经导向鞘引导的超声支气管镜技术对周围型肺癌的诊断价值

Diagnostic value of endobronchial ultrasonography with a guide sheath for peripheral lung cancer

目的探讨经导向鞘（G S）引导的支气管内超声检查（EBU S）进行经支气管肺活检（T BLB）和刷检诊断周围型肺癌的临床价值。方法导向鞘经支气管镜插入并靠近周围型肺占位,插入超声微探头,一旦获得典型影像,撤出探头并在原位保留套管,经导向鞘行细胞学及组织学检查。结果 104例患者中细胞学诊断恶性65例,组织学诊断恶性46例,细胞学的阳性率、敏感度及准确度分别为62.5%、81.6%及83.7%,组织学的阳性率、敏感度及准确度分别为45.2%、60.5%和71.2%,两者结合可提高诊断的阳性率、敏感度和准确度。诊断C T扫描最长直径≤3 cm、3-5 cm和〉5 cm周围型肺癌的敏感度分别为85%、90.6%和87.5%,组间差异无显著性（P〉0.05）。左上叶舌段病灶的诊断率（90.9%）显著高于其他部位（P〈0.05）。结论 EBU S-G S对周围型肺癌的诊断具有较高价值,细胞学和组织学结合可提高诊断率。

【Objective】To evaluate the feasibility and efficacy of transbronchial biopsy（TBLB） and bronchial brushing by endobronchial ultrasonography（EBUS） with a guide sheath（GS） for diagnosing peripheral pulmonary lesions. 【Methods】An EBUS-GS was inserted and advanced to the PPL. Once we obtained the EBUS image, the probe was withdrawn and the GS was left in place. TBB and/or bronchial brushing were performed via the GS.【Results】 Cytological diagnosis malignancy in 65 cases, histological diagnosis malignancy in 46 cases. The positive rates, sensitivities and accuracies of cytology and histology were 62.5%,81.6%,83.7% and 45.2%,60.5%,71.2%, respectively. The combining bronchial brushing and biopsy improved diagnostic sensitivity and accuracy. The PPLs located in the lingular segment had significantly higher diagnostic yields（P〈0.05）.【Conclusion】EBUS-GS is effective for diagnosing peripheral lung cancer.