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

发布时间：2018-03-18 04:04

  本文选题：支气管镜检查　切入点：支气管内超声检查　出处：《第三军医大学学报》2017年17期 　论文类型：期刊论文

【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%)(χ~2=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)(χ~2=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 evaluate the value of radial endobronchial ultrasound guided by bronchoscopy in the diagnosis of peripheral pulmonary lesions (PPLs), and to evaluate the diagnostic success rate. Methods from January 2015 to March 2017, we retrospectively analyzed the clinical data of 140 patients who underwent transbronchial biopsy (R-EBUS transbronchial biopsysyR-EBUS TBBB) and brushing in our hospital from January 2015 to March 2017. 83 patients with PPLs were selected. Objective: to observe the localization ability of EBUS for pathological changes, analyze the diagnostic success rate and influencing factors, observe the complications and evaluate the safety. Results there were 55 males and 28 females in 83 patients. Age 59.81 卤11.85) .R-EBUS guided total diagnostic success rate of 59.04% of 49 / 83 cases, of which the diagnostic rate of malignant pulmonary lesions was 50.944 / 27 / 53, and the diagnostic rate of non-malignant lesions was 73.33%. The diagnostic rate of R-EBUS TBB was 56.9237 / 65) higher than that of brushing bronchoscopy (蠂 210.76.75% P 0.001, P 0.001). The diagnostic rate of EBUS-Dwas 60.005 / 75%, and that of guided sheath guided EBUS-GSwas 50.005 / 8. There was no significant difference between the two groups (蠂 2 0.03 P 0.87). The diameter of lesion was 10.0 0 ~ 52.4 mm, and the diagnostic rate of lesion 鈮，

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