纤维支气管镜对早期诊断菌阴肺结核合并肺癌的临床意义

目的探讨通过纤维支气管镜(纤支镜)检查提高对菌阴肺结核合并肺癌的早期诊断率。方法40例临床诊断为菌阴肺结核的患者均接受诊断性抗结核治疗1月后,临床症状部分好转,仍不能排除肺部肿瘤的患者,同时进行纤支镜检查行病理活检、刷检、支气管肺泡灌洗液(BALF)找癌细胞、BALF涂片、BALF结核菌培养、BALF的TB-DNA。结果 40例患者中肺癌与菌阴肺结核共存25例(62.5%),肺癌4例(10%),菌阴肺结核11例(27.5%),40例患者进行BALF检查,其中36例患者的BALF的TB-DNA≥1.14×103,13例BALF结核菌培养阳性,2例发现癌细胞;40例患者中的16例纤支镜下有异常改变者,进行病理活检和刷检,其中13例患者病理为典型结核和肺癌并存,3例为典型结核结节;24例在病变部位行刷检,其中10例病理证实肺癌。结论纤维支气管镜检查操作简单,镜下多种联合检测可提高菌阴肺结核合并肺癌的早期诊断率,避免漏诊及误诊。

Clinical significance of earl diagnosis for negative bacteria pulmonary tuberculosis with lung cancer by fiber bronchoscope

Objective To improve early diagnosis rate of negative bacteria pulmonary tuberculosis and lung cancer by fiber bronchoscope .Methods 40 cases of negative pulmonary tuberculosis received diagnostic anti-tuber-culosis treatment for 1month, and some of their clinical symptoms made partially improvement .For a accurate diagno-sis, all these patients accepted fiber bronchoscope and biopsy , brush, lavage for pathological cell , tuberculosis bacte-ria cultivation and lavage TB-DNA at the same time.Results 25 cases (62.5%) had negative bacteria pulmonary tu-berculosis and lung cancer co-existed, 4 cases (10%) had lung cancer, 11 cases (27.5%) had negative bacteria pulmonary tuberculosis .36 cases of 40 BALF ( bronchoalveolar Lavage Fluid ) of TB-DNA were higher than 1.14 × 103 , of which 13 case showed tuberculosis bacterium culture positive , and 2 cases found cancer cells .16 cases of 40 found abnormal changes under bronchoscope , of which 13 cases with pathological for typical tuberculosis and lung cancer co-existed, 3 cases had typical tuberculosis .24 cases of 40 brush the lesion site, of which 10 cases of patho-logical proved lung cancer .Conclusion Fiber bronchoscope operation is simple , and the joint detection can improve early diagnostic rate of negative bacteria pulmonary tuberculosis and lung cancer , which can avoid missed diagnosis and misdiagnosis .