[1]宫蓓蕾,李伟,陈余清,等.超声引导下经支气管镜检查在周围性肺部病变诊断中的应用[J].第三军医大学学报,2017,39(17):1756-1761.
 GONG Beilei,LI Wei,CHEN Yuqing,et al.Radial probe endobronchial ultrasound-guided bronchoscopy for peripheral pulmonary lesions[J].J Third Mil Med Univ,2017,39(17):1756-1761.
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超声引导下经支气管镜检查在周围性肺部病变诊断中的应用(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第17期
页码:
1756-1761
栏目:
临床医学
出版日期:
2017-09-15

文章信息/Info

Title:
Radial probe endobronchial ultrasound-guided bronchoscopy for peripheral pulmonary lesions
作者:
宫蓓蕾李伟陈余清高华陈雪英李翠侠
安徽省蚌埠医学院第一附属医院呼吸与危重症医学科
Author(s):
GONG Beilei LI Wei CHEN Yuqing GAO Hua CHEN Xueying LI Cuixia

Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, 233004, China

关键词:
支气管镜检查支气管内超声检查周围性肺部病变诊断
Keywords:
bronchoscopy endobronchial ultrasonography peripheral pulmonary lesions diagnosis
分类号:
R445.1; R563.04; R768.1
文献标志码:
A
摘要:

目的      探讨气道内径向超声(radial endobronchial ultrasound,R-EBUS)引导下经支气管镜检查在诊断周围性肺部病变(peripheral pulmonary lesions,PPLs)中的应用价值,评估其诊断成功率、安全性及影响因素。 方法     回顾性分析2015年1月至2017年3月在我院呼吸内镜室行径向超声引导下经支气管镜活检(R-EBUS transbronchial biopsy,R-EBUS TBB)和刷检的140例患者的临床资料,筛选出83例PPLs患者,观察EBUS对病变的定位能力,分析其诊断成功率及影响因素,观察有无并发症,进行安全性评估。结果     83例患者中男性55例,女性28例,年龄(59.81±11.85)岁。 R-EBUS引导下经支气管镜检查总诊断成功率59.04 %(49/83),其中肺恶性病变诊断率50.94%(27/53),非恶性病变诊断率73.33%(22/30);R-EBUS TBB诊断率(56.92%,37/65)高于经支气管镜刷检诊断率(30.12%,25/83)(χ2=10.76,P=0.001);支气管镜下超声引导联合测量技术(EBUS-D)诊断率为60.00%(45/75),经导向鞘引导的超声支气管镜(EBUS-GS)诊断率为50.00%(4/8),二者相比差异无统计学意义(χ2=0.03,P=0.87)。病灶直径10.0~52.4 mm,其中直径≤20 mm者诊断率(36.84%,7/19)低于直径>20 mm者(65.62%,42/64)(χ2=5.02,P=0.03);各叶段病灶诊断率分别为右上叶46.15%(12/26),右中叶100.00%(8/8),右下叶53.85%(7/13),左上叶固有段37.50%(3/8),左上叶舌段63.64%(7/11),左下叶70.59%(12/17),差异无统计学意义(χ2=10.05,P=0.07);而上叶(22/45,48.89%)诊断率低于中/下叶(27/38,71.05%)(χ2=4.18,P=0.04)。R-EBUS明确病变位置者74例(89.16 %,74/83),9例超声下未发现目标病变,超声探头位于病变区域内者诊断率(81.58%,31/38)明显高于病变偏离探头者(50.00%,18/36)(χ2=8.24,P=0.004)。并发症仅为经气管镜取材部位少量出血,无气胸等的发生。结论     R-EBUS可准确定位肺部周围性病变,提高PPLs的诊断率,安全可行;EBUS-D对PPLs诊断具有较高阳性率,且节约成本;病灶大小、径向超声探头与靶病变的位置关系是影响其诊断率的主要因素。

Abstract:

Objective    To investigate the application of radial endobronchial ultrasound (R-EBUS)-guided bronchoscopy in the diagnosis of peripheral pulmonary lesions (PPLs), assess its safety and diagnostic value, and explore the influencing factors. Methods    Clinical data of 140 patients who underwent R-EBUS transbronchial biopsy (TBB) and brush biopsy in our department of respiratory endoscopy from January 2015 to March 2017 were collected and retrospectively analyzed in the study. Eightythree cases were diagnosed as PPLs. The detection rate, ability to locate the peripheral lesions, and influencing factors of EBUS were analyzed. The incidence rate of complications was observed to assess its safety. Results     Of the 83 PPLs patients, they were 55 males and 28 females, and at a mean age of 59.81±11.85 years. The total success rate of EBUS-guided bronchoscopic diagnosis was 59.04% (49/83), and the diagnostic rate was 50.94% (27/53) for malignant lesions, and 73.33% (22/30) for benign diseases. The rate of EBUS-TBB (5692%, 37/65) was significantly higher than that of brush biopsy (30.12%, 25/83, Chi square=10.76, P=0.001). EBUS-guided diagnostic methods had an accuracy of 60.00% (45/75), while the EBUS-guided bronchoscopy had a rate of 50.0% (4/8), but no significant difference was seen between the 2 methods (Chi square=0.03, P=0.87).The sizes of the lesions ranged from 10.0 to 52.4 mm, and the diagnostic yield for PPLs ≤20 mm in diameter (36.84%, 7/19) was lower than that for those >20 mm (65.62%, 42/64, Chi square=5.02, P=0.003). There was no significant difference (Chi square=10.05, P=0.07) in the diagnostic yield for different sites, with that of right upper lobe of 46.15% (12/26), right middle lobe 100.00%(8/8), right lower lobe 53.85%(7/13), left upper lobe 37.50%(3/8), left lingula lobe 63.64%(7/11), left lower lobe 70.59% (12/17). But the detection rate was obviously lower in the upper lobe (22/45, 48.89%) than the middle/lower lobe (27/38, 71.05%, Chi square=5.02, P=0.003). Of all the 83 patients, 74 ones (89.16%) were successfully identified using radial probe EBUS, but the lesions were not found in 9 patients. When the radial probe position was within the target lesion, the diagnostic yield was 81.58% (31/38), notably higher than that when the probe was positioned adjacent to the lesion (50.00%, 18/36, Chi square=8.24, P=0.004). Mild bleeding was observed when performing biopsy under bronchoscope, and no pneumothorax, or other serious complications were observed.  Conclusion     Radial EBUS is a safe and feasible method to accurately identify PPLs and improve its diagnostic rate. EBUSguided bronchoscopy has higher positive detection rate for PPLs, and is cost saving. The relationship of the probe and the site of lesion is the main factor influencing the diagnostic rate.

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更新日期/Last Update: 2017-09-05