肺周围型病变虚拟支气管镜导航诊疗应用价值

Application of virtual bronchoscopic navigation in the peripheral pulmonary lesions

目的目前确诊肺周围型病变(peripheral pulmonary lesions,PPLs)的方法多样,虚拟支气管镜导航(virtual bronchoscopic navigation,VBN)作为一种新型技术,可与已有支气管镜技术结合,提高诊断准确性,减少并发症。本研究对VBN在PPLs中的应用进行概述。方法应用PubMed及CNKI期刊全文检索系统,以"虚拟支气管镜导航、肺周围型病变、诊断、治疗"和"virtual bronchoscopic navigation、peripheral pulmonary lesions、diagnosis、treatment"等为检索词,检索2013-01-2017-12的相关文献,共检索到中文文献21篇,英文文献30篇。纳入标准:(1)VBN简介;(2)VBN软件;(3)VBN在PPLs诊断、治疗中的应用;(4)VBN的不足。根据纳入标准分析文献33篇。结果 VBN是利用胸部薄层CT设定到达PPLS的规划路径,引导支气管镜对PPLs进行精确诊断和治疗的导航技术,有Directpath、LungPoint、LungPoint阿基米德、电磁导航等系统导航软件。VBN可联合超细支气管镜、带鞘超声支气管镜、X射线及CT等提高PPLs诊断率,同时很少发生严重并发症,可辅助应用于术前定位、活瓣、支架放置及微创治疗。结论 VBN在PPLs诊断和治疗中有良好的应用价值。

OBJECTIVE There are many methods to diagnose the peripheral pulmonary lesions(PPLs).As a new technology,virtual bronchoscopic navigation(VBN)combined with the bronchoscopy technology could increase the accuracy of diagnosis and decrease the complication.This study reviewed the application of VBN in the PPLs.METHODS Articles were found in PubMed and CNKI from January 2013 to December 2017 with "virtual bronchoscopic navigation,peripheral pulmonary lesions,diagnosis,treatment"as key words.In all,21 Chinese papers and 30 English papers were searched.Choice criteria:(1)VBN brief introduction;(2)VBN software;(3)the application of VBN in the diagnosis and treatment of PPLs;(4)VBN insufficiency.According to the criteria,33 papers were analyzed and reviewed.RESULTS VBNis a technique which guided the bronchoscope to the PPLs to diagnose and treat precisely using bronchoscopic images along the bronchial route,which had Directpath,LungPoint,LungPoint archimedes and electromagnetic navigation system software.The combination of VBN with ultrathin brochoscopy(UTB),endobronchial ultrasound with a guide sheath(EBUS-GS),X-ray fluoroscopy and CT as well as other equipments can improve the diagnosis rate of PPLs.VBN also had less severe complications,which can be applied in the preoperative localization,valve,stent placement and minimally invasive treatment.CONCLUSION VBN had a good application value in the diagnosis and treatment of PPLs.