虚拟导航联合气管超声下经引导鞘肺活检术对肺周围性病变诊断价值的研究  

Virtual bronchoscopic navigation combined with endobronchial ultrasound transbronchial lung biopsy with guide-sheath for the diagnosis of peripheral pulmonary lesions

作　　者：李譞[1] 李永斌 李婧 李明[1] 隆玄[1] 李君[1] 彭爱梅[1,2] 王昌惠[1] LI Xuan;LI Yong-bin;LI Jing;LI Ming;LONG Xuan;LI Jun;PENG Ai-mei;WANG Chang-hui(Dept.of Respiratory and Critical Care Medicine,Tenth People's Hospital,Tongji University School of Medicine,Shanghai 200072,China;Dept.of Respiratory and Critical Care Medicine,Chongming Campus of Tenth People's Hospital,Tongji University School of Medicaine,Shanghai 202100,China;Dept.of General Practice,Caojiadu Community Health Service Center,Shanghai 200042,China)

机构地区：[1]同济大学附属第十人民医院呼吸与危重症医学科,上海200072 [2]同济大学附属第十人民医院崇明分院呼吸与危重症医学科,上海202100 [3]上海曹家渡街道社区卫生服务中心全科,上海200042

出　　处：《同济大学学报（医学版）》2020年第6期729-733,共5页Journal of Tongji University(Medical Science)

基　　金：上海市崇明区可持续发展科技创新项目(CKY-2019-9)。

摘　　要：目的探讨气管超声下经引导鞘肺活检术(endobronchial ultrasound transbronchial lung biopsy with guide-sheat,EBUS-GS-TBLB)联合虚拟导航(virtual bronchoscopic navigation,VBN)对肺周围性病变(Peripheral pulmonary lesions,PPL)的诊断价值和安全性。方法对2017年6月至2018年12月在同济大学附属第十人民医院就诊的气管镜下未发现异常的肺周围性病变的患者,根据引导设备不同,分为导航组(气管超声下经引导鞘肺活检术联合虚拟导航组)和非导航组(气管超声下经引导鞘肺活检术组),观察诊断率和安全性,并总结影响诊断率的因素。结果共150例患者入选了本次研究,导航组70例,非导航组80例。导航组的诊断率为85.7%(60/70),而非导航组为71.2%(57/80),两组差异有统计学意义(χ2=5.378,P=0.022);导航组在直径≤2 cm的病灶中诊断率高于非导航组;气管超声下经引导鞘肺活检术联合虚拟导航组较气管超声下经引导鞘肺活检术组定位病变时间短,且差异有统计学意义(P<0.001);非导航组,轻度气胸(肺压缩<15%)2例。结论气管超声下经引导鞘肺活检联合虚拟导航技术创伤小、诊断率高、并发症少。Objective To evaluate the feasibility of Virtual bronchoscopic navigation(VBN)combined with endobronchial ultrasound transbronchial lung biopsy with guide-sheath(EBUS-GS-TBLB)in diagnosis of peripheral pulmonary lesions(PPLs).Methods Between June 2012 and December 2018,150 patients with PPL inaccessible by conventional bronchoscopy admitted in Shanghai Tenth People's Hospital were enrolled in the study,including 70 patients undergoing VBN with EBUS-GS-TBLB(VBN group)and 80 patients undergoing EBUS-GS-TBLB alone(EBUS group).The diagnostic yield,safety and the associated factors were analyzed in two groups.Results The diagnostic rate in the EBUS+VBN group was higher than that in the EBUS group[85.7%(60/70)vs 71.2%(57/80),χ2=25.520,P<0.001];the diagnostic rates of lesions<2 cm in diameter in EBUS+VBN group was higher than that in EBUS group.The times for locating lesions and operating in the EBUS+VBN group were shorter than those in the EBUS group(P<0.001).Two cases of mild pneumothorax(lung compression<15%)were found in EBUS group.Conclusion The procedure of EBUS+VBN is minimally invasive,which can obtain higher diagnostic rate and has fewer complications.

关 键 词：超声检查 虚拟导航 支气管镜检查 肺周围性病变 诊断率 

分 类 号：R56[医药卫生—呼吸系统]