支气管内超声/磁导航定位下经引导鞘肺活检术诊断肺周围性病变的影响因素分析

Endobroncheal ultrasonography or electromagnetic navigation bronchoscopy-guided transbronchial lung biopsy in diagnosis of peripheral pulmonary lesions

目的评估在无X线透视情况下,利用支气管内超声检查(endobroncheal ultrasonography,EBUS)或磁导航(electromagnetic navigation bronchoscopy,ENB),通过引导套管(guide sheath,GS)进行经支气管肺活检(transbronchial lung biopsy,TBB)诊断肺周围型病变(peripheral pulmonary lesion,PPL)的可行性和有效性。方法97例患者共99个PPL病灶进行GS-TBB检查,对所有患者的病理结果、最终诊断及相关临床资料及行回顾性分析。其中50例患者通过ENB定位,49例患者通过EBUS定位。所有患者通过术后病理或随访1年明确最终诊断。结果与诊断良性疾病相比,GS-TBB对恶性疾病的诊断率更高[79.6%(43/54)vs 68.9%(31/45),P<0.001]。单因素分析中,PPL直径越大(P<0.01)、PPL位于肺内野(P=0.009)、探头与PPL病灶关系越紧密(包绕、靠近)(P<0.01)、通过ENB定位(P=0.039)都会提高GS-TBB诊断率。多因素分析中,PPL直径大小(OR=2.218,95%CI=1.254~3.925,P=0.006)、PPL内外肺野分布(OR=0.158,95%CI=0.037~0.681,P=0.013)、探头与病灶关系(OR=5.815,95%CI=1.722~19.634,P=0.005)、ENB定位(OR=3.904,95%CI=1.026~14.847,P=0.046)是GS-TBB准确性的独立预测指标。结论 EBUS或者ENB下GS-TBB均是可以不借助X线透视诊断PPL的有效方法,相对于EBUS,ENB定位下活检的准确性更高,另外PPL的直径、PPL的肺内外野位置以及探头与PPL的关系是GS-TBB提高诊断灵敏度的关键因素。

Objective To evalmte the feasibiUty,effectiveness and M u en c in g factors o f endobroncheal ultrasonography or electromagnetic navigation bronchoscopy-guided transbronchial lung biopsy through guide sheath （ EBUS-GS-TBB or ENB-GS-TBB） in diagnosis of peripheral pulmonary lesions （PPLs）. Methods Ninety seven patients with 99 PPLs underwent biopsy during January 2013 to January 2014, 50 PPLs were examined by ENB-GS-TBB and 49 PPLs were examined by EBUS-GS- TBB. The final diagnosis was confirmed after surgery or 1-year follow-up. R e su lts GS-TBB had higher diagnostic rate for malignant diseases than that for benign lesions [79. 6% （43/54） v s 68. 9% （31/45）,尸 〈 0？ 001 ] ？ Univariate analysis showed that longer diameter of PPL, closer position of probe, PPL distributed inside of the lung field, and localization with ENB were associated with accuracy of diagnosis. Multivariate analysis showed that the lesion size, the probe position, PPL distribution, and using ENB were the independent predictors of diagnosis rate of GS-TBB. Conclusion EBUS/ENB GS-TBB without X-ray are both effective in diagnosis of PPLs. Compared with EBUS, the diagnosis rate is higher in ENB-GS-TBB. The tumor size, probe position and PPL distribution are influencing factors for diagnosis rate of GS-TBB.