电磁导航支气管镜联合支气管内径向超声引导肺活检诊断肺外周结节  

Diagnostic utility of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary lesions

作　　者：余敏[1] 石沈云 李燕[1] 俞砚喆[1] 赵婷婷[1] 徐庆庆[1] 赵琪[1] 丁晶晶[1] 冯安宁[2] 代静泓[1] 肖永龙[1] YU Min;SHI Shenyun;LI Yan;YU Yanzhe;ZHAO Tingting;XU Qingqing;ZHAO Qi;DING Jingjing;FENG Anning;DAI Jinghong;XIAO Yonglong(Department of Respiratory and Critical Care Medicine,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing,210008,P.R.China;Department of Pathology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing,210008,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院呼吸与危重症医学科,南京210008 [2]南京大学医学院附属鼓楼医院病理科,南京210008

出　　处：《中国胸心血管外科临床杂志》2022年第1期44-49,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：鼓楼医院新技术发展基金重点项目(XJSFZJJ202005)。

摘　　要：目的探讨电磁导航支气管镜联合支气管内径向超声引导肺活检对肺外周结节的诊断价值和安全性。方法回顾性分析2020年6月至2021年6月期间就诊于南京大学医学院附属鼓楼医院行电磁导航支气管镜联合支气管内径向超声引导肺活检的60例患者的76枚肺外周结节的临床影像、手术及病理资料,分析总结病理诊断率及并发症情况。其中男23例、女37例,年龄46~78(62.8±10.3)岁。肺结节按直径大小分为肺小结节组(10枚肺小结节,直径≤1 cm)和肺结节组(66枚肺结节,1 cm<直径≤3 cm),比较两组在手术及病理诊断率方面的差异。结果76枚肺结节直径为(1.8±0.6)cm,手术时间(29.8±8.6)min,导航(2.9±0.9)次,活检(9.5±1.9)块。76枚肺结节中55枚活检病理确诊,总诊断率72.4%,其中恶性病变32例、良性病变23例。76枚肺结节中59枚0级出血,17枚1级出血,无2级及以上出血;8例患者术后出现气胸,肺压缩程度均<30%,吸氧对症处理后好转。肺小结节组手术时间长于肺结节组(P<0.05),两组诊断率、并发症方面的差异无统计学意义(P>0.05)。结论电磁导航支气管镜联合支气管内径向超声引导肺活检是诊断肺外周结节的一种安全、有效的方法,且对直径≤1 cm的肺小结节也具有较高的诊断率,值得临床推广应用。Objective To investigate the diagnostic value and safety of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary nodules.Methods The clinical imaging,surgical and pathological data of 60 patients with 76 peripheral pulmonary nodules who underwent electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound guided biopsy in the Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School from June 2020 to June 2021 were retrospectively analyzed.The diagnosis rate and complications were analyzed and summarized.The 76 pulmonary nodules were divided into a small pulmonary nodules group(10 nodules,diameter≤1 cm)and a pulmonary nodules group(1 cm<diameter≤3 cm,66 nodules)according to diameter.The two groups were compared in terms of operation and diagnosis rate.Results Pulmonary nodules diameter was 1.8±0.6 cm,operation time 29.8±8.6 min,navigation 2.9±0.9 times,biopsy 9.5±1.9 pieces.In the 76 pulmonary nodules,55 were confirmed by pathology,with a total diagnosis rate of 72.4%,including 32 of malignant lesions and 23 of benign lesions.In the 76 pulmonary nodules,59 had grade 0 hemorrhage,17 had grade 1 hemorrhage,and none had grade 2 or more serious hemorrhage.Eight patients developed pneumothorax after surgery,and the degree of lung compression was less than 30%,which was improved after symptomatic treatment with oxygen inhalation.The operation time in the small pulmonary nodules group was significantly longer than that in the pulmonary nodules group,and there was no significant difference in diagnosis rate or complications between the two groups.Conclusion Electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound is a safe and effective method for the diagnosis of periphery pulmonary nodules,and it also has a high diagnostic rate for small pulmonary nodules(≤1 cm),which is worthy of clinical promotion and application.

关 键 词：电磁导航支气管镜 支气管内径向超声 肺外周结节 

分 类 号：R734.2[医药卫生—肿瘤]