气道内超声-引导鞘管技术在诊断肺周围型病变中的应用研究

Application of endobronchial ultrasound-guide sheath in diagnosis of peripheral pulmonary lesions

目的:评估气道内超声(EBUS)-引导鞘管(GS)技术引导经支气管镜肺活检(TBLB)对肺周围型病变的诊断价值。方法:回顾性分析2011年12月1日至2017年4月1日于广东省人民医院行支气管镜检查的66例患者,均行胸部CT检查确诊为肺周围型病变且支气管镜检查未能发现病灶。本研究分2组,EBUS-GS组31例,常规TBLB组35例。EBUS-GS组患者经支气管镜活检通道插入EBUS-GS并伸向肺周围型病变,通过GS对肺周围型病变活检;对无法采获EBUS图像的肺周围型病变,按胸部CT提示的位置插入活检钳给予活检。常规TBLB组根据胸部CT的定位直接对病灶进行活检。结果:EBUS-GS组诊断阳性率为67.7%(21/31),常规TBLB组为37.1%(13/35),EBUS-GS组具有更高的诊断阳性率( χ^2=6.163, P<0.05)。为了得到足够的组织标本,EBUS-GS组平均每例患者行活检4.58次,常规TBLB组平均每例患者行活检7.89次。和常规TBLB组相比,EBUS-GS组需施行的活检次数更少( t=-5.443, P<0.05)。 结论:EBUS-GS引导TBLB可较常规TBLB提高诊断的阳性率,且不增加操作风险;为了得到足够的组织标本,EBUS-GS组需施行的活检次数更少。

Objective To evaluate the role of endobronchial ultrasonography(EBUS)-guide sheath(GS)assisted transbronchial lung biopsy(TBLB)in the diagnosis of peripheral pulmonary lesions.Methods 66 patients with peripheral pulmonary lesions in Guangdong General Hospital from December 1st,2011 to April 1st,2017 were recruited in this study.All cases were diagnosed with peripheral pulmonary lesions by computed tomography(CT)and no lesions were detected by bronchoscopy examinations.Patients were divided into two groups:EBUS-GS assisted TBLB group(31 patients)and routine TBLB group(35 patients).In the EBUS-GS group,when the EBUS image was obtained,the probe was withdrawn and the GS was left in place.TBLB was performed via the GS.In those left cases without accessible EBUS images,blind biopsy was performed based on the localization by CT data.The routine group without any EBUS examination underwent blind biopsy on the localization by CT data.Results The diagnostic positive rate of the EBUS-GS group was 67.7%(21/31),that of the routine TBLB group was 37.1%(13/35).The diagnostic positive rate of the EBUS-GS group was higher than that of the routine TBLB group(χ^2=6.163,P<0.05).In the EBUS-GS assisted TBLB group,142 times of biopsy process were performed,with an average of 4.58 times per case,whereas the routine TBLB group required 276 times,with an average of 7.89 times per case.Compared with the routine TBLB group,EBUS-GS assisted TBLB decreased the times of biopsy to acquire adequate specimen(t=-5.443,P<0.05).Conclusions Compared with routine TBLB,EBUS-GS assisted TBLB can improve diagnostic positive rate without increasing operational risk.EBUS-GS assisted TBLB can decrease the times of blind biopsy process to obtain adequate specimen.