摘要
目的评估气管内超声（EBUS）非实时引导下经气管镜肺活检（TBLB）对肺周围型病变的诊断价值。方法纳入2011年6月1日至2012年3月1日广东省人民医院呼吸科行TBLB的105例患者，其中男68例，女37例，年龄39～81岁，平均为（59±12）岁，胸部CT均发现肺周围型病变，所有患者的气管镜检查均大致正常，其中54例患者行EBUS检查，对可获得病灶EBUS图像的外周病变，在撤出超声探头后，沿超声探头路径伸入活检钳对病灶进行盲检；对不能获得病灶EBUS图像的外周病变，根据术前影像学资料提示的位置对病灶进行盲检。另51例患者未行EBUS检查，常规根据术前影像学资料进行定位后直接进行盲检，采用χ2检验比较两组患者的病理诊断阳性率。结果EBUS对肺周围型病变的总体发现率为76％（41／54），EBUS引导TBLB组诊断阳性率为67％（36／54），常规TBLB组的诊断阳性率为45％（23／51），EBUS引导TBLB的诊断率较高（P〈0．05）。而EBUS引导TBLB组未能获得EBUS图像的13例患者，均未能获得阳性病理结果。应用EBUS引导TBLB技术诊断直径≤30mm和〉30mm的诊断率分别为44％（8／18）、78％（28／36）。直径〉30mm病灶的诊断率高于直径≤30mm的病灶（P〈0．05）。EBUS引导TBLB组、普通TBLB组对直径≤30mm病灶的诊断率分别为44％（8／18）、12％（2／17），EBUS引导TBLB组诊断率更高（P〈0．05）。EBUS引导TBLB组、普通TBLB组对直径〉30mm病灶的诊断率分别为52％（28／54）、41％（21／51），两组的诊断率差异无统计学意义（P〉0．05）。EBUS引导TBLB组盲检共269次，平均每例盲检4．8次，普通TBLB组盲检共398次，平均每例盲检7．8次。在确保获得足够、合适的组织标本的前提下，EBUS引导TBLB组需要的盲检次数更少（P〈0．05）。本研究中患者活检后出现的并发症有少量咯血（61／105，58．1％）、胸痛（25／105，23．8％）及气胸（2／105，1．9％），均无需特别处理可缓解。结论气管内超声非实时引导下经纤维气管镜行TBLB术可提高操作的诊断阳性率，且不增加操作风险，如EBUS检查未能发现病灶的病例，盲检成功率极低；周围型病变的直径是影响EBUS非实时引导TBLB成功率的重要因素；对于直径≤30mm的病灶，EBUS引导TBLB组诊断率更高，对于直径〉30mm的病灶，两组诊断率差异无统计学意义。
Objective To evaluate the role of non-real-time endobronchial bronchoscopy uhrasound （EBUS） assisted transbronchial lung biopsy （TBLB） in diagnosing peripheral pulmonary lesions （PPL）. Methods One hundred and five patients [68 males and 37 females,mean age （59 ± 12） years,ranged from 39-81 years] with PPL confirmed by computered tomography（CT） were recruited in this study between June 1 st 2011 and March 1 st 2012. All cases received bronchoscopy examinations and presented with roughly normal results. Fifty-four cases received EBUS examinations. For peripheral lesions with accessible EBUS images, blind biopsy was performed with biopsy forceps through pathways of the ultrasonic probe after the retreat of the probe. In those cases without accessible EBUS images, blind biopsy was performed based on the localization by image data. The other 51 cases without EBUS testing underwent blind biopsy on the localization by image data. Positive rates of pathological diagnosis of the 2 groups were compared. Analysis was by χ2-test. Results In 54 patients who received EBUS examinations, 76% （41/54） of PPLs were detected performed by EBUS. The positive rate of the EBUS assisted TBLB group was 67% （36/54） , compared with 45 % （23/51 ） in the general TBLB group. There was a better diagnostic rate （ P 〈 0. 05） in the EBUS assisted TBLB group than the general TBLB group . Thirteen patients without accessible EBUS images obtained negative pathological results. The diagnosis rate of EBUS assisted TBLB on lesions with ≤ 30 mm minimum diameter was 44% （8/18）, lower than 78% （28/36） on lesions with 〉 30 mm minimum diameter （P 〈 0.05 ）. In terms of diagnosis rate on lesions with ≤30 mm minimum diameter, EBUS assisted TBLB was 44% （8/18）, higher than 12% （2/17） of TBLB alone （P 〈0. 05）. As for lesions with 〉 30 mm minimum diameter, diagnosis rate of EBUS assisted TBLB was 52% （28/54） and TBLB alone was 41% （21/51）, representing insignificant difference （P 〉 0. 05）. In the EBUS assisted TBLB group, we performed 269 blind biopsies, with an average of 4. 8 times per case, whereas the general TBLB group required 398 times, with an average of 7.8 times per case. EBUS assisted TBLB decreased the operation times of blind biopsy （ P 〈 0. 05 ） to acquire adequate and appropriate specimen. Complications of biopsy occurred in this study included slight haemoptysis （61/105,58. 1% ）, chest pain （25/105,23.8%） and pneumothorax （2/105,1.9%）. Patients with these complications recovered spontaneously without special managements. Conclusions Non-real-time EBUS assisted TBLB could improve diagnostic positive rate without increasing operational risk. In most cases, the blind biopsy did not succeed if EBUS failed to detect the lesions. The success rate of non-real-time EBUS assisted TBLB was related to the minimum diameter of PPL. In terms of diagnosis rate on lesions with ≤ 30 mm minimum diameter, EBUS assisted TBLB was higher than TBLB alone. As for lesions with 〉 30mm minimum diameter, there was no significant difference in the diagnosis rate between these 2 groups. EBUS assisted TBLB decreased the times of blind biopsy process （P 〈 0. 05 ） to obtain adequate and appropriate specimen.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2013年第1期12-16,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
广东省自然科学基金（S2011010001278）
