支气管内超声结合引导鞘对肺磨玻璃密度影的诊断价值

Diagnostic value of endobronchial ultrasonography with a guide sheath for peripheral pulmonary ground glass opacity

目的 探讨支气管内超声结合引导鞘（EBUS-GS）技术对肺磨玻璃密度影（GGO）的诊断价值.方法 回顾性分析2014年11月至2015年12月中国医学科学院肿瘤医院采用EBUS-GS技术进行诊断的27例患者27个GGO的临床资料,其中男9例,女18例,年龄为（59 ±11）岁.病变长径为（2.9±1.2）cm,27例病变中混合磨玻璃密度影（mGGO） 24例,纯磨玻璃密度影（pGGO）病变3例.回顾GGO的超声图像特征,统计EBUS-GS细胞学标本的诊断结果、病理诊断结果、病理联合细胞学诊断结果以及并发症的发生情况.结果 27例病变细支气管镜下除2例支气管狭窄,1例支气管狭窄伴黏膜肿胀外,其余24例患者细支气管镜下均未见异常.27例患者中25例EBUS找到了GGO,包括22例mGGO和3例pGGO.22例mGGO中18例EBUS图像为“混合暴风雪征”,3例为弥漫性不均匀回声影,1例为“暴风雪征”.3例pGGO的EBUS图像均为“暴风雪征”.26例取得了EBUS-GS细胞学标本,其中16例明确诊断;27例均获得病理组织标本,其中18例明确诊断.EBUS-GS病理联合细胞学共诊断19例.27例中有1例发生并发症,为少量出血,经保守治疗后出血停止.结论 EBUS-GS技术对GGO具有较高的诊断价值,并发症少,较为安全.GGO超声图像可表现为“混合暴风雪征”“暴风雪征”或弥漫性不均匀回声影.

Objective To explore the diagnostic value of endobronchial ultrasonography with a guide sheath （EBUS-GS） for peripheral pulmonary ground glass opacity （GGO）.Methods The clinical data of 27 consecutive patients with 27 GGOs diagnosed by EBUS-GS between November 2014 to December 2015 in our Cancer Hospital were retrospectively analyzed.The average age of these 27 patients,including 9 males and 18 females,was 59 ± 11 years.The median lesion size of the 27 GGOs was 2.9 ± 1.2 cm,including 24 mixed GGOs and 3 pure GGOs.EBUS images of all 27 GGOs were evaluated,cytological,histological and combination diagnosis analyzed,and complications observed.Results Under thin bronchoscope,2 out of 27 cases showed bronchial stenosis,1 showed bronchial stenosis with mucosal swelling,and the other 24 did not show abnormalities.Twenty-five out of 27 GGOs were found by EBUS,including 22 cases of mGGO and 3 of pGGO.In these ultrasonic images of 22 mGGOs,18 showed mixed blizzard sign,3 showed diffusely heterogeneous acoustic shadow and l showed blizzard sign.Ultrasonic images of 3 pGGOs all appeared as blizzard sign.Twenty-six cytological specimens were obtained,and 16 were diagnosed clearly.All 27 histological specimens were collected,and 18 were diagnosed clearly.Nineteen of 27 cases were diagnosed by combination of cytological and histological specimens.One complication of EBUS-GS with mild bleeding was observed,and hemorrhage was terminated by conservative treatment.Conclusions EBUS-GS is valuable for GGO diagnosis with less complications and higher safety.GGO ultrasonic image manifested as mixed blizzard sign,blizzard sign or diffusely heterogeneous acoustic shadow.