支气管腔内超声非实时引导下经气管镜肺活检对周围型肺癌的诊断价值  

Non-real-time endobronchial ultrasound guided transbronchial lung biopsy for the diagnosis of peripheral lung cancer

作　　者：谢强[1] 瘳胜祥 卢筠[1] 钟爱虹[1] 连秀华[2] XIE Qiang LIAO Shengxiang LU Jun ZHONG Aihong LIAN Xiuhua(Department of Tumor, Fuzhou Pul- monary Hospital, Fuzhou 350008, Chin)

机构地区：[1]福建医科大学教学医院福州肺科医院肿瘤科,福州350008 [2]福建医科大学教学医院福州肺科医院内镜中心,350008

出　　处：《临床肿瘤学杂志》2017年第2期171-174,共4页Chinese Clinical Oncology

摘　　要：目的探讨支气管腔内超声(EBUS)非实时引导下经气管镜肺活检(TBLB)对周围型肺癌病变的诊断价值和安全性。方法回顾性分析2014年12月至2016年6月于福州肺科医院进行常规支气管镜检查未能发现病变,后使用EBUS检查并最终确诊为周围型肺癌的142例患者临床资料,其中102例行EBUS非实时引导下TBLB,40例患者行常规TBLB,比较EBUS引导TBLB和常规TBLB的诊断率、病灶发现率及安全性并总结影响诊断率的因素。结果 EBUS检查对肺部病灶的总体发现率为71.8%(102/142)。EBUS引导TBLB的诊断率为69.6%(71/102),高于常规TBLB的15.0%(6/40),差异有统计学意义(P<0.05)。EBSU引导TBLB技术诊断在直径>20 mm和≤20 mm病灶中的诊断率分别为75.0%(60/80)和50.0%(11/22),超声下全包绕探头病灶和超声下不全包绕探头病灶的诊断率分别为84.4%(38/45)和57.9%(33/57),高分辨CT影像上见支气管征病灶和无支气管征病灶的诊断率分别为82.4%(28/34)和63.2%(43/68),以上差异均有统计学意义(P<0.05)。TBLB活检后的主要并发症为少量咯血、胸痛,EBUS引导TBLB和常规TBLB的咯血发生率分别为30.3%(43/142)和32.5%(13/40),胸痛发生率分别为12.7%(18/142)和10.0%(4/40),差异均无统计学意义(P>0.05)。结论 EBUS非实时引导下TBLB创伤小,诊断率高,并发症少,用于诊断周围型肺癌安全有效,选择合适的病例可以提高诊断率。Objective To evaluate the diagnostic value and safety of non-real-time endobronchial ultrasound （EBUS） guided transbronchial lung biopsy （TBLB） for the diagnosis of peripheral lung cancer. Methods From December 2014 to June 2016, 142 pa- tients without obvious pathological changes in ophthalmic examinations by routine bronchoscopy were diagnosed as peripheral lung canc- er in Fuzhou Pulmonary Hospital by EBUS, and their clinical data were retrospectively analyzed. In this study, 102 cases of peripheral lung cancer patients received non-real-time EBUS guided TBLB, and 42 patients received routine TBLB. The diagnostic positive rate, lesion detection and safety were compared between non-real-time EBUS guided TBLB and conventional TBLB. Moreover, the factors that affect diagnosis positive rate were summarized. Results Among 142 patients receiving EBUS examinations, 71.8%（102/142） of pulmonary lesions were detected by EBUS. The dignostic rate of the EBUS guided TBLB was 69.6% （71/102）, higher than 15.0% （6/40） of conventional TBLB （P〈0.05）. The dignostic rate of EBUS guided TBLB on lesions with diameter ≤20 mm was 50. 0% （11/22）, lower than 75.0% （60/80） on lesions with diameter 〉20 mm （P〈0.05）. The dignostic rate of EBUS guided TBLB on probe completely envelop wind the lesions was 84.4% （38/45）, higher than 57.9% （33/57） on probe incompletely envelop wind the lesions （P〈0. 05）. The dignostic rate of EBUS guided TBLB on lesions with the presence of a bronchus sign on HRCT imaging was 82.4% （28/34）, higher than 63.2% （43/68） on lesions without the presence of a bronchus sign on HRCT imaging （P〈0.05）. Com- plications of biopsy occurred in this study included slight haemoptysis and chest pain without pneumothorax. The incidence rates of hae- moptysis were 30. 3% （43/142） in EBUS guided TBLB and 32. 5% （13/40） in conventional TBLB （P〉0. 05）. The incidence rates of chest pain were 12. 7% （18/142） in EBUS guided TBLB and 10. 0% （4/40

关 键 词：周围型肺癌 支气管镜检查 腔内超声检查 活组织检查 

分 类 号：R734.2[医药卫生—肿瘤]