支气管镜径向超声、ROSE联合支气管镜下肺活检在肺外周病变诊断中的价值

The value of bronchoscopic radial ultrasound,ROSE combined with bronchoscopic lung biopsy in the diagnosis of peripheral lung lesions

目的探讨支气管镜径向超声、ROSE联合支气管镜下肺活检在肺外周病变诊断中的价值。方法收集2020年11月~2022年6月在本院确诊为肺外周病变且均需要进一步明确病变性质的患者63例。采用随机数字表法分组,将行REBUS-D-TBB+ROSE检查患者纳入实验组(n=32),将行REBUS-D-TBB检查患者纳入对照组(n=31)。结果同一病变直径,组间比较时实验组诊断率均高于对照组;不同病变直径进行组间比较,直径>2cm诊断率均高于≤2cm诊断率,差异均具有统计学意义(P<0.05)。同一病变性质,组间比较时实验组诊断率均高于对照组;不同病变性质进行组间比较,实性病变诊断率均高于非实性病变诊断率,差异均具有统计学意义(P<0.05)。32例患者的ROSE结果与病理检查结果诊断符合率为81.3%(26/32),Kappa值为0.611,ROSE诊断的灵敏度为84.62%(22/26)、特异度为66.67%(4/6)、阳性预测值为91.67%(22/24)、阴性预测值为50.00%(4/8)。两组均可耐受支气管镜操作,且均无严重并发症产生,术中活检后均未出现明显大出血,部分患者在活检后出现少量痰中带血,经予以止血药物处理后,咯血逐渐停止。影响REBUS-D-TBB在肺外周病变的诊断因素可能与病灶大小、超声探头与病灶关系及活检次数存在关系,差异均具有统计学意义(P<0.05)。结论REBUS-D-TBB+ROSE检查肺外周病变,可提高病变诊断率,安全性高、有效性高,具有-定应用价值。

Objective To investigate the value of bronchoscopic radial ultrasound,ROSE combined with bronchosoopic lung biopsy in the diagnos's of peripheral lung lesions Methods A total of 63 patients diagnosed with peripheral lung lesonsin our hopital from November 2020 to February 2022.6 were collected and the nature of the lesions needed to be further determined.Patients undergoing REBUS-D-TBB+ROSE examination were induded in the experimental group(n=32),and those undergoing REBUS-D-TBB examination were induded in the control group(n=31).Results For the same lesion diameter,the diagnostic rate of experimenta group washigher than that of control group.The diagnoss rate of lesons with diameter>2cm was higher than that with diameter ≤ 2cm,and the differenoes were statistically sgnificant(P<0.05).The diagnostic rate of the experimental group Was higher than that of the control group for the same lesion nature.The diagnossrate of solid lesons was higher than that of non-solid lesons and the differences were statistically sgnifcant(P<0.05).The coinddence rate between R0SE results and pathologcal examination resultsof 32 patients was 81.3%(26/32),and Kappa value was 0.611.The senstivity of ROSE diagnos's was 84.62%(22/26).specifldty 66.67%(4/6).postive predictive value 91.67%(22/24)and negative predictive value 50.00%(4/8).Both groups could tolerate bronchoscopy operation,and no srious complications oourred.No obvious masive bleeding oourred after Intraoperative biopsy.Some patients showed a smal amount of blood In sputum after biopsy,and hemoptys's gradually stopped after treatment with hemostatic drugs The factors afecting the diagnossof REBUS-D-TBB in peripheral pulmonary lesionsmay be related to the sze of the lesion,the relaionship between the ultrasonic probe and the leion,and the number of biopsy,with statistical signlficance(P<0.05).Conclusion REBUS-D-TBB+ROSE can improve the diagnos's rate of pulmonary peripheral lesions with high safety and effectiveness and has certain application value.