支气管内超声结合引导鞘联合针吸术对肺外周结节的诊断价值

Transbronchial needle aspirationcombined with endobronchial ultrasonography using a guide sheath in diagnosis of peripheral pulmonary lesions

目的评价支气管内超声结合引导鞘联合针吸术(EBUS-GS-TBNA)对肺外周结节(PPLs)的诊断价值。方法选取采用支气管内超声结合引导鞘(EBUS-GS)检查的PPLs患者142例,根据是否联合TBNA,将患者分为TBNA联合组(针吸+活检+毛刷)70例和非TBNA联合组(活检+毛刷)72例。依据探头和病灶相对位置,将两组患者分为探头位于病灶内部、探头位于邻近病灶和探头位于病灶外部3个亚组;按照病灶大小,将两组患者分为病灶大小8~20mm、病灶大小>20~30mm两个亚组。比较各亚组患者EBUS-GS病理学标本的诊断结果及两组并发症发生情况。结果TBNA联合组患者中病理学明确诊断56例,诊断率为80.0%;非TBNA联合组患者中病理学明确诊断44例,诊断率为61.1%,两组比较差异有统计学意义(P=0.014)。TBNA联合组和非TBNA联合组探头位于邻近病灶亚组的诊断率分别为83.9%和55.2%,两组比较差异有统计学意义(P=0.015);探头位于病灶外部亚组的诊断率分别为72.8%和30.8%,差异有统计学意义(P=0.049)。在TBNA联合组中,病灶大小8~20mm亚组的诊断率低于病灶大小>20~30mm亚组的诊断率,差异有统计学意义(P=0.020);在非TBNA联合组中,病灶大小8~20mm亚组的诊断率低于病灶大小>20~30mm亚组的诊断率,差异有统计学意义(P=0.004)。TBNA联合组中3例并发少量出血,非TBNA联合组中2例并发少量出血。结论EBUS-GS-TBNA能有效提高PPLs的诊断率,且并发症少,较为安全。

Objective To evaluate the application of transbronchial needle aspiration with endobronchial ultrasonography using a guide sheath(EBUS-GS-TBNA)in diagnosis of peripheral pulmonary lesions(PPLs).Methods One hundred and forty-two patients with peripheral pulmonary lesions undergoing EBUS-GS examination were divided into TBNA group(needle aspiration+biopsy+brush,n=70)and non-TBNA group(biopsy+brush,n=72).According to the relative position of the probe and the lesion,the patients in the two groups were divided into three subgroups:the probe was located in the interior of the lesion,the probe was located in the adjacent focus and the probe was located in the outside of the lesion;meanwhile,they were divided into 8~20 mm pulmonary lesion and>20~30 mm pulmonary lesion subgroupaccording to thediameter of lesions.The images of EBUS-GS probe position were evaluated,histopathological diagnosis was made and the complications observed.Results In the non-TBNA group,44 cases were diagnosed by combination of cytological and histological specimens(61.1%),2 cases were complicated with mild bleeding.In the TBNA group,56 cases were diagnosed by combination of cytological and histological specimens(80.0%),which was higher than that in non-TBNA group(P=0.014),3 cases complicated with mild bleeding.The diagnostic rate of subgroup where the probe was seen"near"the lesions was 83.9%and 55.2%respectively,the diagnostic rate of subgroup where the probe was seen"outside"the lesions was 72.8%and 30.8%respectively,the difference was statistically significant(P=0.015 and 0.049).The diagnostic rate of>20~30 mm pulmonary lesion subgroup was significantly higher than that of 8~20 mm pulmonary lesion subgroup in TBNA group and non-TBNA group,respectively(P=0.020 and 0.004).Conclusion EBUS-GS-TBNA can improve the diagnostic rate of PPLs with mild complications and high safety.