C型臂联合径向超声引导下经支气管镜肺活检对肺外周病变的诊断价值  

Diagnostic value of TBLB under the guidance of C-arm combined with R-EBUS on peripheral pulmonary lesions

作　　者：刘凯跃 何馨[1] 贾楠[1] 谭春婷[1] 姚志刚[1] 徐波[1] LIU Kai-yue;HE Xin;JIA Nan(Department of Respiratory,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院呼吸科,北京100050

出　　处：《中国医学装备》2022年第4期92-96,共5页China Medical Equipment

基　　金：国家自然科学基金青年科学基金项目(82000065)“Lonp1基因通过线粒体调控肺泡2型细胞衰老在肺纤维化中的作用及机制研究”。

摘　　要：目的:探讨C型臂联合径向超声(R-EBUS)引导下经支气管镜肺活检(TBLB)对肺外周病变(PPL)的诊断价值。方法:选取医院收治的116例肺外周病变患者,根据检查方式的不同将其分为C型臂联合R-EBUS引导经支气管镜肺活检组(C型臂+R-EBUS+TBLB组,31例)、R-EBUS引导经支气管镜肺活检组(R-EBUS+TBLB组,30例)和传统经支气管镜肺活检组(TBLB组,55例),分析比较3组的诊断率,分层比较不同病变大小、病变性质的诊断率,并观察有无并发症,同时对3组进行安全性评价。结果:C型臂+R-EBUS+TBLB组总体诊断率为83.9%,R-EBUS+TBLB组为60%,TBLB组为40%,3组比较差异有统计学意义(χ^(2)=15.718,P<0.05)。当PPL直径>2 cm或PPL直径≤2 cm时,诊断率C型臂+R-EBUS+TBLB组>R-EBUS+TBLB组>TBLB组,且直径≤2 cm的病灶中诊断率低于直径>2 cm病灶的诊断率,差异有统计学意义(χ^(2)=5.161,χ^(2)=11.00,χ^(2)=4.43;P<0.05)。当PPL性质为实性时,C型臂+R-EBUS+TBLB组诊断率最高,为92%,差异有统计学意义(χ^(2)=8.848,P<0.05)。当PPL性质为非实性时,C型臂+R-EBUS+TBLB组诊断率最高,为50%,但差异无统计学意义(χ^(2)=5.244,P>0.05),PPL为实性时诊断率明显高于非实性时,差异有统计学意义(χ^(2)=6.310,χ^(2)=11.786,χ^(2)=4.043;P<0.05)。3组均未见出现严重并发症。结论:C型臂联合R-EBUS引导下经支气管镜肺活检可提高肺外周病变的诊断率,是一种安全、有效的诊断方式,具有较高的临床应用价值。Objective:To explore the diagnostic value of transbronchial lung biopsy(TBLB)under the guidance of C-arm combined with radial endobronchial ultrasound(R-EBUS)on peripheral pulmonary lesions(PPL).Methods:116 PPL patients who admitted to hospital were selected,and they were divided into three groups:TBLB under the guidance of C-arm combined with R-EBUS group(C-arm+R-EBUS+TBLB group,31 cases),R-EBUS guided TBLB group(R-EBUS+TBLB group,30 cases)and conventional TBLB group(TBLB group,55 cases)according to the different examination methods.The diagnostic rates of the three groups was analyzed and compared,and the diagnostic rates of different size and different nature of lesions were compared as delamination.And the incidence rates of complications were observed,and the safety evaluation was conducted on three groups at the same time.Results:The totally diagnostic rate of C-arm+R-EBUS+TBLB group was highest(83.9%),and that of R-EBUS+TBLB group was 60%and that of TBLB group was 40%,and the differences of that among three groups was significant(χ^(2)=15.718,P<0.05).The decreasing sequences of diagnostic rates of three groups were C-arm+R-EBUS+TBLB group>R-EBUS+TBLB group>TBLB group when PPL diameter>2cm or PPL diameter≤2cm,and the diagnostic rate in lesions with diameter≤2cm was lower than that in lesions with diameter>2cm,and the difference of that among three groups was statistically significant(χ^(2)=5.161,χ^(2)=11.00,χ^(2)=4.43,P<0.05).The diagnostic rate of C-arm+R-EBUS+TBLB group was the highest(92%)when the nature of PPL was solid,and the difference of that among three groups was statistically significant(χ^(2)=8.848,P<0.05).And the diagnostic rate of C-arm+R-EBUS+TBLB group still was the highest(50%)when the nature of PPL was non-solid,but the difference of that among three groups was no significant(χ^(2)=5.244,P>0.05).The diagnostic rate of three groups when the nature of PPL was solid was significantly higher than those when nature of PPL was non-solid,the differences of those among them were statisti

关 键 词：肺外周病变(PPL) C型臂 径向超声(R-EBUS) 支气管镜 活检 

分 类 号：R445.1[医药卫生—影像医学与核医学]