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目的 :探讨≤ 3cm的小病灶肺癌各种术前诊断方法的准确率及其临床应用价值。方法 :回顾分析2 6 6例原发肿瘤≤ 3cm的支气管肺癌 ,痰检、支气管镜、CT引导下经皮肺穿刺等各种检查方法在术前诊断中的准确率。结果 :痰检和直视下 (TBB)毛刷检测率最高 ,分别为 71 8%和 6 1 3% ;支气管镜活检和经皮肺穿刺的阳性率最高 ,分别为 89 5 %和 10 0 % ;痰检和TBB毛刷在中央型病变的阳性率比周围型明显提高 ,差异有统计学意义 ,P值分别 <0 0 5和 <0 0 1;2 6 6例中≤ 2cm的仅 79例 ,各种确诊方法阳性率在≤ 2cm和 2～ 3cm组之间无明显差异 ;周围型中 2～ 3cm组的TBB毛刷阳性率比≤ 2cm组明显增高 (P <0 0 5 ) ;而≤ 2cm组中Ⅰ期占 6 0 8% ,Ⅲ期和Ⅳ期为 2 4 1% ,两组之间有显著差异 (P <0 0 1)。结论 :痰检和TBB毛刷的检测率较高 ,但诊断的阳性率则是CT引导下经皮肺穿刺和TBB活检较高 ,而各种方法在≤ 2cm的微小病灶和 2～ 3cm的较大病灶之间的应用价值并无明显差异 ,但在周围型中 2～ 3cm组的TBB毛刷阳性率比≤ 2cm组明显增高。
Objective: To investigate the accuracy and clinical value of various preoperative diagnostic methods for small lesions of ≤3cm. Methods: The accuracy of preoperative diagnosis was analyzed retrospectively in 266 cases of bronchial carcinoma with primary tumor less than 3 cm, sputum examination, bronchoscope and CT guided percutaneous pulmonary puncture. Results: The detection rates of sputum and under direct vision (TBB) brushes were the highest, 71.8% and 61.3% respectively; the positive rates of bronchoscopy and percutaneous lung biopsy were 89.5% and 100% ; Sputum examination and TBB brush in the central lesions of the positive rate was significantly higher than the surrounding type, the difference was statistically significant, P values were <0 0 5 and <0 0 1; 266 cases ≤ 2cm in only 79 cases The positive rate of various diagnostic methods in ≤ 2cm and 2 ~ 3cm group no significant difference between the peripheral type 2 ~ 3cm TBB brush brush positive rate than ≤ 2cm group was significantly higher (P <0 05); and ≤ In the 2 cm group, 60.8% of patients in stage I and 24.1% in stage III and IV were significantly different between the two groups (P <0.01). Conclusion: The detection rate of sputum test and TBB brush is high, but the positive rate of diagnosis is higher in percutaneous pulmonary puncture and TBB biopsy under the guidance of CT. However, in all kinds of small lesions ≤ 2 cm and 2 ~ 3 cm There was no significant difference between the application values of large lesions, but the positive rate of TBB brush in 2 ~ 3cm group in peripheral type was significantly higher than that in ≤ 2cm group.