虚拟导航联合径向支气管内超声引导下冷冻活检在肺外周病变诊断中的应用价值  

The Diagnostic Value of Virtual Bronchoscopic Navigation and Radial Endobronchial Ultrasound Guided Transbronchial Cryobiopsy in Peripheral Pulmonary Lesions

作　　者：陈众博[1] 陈辉[1] 李莎[1] 邵磊 於学婵 徐如意 庄起东 吕丹[1] 郑琳[1] 邓在春[1] 虞亦鸣[1] CHEN Zhongbo;CHEN Hui;LI Sha(Department of Pulmonary and Critical Care Medicine,The Affiliated Hospital of Medical School,Ningbo University,Zhejiang 315020,China)

机构地区：[1]宁波大学医学院附属医院-呼吸与危重症医学科,315020 [2]宁波市临床病理诊断中心,315020

出　　处：《医学研究杂志》2023年第10期141-145,159,共6页Journal of Medical Research

基　　金：浙江省宁波市科技惠民项目(2015C50012);宁波大学青苗人才培育项目(FYQM-LC-202003);宁波市卫生健康委员会青年骨干人才基金资助项目(2020SWSQNGG-05);宁波市医学科技计划项目(2021Y13);浙江省卫生健康科技计划项目(2022RC247)。

摘　　要：目的经支气管冷冻探头的出现是肺活检技术的一项重要进步。既往关于经支气管冷冻活检(transbronchial cryobiopsy,TBCB)在肺外周病变(peripheral pulmonary lesions,PPLs)诊断中价值的研究主要基于X线透视辅助引导条件下,关于非X线透视下使用径向支气管内超声(radial endobronchial ultrasound,REBUS)联合引导鞘管(guild sheath,GS)辅助行TBCB的研究相对稀少。虚拟导航系统(virtual bronchoscopic navigation,VBN)被认为是一种更经济、危害性更小的引导方法,本研究为了评价VBN-REBUS-GS引导下TBCB在PPLs诊断中的可行性及安全性。方法纳入了2018年5月~2021年10月在宁波大学医学院附属医院经VBN-REBUS-GS引导下行TBCB并最终诊断明确的84例患者。评估VBN-REBUS-GS引导下TBCB在PPLs诊断中的准确率,同时采用McNemar检验分析TBCB与传统钳夹活检(transbronchial forceps biopsy,TBFB)在PPLs中的诊断效能有无差异。结果本研究发现仅REBUS-GS引导下TBCB的总体诊断率可达70.24%,且较TBFB(50.00%)明显更具优势(χ^(2)=8.83,P<0.05)。本研究中无严重出血患者,仅3例(3.57%)术后出现了气胸。结论无X线透视辅助条件下,VBN-REBUS-GS引导下行TBCB对PPLs仍具有良好诊断效果,且较传统的TBFB具有更高的诊断价值,有利于临床精准医疗,且未明显增加气胸及出血的风险。Objective The emergence of transbronchial cryoprobe was regarded as an important advance in lung biopsy.In the past,research mainly focused on the value of transbronchial cryobiopsy(TBCB) with fluoroscopic guidance.However,few studies have investigated the performance of cryobiopsy under the assistance of radial endobronchial ultrasound(REBUS) and guide sheath(GS) without X-ray fluoroscopy for diagnosing peripheral pulmonary lesions(PPLs).Furthermore,virtual bronchoscopic navigation(VBN) is regarded as a relatively more economical and less harmful guidance method for diagnosing PPLs.We aimed to evaluate the application value of VBN-REBUS-GS-guided TBCB in diagnosing PPLs.Methods From May 2018 to October 2021 in the Affiliated Hospital of Ningbo University School of Medicine,84 patients who underwent VBN-REBUS-GS-guided TBCB and final confirmed diagnosis were retrospectively analyzed.To evaluate the accuracy of TBCB in the diagnosis of PPLs under the guidance of VBN-REBUS-GS only,and the McNemar test was used to compare the diagnostic performance between TBCB and traditional forceps biopsy(TBFB) in PPLs.ResultsThis study found that the overall diagnostic yield of TBCB under the guidance of VBN-REBUS-GS was 70.24%,which was significantly higher than that of TBFB(50.00%,χ^(2)=8.83,P<0.05).In this study,there were no severe bleeding patients,only 3 cases(3.57%) developed pneumothorax.Conclusion Without X-ray fluoroscopy,TBCB under the guidance of VBN-REBUS-GS still has good diagnostic performance on PPLs,which is better than conventional TBFB.This is beneficial to clinical precision medicine and without significantly increased risk of pneumothorax and bleeding.

关 键 词：径向支气管内超声 引导鞘管 肺外周病灶 非X线透视 肺冷冻活检 

分 类 号：R44[医药卫生—诊断学]