支气管超声下经引导鞘肺活检术诊断肺周围性疾病的价值  

Endobronchial ultrasound transbronchial lung biopsy with guide-sheath for the diagnosis of pulmonary peripheral lesions

作　　者：张华楠[1] 王超超[1] 张媛[2] 徐少华[1] 王莹[1] 王伟[1] 

机构地区：[1]山东大学第二医院呼吸内科,山东济南250033 [2]山东大学第二医院循证医学中心,山东济南250033

出　　处：《山东大学学报（医学版）》2017年第4期34-38,共5页Journal of Shandong University:Health Sciences

摘　　要：目的评价支气管超声下经引导鞘肺活检术(EBUS-GS-TBLB)对肺周围性病变(PPL)的诊断价值和安全性,考察提高EBUS-GS-TBLB诊断阳性率的相关因素。方法回顾性分析2015年1月至2016年3月于山东大学第二医院在不同引导设备下行经支气管肺组织活检的67例PPL患者的临床资料,根据引导设备的不同分为传统组(n=38)和支气管超声导向鞘(EBUS-GS)组(n=29);比较两组间的诊断率及影响EBUS-GS-TBLB诊断阳性率的相关因素。结果传统组和EBUS-GS组在性别、年龄、病灶大小上的差异无统计学意义(P>0.05),两组具有可比性。传统组、EBUS-GS组的诊断率分别为47.4%(18/38)和75.9%(22/29),差异有统计学意义(χ~2=5.55,P=0.018)。EBUS-GS组中EBUS-GS-TBLB对病灶直径>2 cm的诊断率为94.1%(16/17),病灶直径≤2 cm的诊断率为50.0%(6/12),差异有统计学意义(P=0.011)。EBUS-GS-TBLB中超声探头能穿过病灶的诊断阳性率为89.4%(17/19),探头不能穿过病灶的诊断阳性率为50.0%(5/10),差异有统计学意义(P=0.030)。EBUS-GS-TBLB诊断率与病灶的位置无明显相关性(P>0.05)。结论 EBUS-GS-TBLB可提高肺周围性疾病的诊断率,并发症少,用于诊断PPL安全有效。EBUS-GS-TBLB诊断的阳性率与病灶的大小、超声探头及病灶关系等因素有关。Objective To evaluate the diagnostic value and safety of endobronchial ultrasound transbronchial lung biop- sy with guide-sheath （EBUS-GS-TBLB） in peripheral pulmonary lesions （PPL）, and to investigate the related factors of improving EBUS-GS-TBLB diagnostic rate. Methods A total of 67 patients with suspected PPL who underwent transbronchial lung biopsy in the Department of Respiratory Medicine of the Second Hospital of Shandong University be- tween January 2015 and March 2016 were prospectively evaluated. The patients were divided into the conventional group （n = 38 ） and the endobronchial ultrasound group with guide sheath group （EBUS-GS group, n = 29 ）. The diag- nostic rate and the related factors were analyzed. Results There was no significant difference in gender, age and lesion size of the two groups （P 〉 0.05 ）. The diagnostic rate of the EBUS-GS group was 75.9% （22/29）, which was higher than that of the conventional group, 47.4% （18/38）, （χ2 = 5.55, P = 0.018）. In EBUS-GS group, the diagnostic rate of the lesion diameter 〉2 cm was 94. 1% （16/17）, while the lesion diameter ≤2 cm was 50.0% （6/12）. The difference was statistically significant （P = 0.011 ）. The diagnostic rate of EBUS probe within the lesions was 89.4% （17/19）, while probe outside the lesions was 50. 0% （5/10）. The difference was statistically significant （P = 0. 030）. There was no correlation between the diagnostic rate and the location of the lesions（ P 〉0.05 ） in EBUS-GS-TBLB. Conclusion The procedure of EBUS-GS-TBLB is minimally invasive, has higher diagnostic rate and fewer complications, so it is a safe and effective method to diagnose PPL. The diagnostic rate of EBUS-GS-TBLB is related to both the lesion size and ultrasonic probe position.

关 键 词：支气管镜检查 超声介入 活组织检查 肺周围性病变 

分 类 号：R574[医药卫生—消化系统]