内科胸腔镜窄带成像技术联合冷冻活检对不明原因胸腔积液的诊断价值

Clinical value of thoracoscopic narrow band imaging combined with cryobiopsy in the diagnosis of unexplained pleural effusion

目的探讨内科胸腔镜窄带成像技术(NBI)联合胸膜冷冻活检对不明原因胸腔积液的诊断价值。方法选择113例不明原因胸腔积液患者,应用内科胸腔镜对胸膜病变进行检查,检查过程中,先通过内科胸腔镜白光观察胸膜表面情况,再切换至NBI模式对胸膜表面进行观察,分析不同病变在内科胸腔镜白光及NBI下的形态表现,并在白光及NBI下分别对胸膜表面怀疑病变的部位进行常规钳夹活检及冷冻活检,对比两组患者活检标本诊断准确率、敏感度、特异度及取材直径的情况,同时分析不同活检方式的安全性及并发症情况。结果NBI联合冷冻活检组的胸膜疾病诊断敏感度、特异度及准确率均高于白光联合冷冻活检组,两组比较,差异均具有统计学意义(P=0.047、P=0.024和P=0.015);NBI联合钳夹活检组的胸膜疾病诊断敏感度和准确率高于白光联合钳夹活检组,两组敏感度比较,差异有统计学意义(P=0.033),两组准确率比较,差异无统计学意义(P=0.079)。NBI联合钳夹活检组特异度明显低于白光联合钳夹活检组,差异有统计学意义(P=0.041)。通过NBI对胸膜表面血管情况进行分析,病变血管≥2根的冷冻活检灵敏度、特异度及准确率分别为97.56%、83.33%和95.74%,高于病变血管<2根的冷冻活检;对冷冻活检及钳夹活检组织直径进行对比,结果显示,两组直径分别为(27.16±4.33)和(1.87±0.10)mm,差异有统计学意义(t=-5.84,P=0.000);使用冷冻活检,无严重的不良反应发生。结论内科胸腔镜NBI联合胸膜冷冻活检,能够提高不明原因胸腔积液的敏感度、特异度及诊断率,且安全性高,值得临床推广应用。

Objective To evaluate the clinical value of narrow-band imaging(NBI)combined with pleural cryobiopsy in the diagnosis of unexplained pleural effusion.Methods 113 patients with unexplained pleural effusion were examined by medical thoracoscopy.During the examination,the pleural surface was observed by white light thoracoscopy,then the pleural surface was observed by NBI.The morphological manifestations of different lesions under white light thoracoscopy and NBI were analyzed.Routine clamp biopsy and cryobiopsy were performed on the suspected lesions on the pleural surface under white light and NBI,respectively.The diagnostic rate,sensitivity,specificity and lesion diameter of the two groups were compared,and the safety and complications of different biopsy methods were analyzed.Results The sensitivity,specificity and diagnostic rate of pleural diseases in NBI combined with cryobiopsy group were higher than those in white light combined with cryobiopsy group,and there were significant differences between the two groups.The diagnostic sensitivity and diagnostic rate of pleural diseases in NBI combined with clamp biopsy group were higher than those in white light combined with clamp biopsy group.There was significant difference in sensitivity between the two groups(P=0.033),but there was no significant difference in diagnostic rate between the two groups(P=0.079).The specificity of NBI combined with clamp biopsy group was significantly lower than that of white light combined with clamp biopsy group,and the difference was statistically significant(P=0.041).The abundance of blood vessels on the pleural surface was analyzed by NBI.The sensitivity,specificity and diagnostic rate of cryobiopsy with more than 2 diseased vessels were 97.56%,83.33%and 95.74%,respectively,which were higher than those with less than 2 diseased vessels.The diameters of clamp biopsies and cryobiopsies were compared.The results showed that the diameters of the two groups were(1.87±0.10)and(27.16±4.33)mm,respectively,and there was significant difference between the two groups(t=-5.84,P=0.000).Conclusion Medical thoracoscopic NBI combined with pleural cryobiopsy can improve the sensitivity,specificity and diagnostic rate of unexplained pleural effusion,and has high safety,it is worthy of clinical application.