电磁导航支气管镜实时引导肺活检对肺外周微小病变的诊断价值

Electromagnetic navigation bronchoscopy real-time guidance lung biopsy for the diagnosis of small peripheral pulmonary lesions

目的 评价电磁导航支气管镜实时引导定位下肺活检（ENB guide TBLB）对肺外周小病灶（直径＜3 cm）的诊断价值及其安全性.方法 对广州医科大学附属第一医院2011年9月1日至2012年5月30日收治的胸部螺旋CT显示为孤立性肺外周微小病变（直径＜3 cm）的患者进行电磁导航支气管镜实时引导定位下肺活检,同时以床旁X线定位肺活检作为对照,比较两种方法活检病理结果与最后诊断的符合程度,最后诊断通过外科手术切除病灶行病理检查或随诊12个月至临床治愈确诊.记录术中及术后的相关并发症以评价其安全性.结果 17例患者共20个肺外周微小病灶进行电磁导航实时引导下完成活检,其中男11例,女6例,平均年龄（53±14）岁,病灶平均直径为（1.8 ±0.7）cm;其中11例患者行手术治疗,6例患者经内科治疗并随诊超过12个月均达到临床治愈.肺活检组织病理结果与最后诊断符合率：电磁导航组为80.0％ （16/20）,X线透视组为45.0％（9/20）,两组确诊率差异有统计学意义（x2=5.227,P=0.048）.亚组分析：病灶直径为2～3 cm时两组确诊率差异无统计学意义（x2 =0.000,P=1.000）;病灶直径＜2 cm时,两组确诊率差异有统计学意义（x2=8.224,P=0.012）.使用ENB方法时,病灶直径为2～3 cm与＜2 cm时确诊率差异无统计学意义（x2=0.208,P=1.000）;导航计划图的胸部CT层厚为1 cm时确诊率高于层厚为2 cm时（x2 =6.111,P=0.026）;病灶具有“支气管征”时确诊率高于不具有“支气管征”（x2 =6.111,P=0.026）.结论 电磁导航支气管镜实时引导定位下对肺外周微小病灶行肺活检是安全的,并且具有较高的确诊率.

Objective To evaluate the diagnostic value and safety of electromagnetic navigation bronchoscopy real-time guidance lung biopsy （ENB-guided TBLB） of small peripheral lung lesions （diameter 〈 3 cm）.Methods Patients were selected by small peripheral pulmonary lesions （diameter 〈 3cm） on thoracic CT in our hospital between September 1,2011 and May 30,2012.ENB-guided TBLB was performed by flexible bronchoscope,while fluoroscopy-guided lung biopsy was performed as a control.Then the diagnostic yield of ENB-guided and fluoroscopy-guided lung biopsy was compared.The final diagnosis was confirmed by pathologic examination of surgically removed lesions or by 12 month follow-up until clinical cure being confirmed.The intraoperative and postoperative complications were recorded.Results Seventeen patients （11 males,6 females） with 20 small peripheral pulmonary lesions all underwent ENB-guided TBLB.The patients＇ average age was （53 ± 14） yrs,and the lesions＇ average diameter was （1.8 ± 0.7） cm.Eleven patients finally received surgical resection,while other 6 patients received medical treatment and follow-up for more than 12 months to achieve clinical cure.Pathologic results showed that the diagnostic yield of ENB group was 80.0% （16/20） and that of the fluoroscopy group was 45.0% （9/20）,the difference between the 2 groups being statistically significant （c2 =5.227,P =0.048）.Subgroup analysis showed that,if the lesion diameter was 2-3 cm,the diagnostic yield between the 2 groups had no statistical difference （x2 =0.000,P =1.000）,but if the lesion diameter was 〈 2 cm,the diagnostic yield of the 2 groups was statistically different （x2 =8.224,P =0.012）.In the ENB method,the diagnostic yield between the diameter of 2-3 cm group and the 〈 2 cm group had no statistical difference （x2 =0.208,P =1.000）.Analysis of the diagnostic yield of different navigation plan CT graph layer thickness showed that,the 1 cm group was higher than the 2 cm group （x2 =6.111,P =0.026）.The diagnostic yield of lesions with ＂air bronchogram＂ was higher than that of lesions without ＂air bronchogram＂ （x2 =6.111,P =0.026）.Conclusion Electromagnetic navigation bronchoscopy real-time guidance lung biopsy for small peripheral pulmonary lesions is safe,and has higher diagnostic rate.