可弯曲内科胸腔镜检查在肺癌分期中的应用价值探讨

目的探讨可弯曲内科胸腔镜检查在肺癌分期中的临床应用价值。方法采用Olympus LTF-240型可弯曲内科电子胸腔镜，对病理已确诊的肺癌25例行内科胸腔镜检查。25例包括腺癌14例、鳞癌8例、小细胞肺癌3例，根据胸部CT结果分为：胸腔积液组15例，无胸腔积液组（cT未见胸腔积液但可见胸膜病变）10例。结果胸腔积液组可见胸膜病变10例，包括结节9例、扁平隆起1例，经内科胸腔镜检查证实为胸膜转移7例，排除胸膜转移8例；无胸腔积液组可见胸膜病变9例，包括结节7例、扁平隆起、自斑1例、胸膜瘢痕样增厚1例，经胸腔镜检查证实为胸膜转移7例，排除胸膜转移3例。经内科胸腔镜排除胸膜转移的11例中6例转外科手术治疗，术中均未见胸膜转移。25例胸腔镜检查均未见严重并发症。结论可弯曲内科胸腔镜检查能在微创代价下提高肺癌分期的准确率。建议对于胸部CT可见胸水或胸膜病变的肺癌确诊病例，在分期诊断中积极行内科胸腔镜检查。

The value of flexi-rigid medical thoracoscopy in the staging of lung cancer

Objective To investigate the clinical application value of flexi-rigid medical thoracoscopy in the staging of lung cancer. Methods 25 lung cancer patients which were diagnosed by pathology were examined with the Olympus LTF-240 flexi-rigid medical thora- coscope in our department. They included adenocareinoma 14 cases, squamous cell carcinoma 8 cases and small cell lung cancer 4 cases. They were grouped as pleural effussion 15 cases and non pleural effussion （pleural lesion was found） 10 cases by CT. Results 10 eases in pleural effussion group had found pleural lesion,9 of which were nodus, 1 of which was flat protrusions. 7 of the pleural effussion group were confirmed as pleural metastasis by the thoracoseopy, and 8 of which were excluded. The non pleural effussion group had 9 cases of pleura disease,7 of which were nodus, 1 of which was fiat protrusions and hiekie, 1 of which was pleura thickening like cicatrix. 7 of the non pleural effussion group were confirmed as pleural metastasis by the thoracoseopy, and 3 of which were excluded. 6 of the 11 eases which were excluded from the pleural metastasis couldn＇t be found the pleural lesion in the following operations. There was no severe complication in the 25 patients. Conclusions Flexi-rigid medical thoraeoseopy could increased the exactitude of the staging in lung cancer. So it should be actively applied to the staging diagnosis in the cases which pleural effussion or pleural lesion can be found by the chest CT.