虚拟导航联合支气管超声在肺外周结节诊断中的价值  

A study of the diagnostic value of endobronchial ultrasound guide sheath transbronchial lung biopsy combined with virtual bronchoscopic navigation in peripheral pulmonary lesions

作　　者：陈众博[1] 金燕平[1] 虞亦鸣[1] 朱丹萍[1] 马红映[1] 陈磊[1] 张筠[1] 丁群力[1] 邓在春[1] 

机构地区：[1]宁波大学医学院附属医院呼吸内科,315020

出　　处：《中华结核和呼吸杂志》2016年第7期509-513,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：宁波市社会科学发展基金（2012C50006,2015C50012）;浙江省医药卫生研究基金（2016KYB268）

摘　　要：目的：评价虚拟支气管镜导航（ VBN）联合支气管超声经引导鞘管肺活检术（ EBUS－GS－TBLB）在肺外周结节（ PPLs）诊断中的价值。方法对2014年11月至2015年8月于宁波大学医学院附属医院就诊发现的肺外周结节患者行非X线定位下的EBUS－GS－TBLB检查，使用随机数字表法将患者分为VBN联合EBUS－GS－TBLB组（导航－超声组）及EBUS－GS－TBLB组（超声组）中，观察两种检查方法的诊断敏感度及两组间检查时间的差异。结果共有184例患者最终完成了本项研究，其中男117例、女67例，导航－超声组93例，超声组91例。导航－超声组诊断敏感度为72.04％（67／93），在获得诊断的病例中，恶性肿瘤64.1％（43／67），良性疾病35.9％（24／67），检查时间为（45±10） min；超声组诊断敏感度为69.23％（63／91），其中恶性肿瘤52.4％（33／63），良性疾病47.6％（30／63），检查时间为（55±10）min。与超声组相比，两组诊断敏感度差异无统计学意义（χ^2＝0.175，P＝0.747），但两组检查时间差异有统计学意义（t＝6.522，P＜0.01）。两组患者均能耐受检查，无气胸、咯血等并发症。结论 VBN虽不能进一步提高EBUS－GS－TBLB诊断敏感度，但能引导操作者更快更准确地到达目标病灶所在支气管从而缩短了检查时间、减少患者的痛苦且无需使用X线定位，因此将VBN技术联合EBUS－GS－TBLB应用于诊断PPLs是高效而又安全的。Objective To evaluate the diagnostic value of endobronchial ultrasound guide sheath transbronchial lung biopsy （ EBUS-GS-TBLB ） combined with virtual bronchoscopic navigation （ VBN ） in peripheral pulmonary lesions （ PPLs） .Methods Cases with a PPL identified by computed tomography in Affiliated Hospital of Medical College of Ningbo University underwent EBUS-GS-TBLB with or without VBN randomly between Nov .2014 to Aug.2015.X-ray guidance was not performed in these cases .The sensitivity and the operation time were evaluated in the 2 groups.Results A total of 184 patients were enrolled and completed this study .Among them 117 were males and 67 were females .There were 93 cases in the group of EBUS-GS-TBLB with VBN, and 91 in the group without VBN .The diagnostic sensitivity of VBN group was 72.04%（ 67/93 ） .Among these positive cases , 64.1% cases （ 43/67 ） were malignant tumors, and 35.9%cases （24/67） were benign lesions.The mean operation time was （45 ±10）min.In the group without VBN , the diagnostic sensitivity was 69.23%（ 63/91 ） , including 33 malignant tumors （52.4%,33/63）, and 30 benign lesions（47.6%,30/63）.The mean operation time was （55 ±10）min. There was no significant difference between EBUS-GS-TBLB with VBN group and EBUS-GS-TBLB without VBN group in diagnostic sensitivity （χ^2 =0.175,P=0.747）.But there was a significant difference in the mean operation time between the 2 groups （t=6.522,P〈0.001）.EBUS-GS-TBLB was well tolerated.No severe procedure-related complications such as pneumothorax and hemoptysis were observed .Conclusion VBN cannot improve the diagnostic sensitivity , but it can clear the location of lesion , and shorten the＆amp;nbsp;operation time.This technique helps to abandon the X-ray guidance.EBUS-GS-TBLB combined with VBN is a safe and effective technique for PPLs .

关 键 词：支气管镜 外科手术 计算机辅助 超声检查 导向鞘管 肺外周结节 

分 类 号：R655[医药卫生—外科学] R445.1[医药卫生—临床医学]