支气管镜在肺癌诊断中的应用——1315例支气管镜检查结果分析

目的探讨支气管镜在肺癌诊断中的应用。方法回顾性分析我院1998-2005年1315例肺癌患者支气管镜检查结果，应用SPSS10．0医学软件进行统计学分析。结果本组患者男女比例2．5：1，60-69岁为发病年龄高峰占33．0％。其中31．08％（418／1315）为腺癌，其次为鳞癌和小细胞癌，分别占31．0％（408／1315）和25．0％（329／1315）。病变部位以中心型多见，占89．7％（1180／1315），31．7％（417／1315）发生于上叶支气管（P〈0．001），左右支气管发生率相似。60．8％（800／1315）镜下表现为增生型，其次为浸润型、外压型、正常型，分别占28．1％（370／1315）、2．8％（37／1315）和8．2％（108／1315），增生型鳞癌多见（40．6％）（P〈0．001），浸润型、外压型和正常型腺癌多见，分别为48．9％、51．4％和63．0％（P≤0．001）。78．6％（1034／1315）经支气管镜确诊，其中钳检阳性率83．4％（966／1158），刷检阳性率14．0％（176／1257），肺泡灌洗阳性率31．0％（26／84），经支气管镜肺活检阳性率73．9％（17／23），经支气管镜淋巴结针吸活检阳性率63．6％（14／22），21．4％（281／1315）经其他方法确诊。鳞癌和小细胞癌钳检阳性率为81．6％和89．1％，均高于腺癌（P〈0．001和P=0．023），鳞癌刷检阳性率为9．1％，低于腺癌（13．2％）（P=0．029）和小细胞癌（21．0％）（P=0．001）。中心型肺癌钳检阳性率（80．3％）和刷检阳性率（14．4％）均明显高于周围型（P〈0．001）。增生型肺癌钳检阳性率（88．4％）及刷检阳性率（15．6％）均明显高于其他镜下表型（P〈0．001）。正常型联合取材阳性率（23．1％）高于单纯钳检和刷检（P〈0．001）。结论经支气管镜确诊肺癌男性多于女性腺癌比例较前呈明显上升态势；经支气管镜确诊肺癌好发于段以上支气管；支气管镜确诊肺癌阳性率高；联合取材可明显提高正常型肺癌诊断阳性率；经支气管镜淋巴结针吸活检安全有效，有助于提高支气管镜诊断阳性率。

Application of bronchoscopy in the diagnosis of lung cancer

To explore the application of bronchoscopy in the diagnosis of lung cancer. Methods The bronehoseopy results in 1315 patients with lung cancer who were treated in our hospital from 1998 to 2005 were retrospectively analyzed. Results Most patients were males （71.1% ）. The pathological types included adenocarcinoma （ n = 418, 31.1% ）, squamous cell carcinoma （ n = 408, 31.0% ）, and small cell lung cancer （ n = 329, 25.0% ）. Most lesions were located in the central of lung （ n = 1180, 89. 7% ）. According to the appearance of lesions under bronchoscopy, patients were classified into four groups： neoplasm （n = 800, 60. 8% ）, infiltration （ n = 370, 28. 1% ）, outer suppression （ n = 37,2. 8% ）, and normal （ n = 108, 8.2% ）. Pathological diagnosis could be yield by bronchoscopy in 1035 cases （78.6%） and the yield of forceps biopsy was 83.4% （966/1158）, brush 14. 0% （176/1257）, BALF 31.0% （26/58）, TBLB 73.9% （17/23）, and TBNA 63.6% （14/22）. The sensitivities of forceps biopsy for squamous cell carcinoma and small cell lung cancer were 81.6% and 89. 1%, respec- tively, which were significantly higher than that for adenocarcinoma （ P 〈 0. 01 and P = 0. 023 ）. The sensitivity of brush for squamous cell carcinoma was 9. 1% , which were significantly lower than those for adenocarcinoma （ 13.2%, P =0. 029） and small cell lung cancer （21.0%, P =0. 001 ）. The sensitivities of forceps biopsy and brush for central lung cancer were 80. 3% and 14. 4%, respectively, which were significantly higher than those for peripheral lung cancer （P 〈 0. 001 ）. The sensitivities of forceps biopsy and brush for neoplasm group were 88.4% and 15.6%, respectively, which were significantly higher than those for other groups （P 〈 0. 001 ）. The sensitivity of combined methods for normal group was 23. 1%, which was significantly higher than those of forceps biopsy and brush （P 〈0. 001 ）. Conclusions Patients diagnosed through bronchoscopy are mainly male. Lesions mainly locate in the central part of lung. Bronchospy is useful for the detection central lung cancer, neoplasm type, squamous cell cancer and small cell lung cancer. Combined multiple methods can improve the yield of bronchoscopy in normal group.