经纤维支气管镜行气道内超声检查的临床应用

Clinical application of endobronchial ultrasound examination through fiberoptic bronchoscope

目的 初步探讨气道内超声检查的临床应用价值。方法 对 15例X线胸片或CT发现肺部占位性病变或怀疑阻塞性肺炎、肺不张患者采用微探头通过纤支镜的工作通道做气道内超声检查。在气道轴的垂直平面得到一个 3 60°环形超声图象。结果 支气管壁回声增强并分层。肺实质呈致密斑点状强回声。血管影为搏动性的无回声影 ,内见漂浮点状回声。 10例患者超声扫描显示肿瘤破坏管壁 ,病理诊断均为恶性肿瘤 ;1例右肺尖段结节患者超声扫描见管壁完整 ,手术证实为结核。 1例右侧胸积液并肺不张患者纤支镜下见右下叶支气管通畅 ,用超声微探头探查远端支气管未见异常回声 ,提示肺不张为胸水压迫所致 ,排除阻塞性因素。 3例疑阻塞性肺炎患者 ,1例超声扫描见腔外肿大淋巴结压迫致管腔轻度狭窄 ,但管壁完整 ,余 2例未见肿瘤样回声 ,管壁完整 ,排除阻塞性因素。气道内超声检查仅少数患者有轻度不适 ,无明显并发症。结论 气道内超声能清晰显示气道壁和腔外的结构 。

Objective To evaluate the clinical value of endobrochial ultrasound (EBUS) examination,a new ultrasound technique.Method 15 patients with space occupying lesions in lung or doubted obstructive pneumonia or atelectasis were examined by EBUS.The procedure was performed with ultrasound catheters,which were introduced into bronchi through the operating channel of fiberoptic bronchoscope and a full 360℃ cross-sectional image was obtained.Result The bronchial wall was highly echogenic and laminated.The lung parenchyma appeared echo rich and patchy.Pulmonary vessels can be identified by the echo free lumen and the pulsatile changes.Echo poor bronchial carcinomas proved in pathology destructed bronchial wall in different extent were detected in 10 patients.1 patient with nodule in right apical segment who had intact bronchial wall was with tuberculosis proved by operation.1 patient with pleural effusion and atelectasis was detected by EBUS and found no abnormal echo,showing that the reason for atelectasis was compression instead of obstruction.Among the 3 patients who were suspected to have obstructive pneumonia,in 1 case ultrasound scanning showed enlarged lymph node outside the bronchus compressing the wall caused the channel mild narrow;as to the other 2 cases,because bronchial wall was complete and no tumor like echo were found,the obstructive factor was excluded.The ultrasound examination had no particular risk and caused little discomfort.Conclusion Endobronchial ultrasound scan can clearly demonstrate the adjacent extraluminal lesion or structure within the brochial wall itself,which is safe and effective.