七种肺脏介入技术联合应用对肺癌早期诊断的价值

目的 评价7种肺脏介入技术联合应用在肺癌早期诊断中的价值.方法 467例痰脱落细胞学、细菌学、常规支气管镜等检查均无阳性发现的胸、肺部病变(包括肺门淋巴结肿大、纵隔淋巴结肿大、肺部小结节、小肿块、小片状浸润、少量胸腔积液和胸膜小结节等)患者均先进行超细支气管镜肺活检并刷检术.对于无阳性结果且病灶位于肺门、内或中带的155例患者行X线引导超细支气管镜肺活检并刷枪术;对于病灶位于中、外带且与胸壁不连接的95例患者行X线引导经皮肺穿刺活检术;对于病灶紧贴胸壁的102例患者行超声引导经皮肺穿刺活检术;对于可疑中央气道病变的59例患者行自荧光支气管镜活检并刷检术;对于纵隔或伴肺门淋巴结肿大的67例患者行气管内超声引导经支气管针吸术(EBUS-TBNA);对于有少量胸腔积液或胸膜小结节的23例患者行内科电子胸腔镜胸膜活检术.结果 诊断阳性率超细支气管镜活检并刷检术为25.3%(118/467),X线引导超细支气管镜肺活检并刷检术为67.7%(105/155),X线引导经皮肺穿刺针吸活检术为66.3%(63/95);超声引导经皮肺穿刺活检术为67.6%(69/102),自荧光支气管镜活检并刷检术为35.3%(18/51),EBUS-TBNA为77.6%(52/67),内科电子胸腔镜胸膜活检术为52.2%(12/23).7种方法总的诊断阳性率为93.6%(437/467),≤Ⅱ期肺癌(原位癌3例,Ⅰ a期84例,Ⅰ b期63例,Ⅱ a期65例,Ⅱ b期44例)诊断率达82.7%(259/313).结论 联合应用7种肺脏介入技术可明显提高肺癌的早期诊断率.

Joint application of 7 interventional pulmonology methods in early diagnosis of lung cancer

Objective To evaluate the combination of 7 interventional puimonology methods in early diagnosis of lung cancer. Methods A total of 467 patients with thoracic and pulmonary lesions (include hilum pulmonis lymphadenectasis, mediastinal lymphadenectasis, pulmonary scobination, lump, lamellar infiltration, small amount of pleural fluid and pleural scobination) had negative results via exfoliative cytology, bacteriology and routine bronehoscopy. All these patients had uitrathin bronchoscopy with biopsy and brushing. For those 155 cases whose foci were located at ports pulmonis, inner zone or median zone, the authors applied ultrathin brenchoscopy with biopsy and brushing guided by X-ray. For those 95 cases whose foci were located at median zone or outer zone and unconnected with chest wall, per cutem lung puncture needle aspiration was employed under the guidance of X-ray. For those 102 cases whose foci were tightly connected with pleural membrane, per eutem lung puncture biopsy was employed under the guidance of type-B ultrasonic. For those 59 cases with suspected central airway foci, auto-fluorescence bronchoscopic biopsy and brushing were employed. For those 67 cases with hilum pulmonis or mediastinal lymphadenectasis, endobronchial ultrasonic transbronchial needle aspiration (EBUS-TBNA) was employed. For those 23 cases with small amount of pleural fluid or pleural scobination, electronic thoracoscopie biopsy and brushing were employed. Results It was found that 118 cases were diagnosed by ultrathin brunehoscopic biopsy and brushing with a positive rate of 25.3% (118/467), 105 cases by ultrathin brunehoseopy with biopsy and brushing guided by X-ray with a positive rate of 67.7% (105/155), 63 cases by per cutem lung puncture needle aspiration under the guidance of X-ray with a positive rate of 66.3% (63/95), 69 cases by per cutem lung puncture biopsy under the guidance of type-B ultrasound with a positive rate of 67.6% (69/102), 18 cases by auto-fluorescence bronchoscopic biopsy and brushing with a positive rate of 35.3% (18/51), 52 cases by EBUS-TBNA with a positive rate of 77.6% (52/67), 12 cases by electronic thoracoscopic biopsy and brushing with a positive rate of 52.2% (12/23). The total positive diagnostic rate was 93.6% (437/467). And the diagnostic rate of ≤stageⅡ lung cancer (3 cases carcinoma in situ, 84 stage Ⅰa, 63 stage Ⅰb, 65 stageⅡa and 44 stageⅡb) was 82.7% (259/313).Conclusion Joint application of these 7 interventional bronchoscopic techniques can significantly boost the rate of early diagnosis of lung cancer.