数字减影定位下经支气管镜肺活检对肺部周围型病变的诊断价值

Diagnostic value of transbronchial lung biopsy(TBLB) under digital subtraction angiography(DSA) in peripheral lung lesions

目的探讨数字减影(DSA)定位下经支气管镜肺活检(TBLB)对肺部周围型病变的诊断价值。方法对52例无经皮肺活检(PCNA)指征的肺部周围型病变在DSA定位下实行TBLB,同时做纤支镜刷片(BB)及支气管肺泡灌洗(BAL),比较三者的诊断阳性率。并将这3种方法的诊断阳性率与同期住院在CT定位下做PCNA的45例肺周围型病变患者的诊断阳性率做比较。结果TBLB、BB和BAL的诊断阳性率分别为61.53%、57.69%和63.46%。两两配对χ2值分别为0.29、0.07和0.53,均P>0.05,差异无显著性。这3种方法与PCNA的诊断阳性率比较,χ2值分别为0.01、0.22和0.01,均P>0.05,差异无显著性。TBLB联合BB及BAL的诊断阳性率(78.84%)高于PCNA的诊断阳性率(64.44%),P<0.05。上述4种方法所检出各种疾病构成比χ2=3.806(自由度为9),P>0.05,差异无显著性。结论TBLB、BB、BAL与PCNA对肺部外周病变具有同样高的诊断价值,TBLB术后常规进行BB或BAL检查可提高诊断阳性率。

[Objective] To estimate the diagnostic value of transbronchial lung biopsy（TBLB） under digital subtraction angiography（DSA） in peripheral lung lesions. [Methods] 52 patients with peripheral lung lesions were performed TBLB under DSA, and then performed brochial brushing（BB） and bronchoalveolar lavage（BAL）, the positive diagnostic rates of [hree methods were compared respectively. Then three positive diagnostic rates were compared with that of 45 patients with peripheral lung lesions performed by Pereutaneous needle aspiration biopsy （PCNA） guided by chest CT. [Results] The positive diagnostic rate of TBLB, BB and BAL was 61.53%, 57.69% and 63.46% respectively, the answer of X^2 is 0.29, 0.07 and 0.53 respectively, all P 〉0.05, have no significant difference among them. The positive diagnostic rate of these three methods and PCNA （64.44%） have no remarkable difference, the answer of X^2 is 0.01, 0.22 and 0.01, all P 〉0.05. If TBLB was combined with BB and BAL, the positive diagnostie rote （78.84%） would higher than that of PCNA. The constituent ratio of category of lesions have no prominent difference, the answer of X^2 is 3.806, P 〉0.05. [Coneluslons] TBLB, BB, BAL and PCNA have the same important diagnostic value in peripheral lung lesions. We should perform BB and BAL after TBLB routinely to elevate the diagnostic value.