徐家禄+刘德群+陈建勇+余州平+周春玉+丁京玉+伍海伦

[摘要] 目的 探讨纤维支气管镜在肺不张病因诊断中的临床应用价值。 方法 对本院2006年1月~2012年6月收治的105例肺不张患者的影像学资料和纤维支气管镜检查结合病理学结果进行回顾性分析。 结果 102例患者诊断明确，诊断率为97.1%。肺不张的主要病因，依次为肺癌（46.1%），炎症（27.5%），结核（14.7%）；中年及老年患者肺不张的病因主要为肺癌（47例）；肺癌多为双上叶（66.0%），炎症多为右中肺（39.3%），结核多为右上肺及右中肺（73.3%）。 结论 纤维支气管镜诊断率高，操作安全，对肺不张的病因诊断及治疗具有重要的临床意义。

[关键词] 纤维支气管镜；肺不张；诊断

[中图分类号] R563.4[文献标识码] B[文章编号] 1674-4721（2014）04（c）-0158-03

Clinical application of fiber bronchoscope for etiological diagnosis of pulmonary atelectasis

XU Jia-lu1 LIU De-qun1 CHEN Jian-yong2 YU Zhou-ping1 ZHOU Chun-yu1 DING Jing-yu1 WU Hai-lun3

1.Department of Respiration Medicine,People′s Hospital of Gan County in Jiangxi Province,Gan County 341100,China;2.Department of Neurology,People′s Hospital of Gan County in Jiangxi Province,Gan County 341100,China;3.Department of Neurology,People′s Hospital of Guangdong Province,Guangzhou 510080,China

[Abstract] Objective To discuss the clinical application value of fiber bronchoscope for etiological diagnosis of pulmonary atelectasis. Methods Image data,the results of fiber bronchoscope examination and pathology in 105 patients with pulmonary atelectasis admitted into our hospital from January 2006 to June 2012 were retrospectively analyzed. Results 102 patients were definitely diagnosed and the diagnostic rate was 97.1%. The principal cause of pulmonary atelectasis were lung cancer (46.1%),inflammation (27.5%),and tuberculosis (14.7%) in turn;the cause of pulmonary atelectasis in patients at middle and old ages was lung cancer in 47 cases;the lung cancer was mainly reflected in double leaf (66.0%),inflammation was probably manifested in right middle lobe (39.3%),and tuberculosis was in right upper and right middle lobe (73.3%). Conclusion The diagnostic rate of fiber bronchoscope is high with safe operation,and it has important clinical significance on etiological diagnosis and treatment of pulmonary atelectasis.

[Key words] Fiber bronchoscope;Pulmonary atelectasis;Diagnosis

肺不张是呼吸内科临床上常见的疾病之一，是由多种原因导致的肺组织充气减少，肺容积减少及肺萎陷，肺不张的临床诊断较为容易，但对病因的鉴别和诊断才是关键。胸部的影像学检查结果只能发现肺不张的部位，而纤维支气管镜对于判定引起肺不张的病因具有一定的临床价值。现将本院2006年1月~2012年6月诊断为肺不张的102例患者行纤维支气管镜检查的结果进行回顾性分析。

1 资料与方法

1.1 一般资料

本研究中经胸部影像学检查诊断为肺不张而病因未明的患者共105例，其中男58例，女47例，年龄12~76岁，平均52.5岁。最终明确诊断的有102例，其中年龄＜20岁的8例（7.8%），21~40岁的15例（14.7%），41~60岁的40例（39.2%），＞60岁的39例（36.3%）。患者的主要临床表现为胸闷、胸痛、发热、咳嗽、咳痰、咯血、气促和消瘦等。

1.2 检查方法

所有患者接受心电监护，并给其予持续高流量吸氧，按中华医学会呼吸病学分会《诊断性可弯曲支气管镜应用指南（2008 版）》规定进行操作。……