[经薄支气管镜行支气管内超声检查并测量距离在诊断周围型肺病变中的应用]

[Endobronchial ultrasonography with distance by thin bronchoscopy in diagnosing peripheral pulmonary lesions].

作者信息

Zhang Sujuan, Zhou Jun, Zhang Qiudi, Xu Qianqian, Xu Xiong

机构信息

Department of Respiratory Medicine, Third Affiliated Hospital, Soochow University, Changzhou 213003, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2015 Aug;38(8):566-9.

PMID:26703336

Abstract

OBJECTIVE

To evaluate the efficacy, safety and factors related to diagnostic yield of transbronchial biopsy (TBB) using thin bronchoscopy to endobronchial ultrasonography with distance ( EBUS-D) for peripheral pulmonary lesions (PPLs).

METHODS

Between October 2013 to September 2014, 117 patients [67 males and 50 females, aged (62.2 ± 10.9 ) years] underwent EBUS-D-guided TBB for the diagnosis of PPLs [mean size (22.9 ± 9.5) mm] and their medical records were retrospectively reviewed and analysed. EBUS was performed using a 4-mm thin bronchoscope and a 1.4 mm radial ultrasound probe. EBUS-D was to measure the distance between the PPL to the target bronchial orifice or to the outer orifice of the working channel of the bronchoscope when an EBUS image of the PPL was observed, and then the biopsy forceps were advanced to this measured distance and biopsy followed.

RESULTS

The visualization yield of EBUS was 77.8% (91/117). The overall diagnostic yield was 65.0% (76/117) by EBUS-D-guided TBB, and the diagnostic yield in malignant and benign lesions was 75.0% (66/88) and 34.5% (10/29), respectively. The diagnostic yield for PPLs > 20 mm in diameter was significantly higher than that for those ≤ 20 mm in diameter (78.7%,48/61 versus 50.0%, 28/56) (χ² 10.56, P=0.001). There was no significant difference in diagnostic yield between lobar distribution (right upper lobe 61.8%, 21/34; right middle lobe 91.7%, 11/12; right lower lobe 59.1%, 13/22; left upper lobe 57.1%,12/21; lingula 80.0%,4/5; left lower lobe 65.2%,15/23) (χ² = 5.31, P=0.38). The diagnostic sensitivity was only 18.2% for lesions close to visceral pleura with mean size ≤ 20 mm. Sometimes radial probe could pass through the PPL without resistance, and the diagnostic yield was lower in this situation. Complications including bleeding and chest pain recovered spontaneously.

CONCLUSION

Using EBUS-D-TBB with a thin bronchoscope, the vast majority of peripheral pulmonary lesions could be identified. The modality was far more cost-effective than EBUS-GS and there were no significant complications associated with this procedure. Lesion size, connection to the visceral pleura and radial probe through the lesion influenced the diagnostic yield.

摘要

目的

评估使用细支气管镜联合支气管内超声测距（EBUS-D）对周围型肺病变（PPL）进行经支气管活检（TBB）的有效性、安全性及与诊断率相关的因素。

方法

2013年10月至2014年9月期间，117例患者[67例男性和50例女性，年龄（62.2±10.9）岁]接受了EBUS-D引导下的TBB以诊断PPL[平均大小（22.9±9.5）mm]，对其病历进行回顾性审查和分析。使用4mm细支气管镜和1.4mm径向超声探头进行EBUS检查。EBUS-D是在观察到PPL的EBUS图像时测量PPL与目标支气管开口或支气管镜工作通道外口之间的距离，然后将活检钳推进到该测量距离并进行活检。

结果

EBUS的可视化率为77.8%（91/117）。EBUS-D引导下TBB的总体诊断率为65.0%（76/117），恶性和良性病变的诊断率分别为75.0%（66/88）和34.5%（10/29）。直径>20mm的PPL的诊断率显著高于直径≤20mm的PPL（78.7%，48/61对50.0%，28/56）（χ²=10.56，P=0.001）。叶分布之间的诊断率无显著差异（右上叶61.8%，21/34；右中叶91.7%，11/12；右下叶59.1%，13/22；左上叶57.1%，12/21；舌叶80.0%，4/5；左下叶65.2%，15/23）（χ²=5.31，P=0.38）。对于平均大小≤20mm且靠近脏层胸膜的病变，诊断敏感性仅为18.2%。有时径向探头可无阻力地穿过PPL，这种情况下诊断率较低。包括出血和胸痛在内的并发症可自发恢复。