纤维支气管镜检查对肺弥漫性疾病的诊断价值

目的　了解纤维支气管镜(FB)检查对肺弥漫性病变的临床诊断价值。方法 总结1993～1999年间,经痰细胞学及细菌学检查均为阴性的肺部弥漫性病变86例行FB,并做活检、灌洗及刷片检查。结果 FB总的阳性率87.2%,镜下直视有病变51例,占59.4%。活检、灌洗液及刷检阳性率分别为69.2%、55.6%和30.8%。确诊肺癌38例中,支气管内新生物及肺活检阳性率分别为100%和84.2%,支气管肺泡灌洗液阳性率仅27.3%。在25例肺结核中,FB总的活检阳性率85.7%,而FB刷检和培养阳性率低16.2%。支气管镜肺活检的阳性率不因取活检次数的增加而增加。结论 FB,特别是活检是一种安全有效简便的方法,对肺弥漫性病变诊断率高,副作用小。

Diagnostic value of fiberoptic bronchoscopy in diffuse pulmonary diseases

Objective To evalute the diagnosis value of fiberoptic bronchoscopy(FB) in diffuse pulmonary diseases(DPD). Methods In the period of 1993～1999, 86 patients with DPD, who were negative sputum smears for tubercle bacilli and pathological examination for tumor, were received bronchoscopy, transbronchial biopsy, brushing and bronchoalveodar lavage(BAL). Results The overall positive rate of FB in DPD was 87.2%, 51 of 86 (59.4%) cases had lesions by immediate bronchoscopy identification, positive rate of transbronchial biopsy, brushing and BAL was 69.2% ,55.6% and 30.8%. Among 38 patients with lung cancer, the positive rates of bronchial neoplasm, lung biopsy were as high as 100% and 84.2%. On the other hand, the positive rates of BAL was only 27.3%. Among 25 patients with tuberculosis, The overall positive rate of biopsy was 85.7%, while positive rate of tubercle bacilli brushing and culture was only 16.2%. The shows that the positive rate of transbronchial lung biopsy was not increased with the number of biopsies. Conclusions Bronchoscopy, especially with biopsy ,is a safe, simple method which has a high diagnostic rate and less complications.