支气管超声下经引导鞘管肺活检术对肺外周病变的诊断价值

Value of transbronchial lung biopsy using endobronchial ultrasonography with a guide sheath to the diagnosis of peripheral pulmonary lesion

目的探讨支气管超声下经引导鞘管肺活检术(endobronchial ultrasound transbronchial lung biopsy with guidesheath,EBUS-GS-TBLB)在肺外周病变(peripheral pulmonary lesion,PPL)诊断中的价值。方法回顾性分析30例行EBUS-GS-TBLB检查PPL患者的临床资料,与组织病理检查及临床诊断结果进行对照,计算EBUS-GS-TBLB诊断符合率,并比较不同直径病灶、不同病灶与超声探头位置关系者诊断率。结果组织病理检查证实30例中恶性病变22例,良性病变8例;患者均完成EBUS-GS-TBLB检查,检查时间(20±10)min,每例患者PPL取得活检标本(4.3±0.7)个,均未发生气胸、大咯血等并发症;EBUS-GS-TBLB诊断PPL的符合率为66.7%(20/30),其中恶性病变为77.3%(17/22),良性病变为37.5%(3/8);直径>20mm病灶诊断率(83.3%)高于直径≤20mm病灶(41.7%)(P<0.05);操作中病灶完全包绕探头者诊断率(87.5%)明显高于病灶边缘临近探头者(42.9%)(P<0.05)。结论 EBUS-GS-TBLB是诊断PPL的一种安全、有效的方法,病灶直径及超声下病灶位置与探头关系可影响诊断结果。

Objective To evaluate the value of transbronchial lung biopsy （TBLB） using endobronchial ultrasound （EBUS） with a guide sheath （GS） （EBUS-GS-TBLB） to the diagnosis of peripheral pulmonary lesion （PPL）. Methods The clinical data of 30 patients undergoing EBUS-GS-TBLB for PPL were retrospectively analyzed and compared with the histopathological results and clinical follow-up. The diagnostic coincidence rate of EBUS-GS-TBLB was calculated and compared between lesions in different diameters, and the distance between lesion location and acoustic probe position. Results The histopathologic results confirmed malignant diseases in 22 patients and benign diseases in 8 patients. All patients accomplished EBUS-GS-TBLB procedures, with the mean lasting time of （20±10） min. The average number of biopsy specimens from every PPL patient was 4. 3± 0. 7. No pneumothorax or massive haemoptysis occurred. The coincidence of EBUS-GS-TBLB for PPL was 66.7% （20/30）, with the malignant rate of 77.3% （17/22） and benign rate of 37.5% （3/8）. The diagnostic rate for PPL lesion 〉20 mm in diameter （83.3%） was significantly higher than that for those 420 mm in diameter （41.7%） （P〈0.05）. The diagnostic rate was 87.5% for those with EBUS probe surrounded by the lesions, significantly higher than that for those with EBUS probe nearby the lesions （42. 9%） （P〈0.05）. Conclusion EBUS-GS-TBLB is effective and safe for diagnosing PPL. The diameter of lesion and the distance between EBUS probe position and the lesions influence the diagnostic result.