安徽省三级医院肺癌诊断现状分析

目的 分析安徽省三级医院肺癌诊断现状,为肺癌患者诊断方法的优化提供依据。 方法 2016年7月采用安徽省肺癌质控中心专家组设计的"全省肺癌诊治现状调查表"对安徽省57家三级医院进行肺癌诊断现状的问卷调查,对收集的有效数据进行统计学分析。 结果 不同诊断方法在可疑中央型肺癌中以气管镜的选用率最高,占20.0%(163/816),在肺外周病变中以CT或B超引导下肺穿刺术的选用率最高,占18.0%(142/790);对同一诊断方法在不同类型肺癌中的选用率进行比较,气管镜(χ2=59.305,P<0.001)和反复痰细胞学检查(χ2=11.595,P=0.001)在中央型肺癌的应用显著多于肺外周病变,CT或B超引导下肺穿刺术(χ2=14.477,P<0.001)和直接外科手术(χ2=25.014,P<0.001)在肺外周病变的应用显著多于中央型肺癌;对不同等级医院之间诊断方法的选用率进行比较,超声支气管镜或者经支气管针吸活检术(χ2=9.421,P=0.002)和直接外科手术(χ2=4.195,P=0.041)在省级医院的应用显著多于市级医院;径向支气管内超声引导下支气管镜检查在三甲医院的应用显著多于三乙医院(χ2=5.854,P=0.016)。 结论 常规气管镜技术和经皮肺穿刺技术是安徽省肺癌诊断的主要手段,但新技术开展较少,省级医院和三甲医院在肺癌的诊断水平和理念上优于市级医院和三乙医院。 

Analysis of diagnosis status of lung cancer in tertiary hospitals in Anhui Province

Objective To analyze the status of diagnosis of lung cancer in tertiary hospitals in our province, and provide basis for the optimization of diagnostic methods for patients with lung cancer. Methods A lung cancer diagnostic status questionnaire was designed by the expert group of lung cancer quality control center in our province. In July, 2016, the questionnaire survey of lung cancer diagnosis was conducted in 57 three level hospitals in our province. The valid data were collected and analyzed statistically. Results Among different diagnostic methods, bronchoscopy occupied the highest selection rate (20.0%, 163/816) for suspicious central lung cancer. CT- or ultrasound- guided percutaneously transthoracic lung biopsy taken up the highest selection rate for the peripheral pulmonary lesions (18.0%, 142/790). Focusing on the selection rate of a given diagnostic method for different types of lung cancer, bronchoscopy (χ2=59.305, P<0.001) and repeated sputum cytology (χ2=11.595, P=0.001) were commonly used for central lung cancer, that obviously surpassed peripheral pulmonary lesions, however, the selection rate of CT-guided or ultrasound-guided percutaneously transthoracic lung biopsy (χ2=14.477, P<0.001) and direct surgery (χ2=25.014, P<0.001) in central lung cancer was significantly higher than that in peripheral pulmonary lesions. Among the different levels of hospitals, EBUS or TBNA (χ2=9.421, P=0.002) and direct surgery (χ2=4.195, P=0.041) were most commonly used in provincial hospital, the selection rate was significantly more than that of municipal hospitals; the selection rate of R-EBUS guided bronchoscopy (χ2=5.854, P=0.016) in tertiary hospitals was significantly more than that of the three B hospitals. Conclusion Conventional bronchoscopy and percutaneous lung biopsy are the main means for the diagnosis of lung cancer in our province, but new technologies are less developed. Provincial hospitals and tertiary hospitals are superior to municipal hospitals and three B hospitals in the diagnosis level and concept of lung cancer.