引导鞘管在径向超声引导肺外周病灶诊断中的价值

Diagnostic value of radial endobronchial ultrasound guide sheath transbronchial lung biospy in peripheral pulmonary lesions

目的评价引导鞘管(guide sheath,GS)在非X线下支气管内径向超声引导经支气管肺活检(EBUS-TBLB)中对肺外周病灶的诊断价值。方法回顾性分析2012年7月至2015年6月在北京大学第一医院行胸部CT检查发现肺外周病灶,并在支气管内径向超声引导下行经支气管肺活检的患者。根据活检操作,将患者分为GS组、非GS组、双活检组,对比分析三组的诊断率情况。结果入选118例患者,共126个肺外周病灶,总诊断率为60.3%(76/126)。GS组、非GS组、双活检组诊断率分别为65.4%(36/55)、61.5%(8/13)、59.6%(31/52),差异均无统计学意义(χ~2=0.394,P=0.821)。GS组、非GS组、双活检组在病灶≤20 mm诊断率分别为66.7%(18/27)、0.0%(0/3)、78.6%(11/14),非GS组诊断率明显低于其他二组,差异有统计学意义(χ~2=6.8,P=0.033);病灶>20 mm诊断率分别为64.3%(18/28)、80.0%(8/10)、54.1%(20/37),三组间差异无统计学意义(χ~2=2.301,P=0.301)。结论 EBUS-TBLB中使用GS在≤20 mm的肺外周病灶中能明显提高诊断率,>20 mm的病灶中不能提高诊断率,GS活检后更换普通活检钳重复活检不能进一步提高诊断率。

Objective To evaluate the role of guide sheath （GS） utilization in radial endobronchial ultrasound guided transbronchial lung biopsy （EBUS-TBLB） for diagnosis of peripheral pulmonary lesions （PPLs）. Methods The clinical data of patients who underwent EBUS-TBLB in Peking University First Hospital from July 2012 to June 2015 were retrospectively reviewed. The patients were divided into three groups, ie. a GS group, a non-GS group, and a double biopsy group. Results A total of 118 patients with t26 PPLs were collected. The overall diagnostic yield of EBUS-guided bronchoscopy was 60.3%. The diagnostic yield of GS group, non-GS group and double biopsy group was 65.4%（36/55）, 61.5%（8/13）, 59.6%（31/52）, respectively. The diagnostic yield of the non-GS group was significantly lower than other two groups when PPLs≤20 mm （X2=6.8, P=0.033）, whereas no significant difference was observed when PPLs〉20 mm （X2=2.301, P=0.301）. Conclusion GS significantly improves diagnostic yield in EBUS-TBLB when PPLs≤20 mm.