径向超声引导下钳夹肺活检与冷冻肺活检对外周型肺病变的诊断价值

The diagnostic value of clamp lung biopsy and lung cryobiopsy guided by radial ultrasound in peripheral pulmonary lesions

目的传统支气管镜肺活检对周围型肺病变诊断率较低。径向支气管内超声引导下冷冻肺活检研究较少。本研究旨在探讨经纤支镜支气管内超声引导下钳夹肺活检与冷冻肺活检相比对周围型肺病变的诊断价值和安全性。方法回顾性研究2018年12月—2019年12月蚌埠医学院第一附属医院收治的经支气管内超声引导下接受肺活检操作并最终明确诊断的55例患者,分为钳夹肺活检(transbronchial lung biopsy,TBLB)组29例和冷冻肺活检(transbronchial lung cryobiopsy,TBLC)组26例。比较2组操作对周围型肺病变的诊断率及并发症情况。结果经径向支气管镜内超声引导结合TBLC和TBLB诊断率分别为80.8%(21/26)和55.2%(16/29),TBLC组诊断率明显高于TBLB组,差异有统计学意义(χ^2=4.080,P=0.043)。本研究中,外周型肺病变大多数为恶性疾病,占56.4%,其中以腺癌最多见;良性疾病中,结核最常见,占良性疾病的62.5%。TBLC组和TBLC组各有2例出血并发症,均为少量出血,经支气管于活检部位给予注射冰盐水、肾上腺素或凝血酶止血处理后,出血可缓解;TBLC组气胸并发症2例,TBLB组6例,TBLB组气胸发生率高于TBLC组,且有2例患者需行胸腔闭式引流处理;2组并发症比较差异均无统计学意义(χ^2=0.165、0.964,均P>0.05)。2组均无死亡病例。结论经纤支镜支气管内超声引导下冷冻肺活检对外周型肺病变有较高的诊断率及安全性。

Objective To explore the diagnostic value and safety of clamp lung biopsy guided by intrabronchial ultra-sound under fiberbronchoscope compared with frozen lung biopsy in peripheral pulmonary lesions.Methods A retro-spective study was conducted on 55 patients,who received lung biopsy under the guidance of radial endobronchial ultra-sound in the First Affiliated Hospital of Bengbu Medical College from December 2018 to December 2019 and were finally diagnosed.Patients were divided into transbronchial lung biopsy(TBLB)group(n=29)and transbronchial lung cryobi-opsy(TBLC)group(n=26).The diagnostic rate and complications of peripheral pulmonary lesions were compared be-tween the two groups.Results The diagnostic rates of TBLC group(80.8%,21/26)were significantly higher than that of TBLB group(55.2%,16/29),χ^2=4.080,P=0.043.In this study,the majority of peripheral pulmonary lesions were malignant,accounting for 56.4%,among which adenocarcinoma was the most common.Among benign diseases,tuberculosis was the most common,accounting for 62.5%.Complications in the two groups:2 cases in both TBLC group and TBLC group suffered from hemorrhage,all of which were small amount of bleeding,which could be alleviated after bronchus hemostasis treatment with injection of ice saline,epinephrine or thrombin at the biopsy site.The incidence of pneumothorax in TBLB group(6 cases)was higher than that in TBLC group(2 cases),and 2 patients needed closed chest drainage,but there was no significant difference between the two groups(χ^2=0.964,0.165,all P>0.05).There were no deaths in both group.Conclusion Radial endobronchial ultrasound combined with lung cryobiopsy has a high diagnostic rate and safety for peripheral pulmonary lesions.