锥形束CT平台下综合导引技术诊断肺部结节的临床应用初探

Clinical application of cone beam CT guided technique in diagnosis of pulmonary nodules

目的探讨在肺部结节的诊断中,锥形束CT(cone beam computed tomography,CBCT)平台下,联合虚拟支气管镜导航(virtual bronchoscopic navigation,VBN),配合高频叠加喷射呼吸机进行呼吸控制等综合导引技术在肺外周结节活检术的临床应用。方法回顾性分析3例上海长海医院收治的CBCT联合VBN、高频叠加喷射呼吸控制下肺外周结节活检术诊断的肺部结节患者的临床资料。结果共纳入3例患者临床资料,肺部结节直径平均为(25.3±0.3)mm。第1例患者肺结节位于左上叶尖段,活检结果为良性组织,未见恶性细胞,随访5年,病灶未见增大;第2例患者肺结节位于左舌叶,术后明确病理为黏膜相关淋巴瘤;第3例患者肺结节位于右上叶前段,经支气管路径失败后,改行CBCT联合VBN经皮肺穿刺活检术,明确病理为原发性腺癌,术后出现气胸,右侧肺压缩约20%。结论CBCT可运用于肺外周结节活检诊断,联合VBN及高频叠加喷射呼吸控制有可能提高诊断的准确率及安全性,临床广泛开展尚需多中心临床试验来进一步验证。

Objective To explore the clinical application of the comprehensive guidance technologies,such as cone beam computed tomography(CBCT),virtual bronchoscopic navigation(VBN),and superimposed high-frequency jet ventilator for respiratory control in the biopsy of peripheral pulmonary nodules(PPNs).Methods The clinical information of 3 patients with PPNs diagnosed by CBCT combined with VBN and superimposed high frequency superposition jet ventilator in Shanghai Changhai Hospital were retrospectively analyzed.Results Clinical data of 3patients were collected.The average diameter of PPNs was(25.3±0.3)mm with various locations in left and right lung.The first nodule was located in the apex of the left upper lung,and the biopsy was benign without malignant cells.The lesion was not enlarged during the 5-year follow-up.The second one was located in the left lingual lung,and the postoperative pathology was confirmed as mucosa-associated lymphoma.The third one was located in the anterior segment of the right upper lung.After the failure of endobronchial procedure,percutaneous PPNs biopsy under CBCT combined with VBN was performed,and the pathological diagnosis was confirmed as primary lung adenocarcinoma.Postoperative pneumothorax complication occurred in the third patient with right lung compression rate approximately20%.Conclusions The application of CBCT,combined with VBN and the superimposed high frequency jet ventilator for respiratory control can potentially improve the accuracy and safety in the diagnosis of PPNs.Multi-center clinical trials are needed to verify its further clinical application.