组无统计学差异。结论荧光气管镜在中央型肺癌的诊断中具有重要的作用。     

Clinical implication of atypical cells from sputum in patients without lung cancer

OBJECTIVE AND BACKGROUND: Atypical-but not definitely malignant-cells in cytological examinations of sputum are usually associated with lung cancers. However, atypical cells are occasionally identified in patients without lung cancer. The aim of this study was to determine the clinical implication of the atypical cells from sputum in patients without lung cancer or other malignancies. METHODOLOGY: All patients with atypical cells observed following cytological examination of sputum on one or more occasion over a 2-year period in Seoul National University Hospital were enrolled. After exclusion of patients followed up for less than 6 months, their clinical data were reviewed retrospectively. RESULTS: Among 601 enrolled patients with atypical cells, lung cancers were diagnosed within 30 days of identification of atypical cells in 542 (90.2%) patients. Five out of 59 patients who had no evidence of lung cancer, were subsequently diagnosed with lung cancer or other malignancies following a mean observation of 164 days. In the other 54 patients without subsequent malignancies, the most common respiratory diseases were pneumonia including tuberculosis. CONCLUSIONS: The subsequent development of malignancy in patients with atypical cells in sputum despite a thorough evaluation was rare, and close observation without invasive diagnostic procedures might be simply required in these patients.     

The value of sputum cytology

Objective:To assess the value of cytologic examination of expectorated sputum in the diagnosis and management of patients with suspected lung cancer. Design:Retrospective chart review. Setting:Inpatient wards, tertiary care university hospital. Measurements and main results:The charts of 357 patients were reviewed. Two hundred eighty-eight of the 357 patients had had initial sputum cytologic examination prior to other diagnostic procedures, of which 41 (15%) had positive cytologic results. Thirty-six of the 41 were confirmed bistologically or shown to have metastatic spread by noninvasive tests. Of the 222 patients with negative or unsatisfactory sputum tests, 97 went on to bronchoscopy and 35 had needle-aspiration biopsies. In the population of patients whose chest x-rays were highly suggestive of primary or metastatic lung cancer, the positive rate for cytologic examination was 38/94 (40%). There was no false-positive test in this study. Of the 50 patients with positive cytologic results, five (10%) had diseases that were of a different cell type; two of these five (40%) had diseases that involved small-cell cancer. There was an unsatisfactory delay in obtaining these samples for analysis. Conclusions:Sputum cytology was found to be too insensitive and insufficiently accurate to be included in the routine workup of a patient suspected of having lung cancer. The results of the test did not influence further diagnostic procedures. This test should, therefore, be reserved for patients considered on initial assessment to be too sick for further investigations and treatment. Supported by a grant from the Department of Health, Government of Manitoba, Canada.     

多种手段在肺部肿瘤诊断中的应用分析

目的探讨纤维支气管镜(纤支镜)刷检/针吸/活检、肺穿刺组织病理学/细胞学与痰液细胞学在肺部肿瘤诊断中的应用。方法纤支镜在病变部位刷片、针吸或活检;CT引导下肺部病变部位穿刺;取晨痰或新鲜痰液涂片作细胞学检查。结果本组617例患者,经临床或病理学确诊为肺癌患者525例,应用纤支镜、肺穿刺及痰液细胞学诊断肺癌432例,占82.3%;其中纤支镜刷检/针吸/活检阳性318例,占60.6%;肺穿刺阳性108例,占20.6%;痰液细胞学阳性104例,占19.8%(其中痰液细胞学单独阳性者6例,占1.1%)。结论纤维支气管镜刷检/针吸/活检与CT引导下肺穿刺组织病理学/细胞学检查,在肺部肿瘤的诊断中有重要的应用价值;痰细胞学检查简便易行,可作为纤支镜检查阴性和不能耐受纤支镜检查的肺癌患者的补充手段,在肺部肿瘤的筛查中有重要的意义。多种手段联合检查,可进一步提高肺部肿瘤诊断的阳性率。     

重复纤支镜检查对肺癌的诊断价值探讨

目的探讨重复纤支镜检查在肺癌诊断中的价值。方法回顾性分析70例怀疑肺癌接受重复纤支镜检查患者的临床病例资料。结果64例患者重复纤支镜检查1次,4例患者重复纤支镜检查2次,2例患者重复纤支镜检查3次。16例患者重新获得病理学确诊,重复检查的阳性率为22.86%(16/70)。复检病理学阳性以赘生物型为主,粘膜型次之。结论首次纤维镜结果与临床,X线,特别是镜下直视不符时,应积极进行复检,重复检查以1~2次为宜,综合运用各种镜下诊断技术有助于提高阳性率。     

纤支镜检查并发症的回顾性分析及其处理

目的探讨纤支镜检查的并发症及其处理方法。方法回顾性分析2003年1月-2008年1月1658例纤支镜检查并发症的发生情况。结果1658例接受纤支镜检查患者中,鼻出血占首位,喉、支气管痉挛居第二位,其他并发症有咯血、心血管并发症等。结论良好的麻醉是纤支镜顺利进行的基本条件,操作者技术熟练,动作轻柔,严格无菌操作,严格掌握适应症,才能减少并发症。