周边型肺部病变的内镜诊断

Endoscopic diagnosis in peripheral pulmonary lesions

周边型肺部病变是临床上常见的疾病,支气管肺癌、肺转移瘤、肺结核等多种疾病均可表现为相似的影像学表现。周边型肺部病变常规支气管镜难以探及,对于距离胸壁较远或周围有大血管等重要脏器的病灶经皮穿刺也难以实施。合理利用细(或超细)支气管镜、经支气管镜肺活检、径向气道内超声引导肺活检术、支气管肺泡灌洗以及支气管镜导航等新技术可以提高周边型肺部病变的确诊率,便于指导临床早期治疗,以期获得较好的预后。

Peripheral pulmonary lesions（PPL）is very common in clinical work,and the diagnosis of PPL is a challenging task for pulmonologists.PPL includes a variety of diseases with similar X-ray findings,such as bronchial lung cancer,lung metastases,tuberculosis and so on.Diagnostic yield of routine bronchoscopy in PPL is very low,and CT guided percutaneous cutting needle lung biopsy may result in more complications in the lesions far from the chest wall.Multiple approaches may be undertaken to establish a tissue diagnosis,including thin（or）ultra-thin bronchoscopy,transbronchial lung biopsy,endobronchial ultrasound transbronchial lung biopsy with guide-sheath,bronchoalveolar lavage and bronchoscopic navigation system.A suitable method or combination of two methods matter much to improve the diagnostic the accuracy of PPL.