支气管超声导向鞘引导技术与经皮肺穿刺活检在肺外周病变诊断中的比较研究  

Comparative study of bronchial ultrasound-guided sheath technique and percutaneous lung biopsy in the diagnosis of peripheral pulmonary lesions

作　　者：邱斌 陶慧鑫 王志鹏 QIU Bin;TAO Huixin;WANG Zhipeng(Department of Thoracic Surgery,Affiliated Hospital of Shandong Second Medical University,Weifang 261031,China;Department of Operating Room,Affiliated Hospital of Shandong Second Medical University,Weifang 261031,China)

机构地区：[1]山东第二医科大学附属医院胸外科,山东潍坊261031 [2]山东第二医科大学附属医院手术室,山东潍坊261031

出　　处：《山东第二医科大学学报》2024年第6期421-425,共5页Journal of Shandong Second Medical University

基　　金：潍坊市卫生健康委员会科研项目(项目编号:WFWSJK-2023-320;WFWSJK-2023-242)。

摘　　要：目的探讨临床超声经皮肺穿刺活检技术与支气管超声导向鞘引导技术(EBUS-GS)在肺外周病变活检诊断的临床应用价值及安全性。方法2022年3月~2023年9月于山东第二医科大学附属医院就诊行胸部CT发现肺外周结节需要肺穿刺明确诊断的182例患者,随机分为EBUS-GS组(92例)和超声引导下经皮肺穿刺活检组(90例)。术前详细记录肺部病变的大小、部位等信息,将所取标本进行病理诊断,明确病理诊断者视为取材满意,而阴性或无法明确病理诊断者则视为取材不满意。术后随访并详细记录相关并发症的发生情况。结果EBUS-GS组取材满意率和取材成功率稍高于超声引导下经皮肺穿刺活检组,但差异无明显统计学意义(P>0.05)。EBUS-GS组的诊断准确率显著高于超声引导下经皮肺穿刺活检组(χ^(2)=5.325,P=0.029),且假阴性率低于超声引导下经皮肺穿刺活检组(χ^(2)=8.395,P<0.001)。与EBUS-GS组比较,超声引导下经皮肺穿刺活检组患者在穿刺后出现咳血和肺内出血的风险显著增高,差异有统计学意义(P<0.05),且穿刺次数≥3次及病灶距离胸壁距离≥1 cm是超声引导下经皮肺穿刺活检组患者肺内出血的独立危险因素。结论支气管超声导向鞘引导技术和超声引导下经皮肺穿刺活检技术均能够安全有效地诊断肺部外周占位性病变,但EBUS-GS在肺外周病变活检准确率及安全性方面更具优势。Objective To explore the clinical application value and safety of clinical ultrasound-guided percutaneous lung biopsy and endobronchial ultrasound-guided sheath(EBUS-GS)techniques in the biopsy diagnosis of peripheral pulmonary lesions.Methods From March 2022 to September 2023,182 patients with peripheral pulmonary nodules detected by chest CT in the Affiliated Hospital of Shandong Second Medical University,who required lung puncture for a definite diagnosis,were randomly divided into the EBUS-GS group(92 cases)and the ultrasound-guided percutaneous lung biopsy group(90 cases).Before the operation,detailed information such as the size and location of the pulmonary lesions was recorded.The obtained specimens were pathologically diagnosed.Those with a clear pathological diagnosis were regarded as satisfactory sampling,while those with negative or undetermined pathological results were considered as unsatisfactory sampling.Post-operative follow-up was conducted,and the occurrence of relevant complications was recorded in detail.Results The EBUS-GS group had slightly higher rates of satisfactory sampling and successful sampling than the ultrasound-guided percutaneous lung biopsy group,but the difference was not statistically significant(P>0.05).The diagnostic accuracy rate of the EBUS-GS group was significantly higher than that of the ultrasound-guided percutaneous lung biopsy group(χ^(2)=5.325,P=0.029),and the false-negative rate was lower than that of the ultrasound-guided percutaneous lung biopsy group(χ^(2)=8.395,P<0.001).Compared with the EBUS-GS group,patients in the ultrasound-guided percutaneous lung biopsy group had a significantly increased risk of hemoptysis and intrapulmonary hemorrhage after puncture,and the difference was statistically significant(P<0.05).Moreover,the number of puncture times≥3 and the distance of the lesion from the chest wall≥1 cm were independent risk factors for intrapulmonary hemorrhage in the ultrasound-guided percutaneous lung biopsy group.Conclusion Both the endobronchial

关 键 词：超声引导 肺外周结节 EBUS-GS 肺穿刺 肺肿瘤 

分 类 号：R655.3[医药卫生—外科学]