超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值

Significance of fibreoptic bronchoscopy combined with percutaneous pneumocentesis in the diagnosis of peripheral pulmonary diseases

目的评价超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值。方法269例肺外周病变患者均先进行超细支气管镜活检并刷检术,对无阳性结果,且病灶位于肺门、内带或中带的89例患者进行X线引导超细支气管镜肺活检并刷检术;对病灶位于中、外带的77例患者,经X线引导进行经皮肺穿刺针吸活检术;对于超细病灶紧贴胸壁的70例患者经B超引导进行经皮肺自动弹性穿刺切割活检术。结果269例患者行超细支气管镜肺活检并刷检共276例次,获得诊断者82例,阳性率为30.5%(82/269);89例患者行X线引导超细支气管镜肺活检并刷检94例次,获得诊断者66例,阳性率为74.2%(66/89);77例患者行X线引导经皮肺针吸活检85例次,获得诊断者52例,阳性率为67.5%(52/77);70例患者行B超引导经皮肺自动弹性穿刺切割术79例次,获得诊断者49例,阳性率为70.0%(49/70)。4种方法结合后的诊断率(92.6%)明显提高。结论综合超细支气管镜检查结合经皮肺穿等介入诊断技术,可明显提高肺外周病变的阳性率,值得临床推广应用。

Objective To evaluate the significance of fibreoptic bronchoscopy combined with percutaneous pneumocentesis in the diagnosis of peripheral pulmonary lesions.Methods 269 patients with peripheral pulmonary diseases were diagnosed with fibreoptic bronchoscopy biopsy combined with bronchial brush biopsy.In 89 out of the 269 patients no positive findings were obtained,because the lesions were located in the lung hilum,medial sphere or mesosphere,when X-ray guided fibreoptic bronchoscopy biopsy combined with bronchial brush biopsy were employed.In 77 out of the 89 patients positive fingings were still lacking,as their lesions were located in the mesosphere or peripheralzone,when X-ray guided percutaneous pneumocentesis biopsy was used.In 70 out of the 77 patients,positive fingings were lacking,as their lesions were just beneath the chest wall,when B-ultrasonography guided percutaneous automatic elastic biopsy was employed.Results 276 times of fibreoptic bronchoscopy biopsy combined with bronchial brush biopsy were performed in 269 patients,final diagnosis was obtained in 82 of them,with a diagnostic rate of 30.5%;94 times of X-ray guided fibreoptic bronchoscopy biopsy combined with bronchial brush biopsy were performed in 89 patients,and final diagnosis was obtained in 66 patients,with a diagnostic rate of 74.2%;85 times of X-ray guided percutaneous pneumocentesis biopsy were performed in 77 patients,final diagnosis was obtained in 52,with a diagnostic rate of 67.5%;79 times of B-ultrasonography guided percutaneous automatic elastic biopsy were performed in 70 patients,final diagnosis was obtained in 49,with a diagnostic rate of 70.0%.A final diagnosis was made in a total of 249 patients,with a diagnostic rate of 92.6% when 4 methods were used in combination.Conclusion Combined use of fibreoptic bronchoscopy with percutaneous pneumocentesis biopsy may remarkably raise the diagnostic rate in the patients with peripheral pulmonary diseases,and is worth to be recommended for general use in clinical work.