虚拟导航辅助引导带有鞘导向的超声气管镜对不同直径肺周围结节的诊断价值

Value of virtual navigation assisted EBUS-GS in the diagnosis of peripheral pulmonary nodules with different diameters

目的研究虚拟支气管镜导航(VBN)辅助引导带有鞘导向的超声气管镜(EBUS-GS)对不同直径肺周围结节(PPLs)的诊断价值。方法选取本院行CT检查和病理学证实为PPLs病变患者124例,随机数法进行分组,排除无法镜检患者,实际纳入EBUS-GS组65例,EBUS-GS-VBN组52例,分析两组患者基本资料,比较两种方法对PPLs病变诊断率、操作时间、可视率和并发症。结果一般资料比较发现,EBUS-GS组和EBUS-GS-VBN组PPLs病变患者在年龄、性别、病变部位、结节大小、最后诊断结果方面差异无统计学意义(P>0.05);EBUS-GS组可视率、总诊断率分别为70.77%(46/65)和73.85%(48/65),总操作时间、确认病灶时间分别为(28.06±5.27)min和(9.27±1.08)min,EBUS-GS-VBN组可视率、总诊断率分别为84.62%(44/52)和78.85%(41/52),总操作时间、确认病灶时间分别为(26.51±4.75)min和(6.04±1.79)min,两组可视率、总诊断率、总操作时间相比,差异无统计学意义(χ^2=2.389,P=0.122;χ^2=0.170,P=0.680;χ^2=1.651,P=0.101),两组确认病灶时间相比差异有统计学意义(χ^2=11.954,P<0.001)。结节直径<10mm时,EBUS-GS组可视率、诊断率为41.18%(7/17)和35.29%(6/17),EBUS-GS-VBN组可视率、诊断率为85.71%(12/14)和85.71%(12/14),两组相比差异有统计学意义(χ^2=4.679,P=0.031;χ^2=6.079,P=0.014);两组并发症的发生率差异无统计学意义(P>0.05)。结论VBN辅助引导EBUS-GS能够缩短确认病灶时间和提高结节直径<10mm病变可视率和诊断率。

Objective To study the diagnostic value of virtual bronchoscopic navigation(VBN)assisted endobronchial ultrasonography with guide-sheath(EBUS-GS)in different diameter peripheral pulmonary nodules(PPLs).Methods A total of 124 patients with PPLs diagnosed by CT and pathology in our hospital were selected.They were randomly divided into two groups,and the patients who couldn't be examined by microscopy were excluded.There were 65 cases in the EBUS-GS group and 52 cases in the EBUS-GS-VBN group.The basic data of the two groups were analyzed,and the diagnostic rate,operation time,visual rate and complications of the two methods were compared.Results There was no significant difference in age,gender,lesion location,nodule size and final diagnosis result between the EBUS-GS group and the EBUS-GS-VBN group(P>0.05).The visual rate and total diagnostic rate of the EBUS-GS group were 70.77%(46/65)and 73.85%(48/65),respectively,and the total operation time and focus confirmation time were(28.06±5.27)min and(9.27±1.08)min respectively,the visual rate and total diagnostic rate of the EBUS-GS-VBN group were 84.62%(44/52)and 78.85%(41/52),respectively,and the total operation time and focus confirmation time were(26.51±4.75)min and(6.04±1.79)min respectively.There was no significant difference in visual rate,total diagnosis rate and total operation time between the two groups(χ^2=2.389,P=0.122;χ^2=0.170,P=0.680;χ^2=1.651,P=0.101),while there was significant difference in focus confirmation time between the two groups(χ^2=11.954,P 0.001).When the nodule diameter was<10 mm,the visual rate and diagnostic rate of the EBUS-GS group were 41.18%(7/17)and 35.29%(6/17),the visual rate and diagnostic rate of the EBUS-GS-VBN group were 85.71%(12/14)and 85.71%(12/14),and the difference between the two groups was statistically significant(χ^2=4.679,P=0.031;χ^2=6.079,P=0.014).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion VBN assisted EBUS-GS can shorten the focus confirmation time and improve the visual rate and diagnostic rate of lesions with nodule diameter<10 mm.