支气管腔内超声（EBUS）在外周肺结节中的应用价值

发布时间：2018-04-16 01:21

本文选题：支气管镜检查 + 支气管腔内超声　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的评价支气管腔内超声(endobronchial ultrasonography,EBUS)引导支气管镜检查在外周肺结节(peripheral pulmonary nodule,PPN)中的应用价值。方法回顾性分析2015年1月-12月在我院行径向EBUS引导支气管镜检查的73例PPN患者的临床资料,所有患者胸部计算机断层扫描(computer tomography,CT)检查见肺部3cm的类圆形结节而行常规支气管镜检查未见明显异常。使用超声探头引导下在病变处进行活检与刷检协助诊断,未能明确诊断者行进一步侵袭性操作或治疗后随访观察至少6个月获得最终诊断。分析EBUS引导支气管镜检查的诊断符合率,并比较病灶与超声探头的位置关系、引导鞘(guide sheath,GS)的使用对诊断率的影响,以及各肺叶间诊断率的差异,同时分析超声图像特点与病灶良恶性的关系,使用SPSS软件对相关数据进行分析处理。结果1、73名PPN患者中恶性病变50例、良性病变23例,EBUS引导支气管镜检查时PPN的检出率为80.8%(59/73),诊断率为64.4%(47/73),其中恶性病变诊断率为54%(27/50)。2、EBUS探头位于病灶中央时的诊断率(78.7%,37/47)明显高于探头位于病灶一侧(41.7%,5/12)或未查见病灶时(35.7%,5/14)(P=0.003)。3、EBUS检出的59例PPN中,图像为均质型表现者有16例,恶性病变占25%,良性病变占75%,图像为异质性表现者有43例,恶性病变占81.4%,良性病变占18.6%,差异有统计学意义(P0.05)。4、联合使用GS时PPN的诊断率(66.7%,4/6)与未使用GS组(64.2%,43/67)比较,差异无统计学意义(P0.05)。5、各肺叶PPN的诊断率以右肺中叶为最高(83.3%,5/6),左肺上叶固有段最低(40.0%,4/10),各肺叶间诊断率差异无统计学意义(P0.05)。6、并发症:有2例患者(2.7%,2/73)行支气管镜检查时有少量出血,无与EBUS检查直接相关的并发症发生。结论径向EBUS引导支气管镜检查是一种安全、有效的PPN诊断方式,值得临床推广,超声探头与病灶的位置关系可影响其诊断准确率,超声图像下病灶的特点有助于判断病灶的良恶性。
[Abstract]:Objective to evaluate the value of endobronchial ultrasound guided bronchoscopy in peripheral pulmonary nodule PPNs.Methods the clinical data of 73 patients with PPN who underwent EBUS guided bronchoscopy in our hospital from January to December 2015 were analyzed retrospectively.In all patients, the round nodules of lung 3cm were detected by computed tomography CT (CT), but no obvious abnormality was found by routine bronchoscopy.Ultrasound probe guided biopsy and brushing were used to assist the diagnosis, and the final diagnosis was obtained after follow-up observation for at least 6 months after further invasive operation or treatment.To analyze the diagnostic coincidence rate of EBUS guided bronchoscopy, and to compare the relationship between the location of the lesion and the ultrasonic probe, the influence of the use of the guide guide guide GSH on the diagnostic rate, and the difference of the diagnostic rate among the different lobes of the lung.At the same time, the relationship between the features of ultrasound images and benign and malignant lesions was analyzed, and the relevant data were analyzed and processed by SPSS software.Results 1 among 73 PPN patients, 50 were malignant lesions.The detection rate of PPN in 23 cases of benign lesions with EBUS-guided bronchoscopy was 80.8 / 59 / 73 and the diagnostic rate was 64.4 / 47 / 73. The diagnostic rate of malignant lesions was 54 / 2750 / 0.2EBUS (78.7 / 37 / 47), which was significantly higher than that of the probe on one side of the lesion (41.7 / 512) or not.In 59 cases of PPN, 35. 7% of the lesions were detected by P0. 003 and 3 by EBUS.There were 16 cases with homogeneous image, 25 cases with malignant lesions, 75 cases with benign lesions and 43 cases with heterogeneous images.Malignant lesions accounted for 81.4 and benign lesions accounted for 18.6.The difference was statistically significant (P0.05 .4. the diagnostic rate of PPN in combination with GS was 66.7 / 6) compared with that in the non-GS group (64.2% / 67).There was no significant difference in the diagnostic rate of PPN between the right lobe and the middle lobe of the right lung. There was no significant difference in the diagnostic rate between the two lobes (P 0.05). The diagnostic rate of PPN in the right lobe was the highest in the middle lobe of the right lung (83.3% / 5%), and the lowest part was 40.010% in the superior lobe of the left lung. There was no significant difference in the diagnostic rate among the lobes (P0.05. 6). Complications: there were 2 cases with small bleeding during bronchoscopy.There were no complications directly related to EBUS examination.Conclusion Radial EBUS guided bronchoscopy is a safe and effective diagnostic method for PPN, and it is worth popularizing in clinic. The accuracy of diagnosis can be affected by the relationship between the location of ultrasonic probe and the lesion.The characteristics of lesions in ultrasound images are helpful to judge the benign and malignant lesions.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R563

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