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目的探讨多排螺旋CT(MSCT)及多平面重建(MPR)和曲面重建(CPR)对纤维支气管镜取材的导引作用,提高周围型肺癌(PPC)的阳性检出率。方法选择苏州大学附属第一医院2002—2005年收治的60例PPC患者,行MSCT扫描后行MPR及CPR,评价支气管与肿瘤结节之间的关系,确定支气管征(BS)的分型,将BS分型与纤维支气管镜各种取材方式的检测结果相对照。结果(1)全部病例的3~7级支气管均能清晰完整的显示。BS分为4型(Ⅰ~Ⅳ型)。(2)25例腺癌中BS阳性者有22例,17例鳞癌中有13例,6例小细胞肺癌中有4例,8例支气管肺泡癌中有4例,4例其他类型肺癌中有2例。(3)BSⅠ型发生率最高,为31.3%(15/48),BSⅡ型为14.6%(7/48),BSⅢ型为25%(12/48),BSⅣ型为29.2%(14/48)。(4)纤维支气管镜的总阳性率为58.3%,BS阳性的检出率为73.3%,高于BS阴性的检出率(13.3%),BS类型与纤维支气管镜取材的阳性率密切相关。结论横断面联合MPR、CPR能更好地显示肿瘤与支气管之间的关系。在不同BS征的导引下,指导纤维支气管镜取材,可提高周围型肺癌的检出率。
Objective To investigate the guiding effect of multi-slice spiral CT (MSCT), multiplanar reconstruction (MPR) and curved surface reconstruction (CPR) on fiberoptic bronchoscopy and to improve the positive detection rate of peripheral pulmonary carcinoma (PPC). Methods Sixty patients with PPC admitted to the First Affiliated Hospital of Soochow University from 2002 to 2005 were enrolled in this study. MPR and CPR were performed after MSCT scan. The relationship between bronchus and tumor nodules was evaluated to determine the type of bronchial asthma (BS) BS type and bronchoscopy various ways of detection results contrast. Results (1) All cases of grade 3 to grade 7 bronchi can be clearly and completely displayed. BS is divided into 4 types (Ⅰ ~ Ⅳ type). (2) Twenty-two BS positive cases were found in 25 cases of adenocarcinoma, 13 cases of squamous cell carcinoma in 17 cases, 4 cases of small cell lung cancer in 6 cases, 4 cases of bronchoalveolar carcinoma in 8 cases and 4 cases of other types of lung cancer In 2 cases. (3) The highest incidence of BS Ⅰ type was 31.3% (15/48), BS Ⅱ type was 14.6% (7/48), BSⅢ type was 25% (12/48), BS Ⅳ type was 29.2% (14/48) . (4) The total positive rate of bronchoscopy was 58.3%, the positive rate of BS was 73.3%, higher than the negative rate of BS (13.3%). The type of BS was closely related to the positive rate of bronchoscopy. Conclusion Cross-sectional joint MPR and CPR can better show the relationship between tumor and bronchus. Under the guidance of different BS signs, guidance of fiberoptic bronchoscopy can improve the detection rate of peripheral lung cancer.