中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2014年
8期
579-582
,共4页
陈愉%李时悦%陈汉章%钟长镐%钟南山
陳愉%李時悅%陳漢章%鐘長鎬%鐘南山
진유%리시열%진한장%종장호%종남산
活组织检查%支气管镜%电磁导航%肺外周微小病变
活組織檢查%支氣管鏡%電磁導航%肺外週微小病變
활조직검사%지기관경%전자도항%폐외주미소병변
Biopsy%Bronchoscopes%Electromagnetic navigation%Small peripheral pulmonary lesions
目的 评价电磁导航支气管镜实时引导定位下肺活检(ENB guide TBLB)对肺外周小病灶(直径＜3 cm)的诊断价值及其安全性.方法 对广州医科大学附属第一医院2011年9月1日至2012年5月30日收治的胸部螺旋CT显示为孤立性肺外周微小病变(直径＜3 cm)的患者进行电磁导航支气管镜实时引导定位下肺活检,同时以床旁X线定位肺活检作为对照,比较两种方法活检病理结果与最后诊断的符合程度,最后诊断通过外科手术切除病灶行病理检查或随诊12个月至临床治愈确诊.记录术中及术后的相关并发症以评价其安全性.结果 17例患者共20个肺外周微小病灶进行电磁导航实时引导下完成活检,其中男11例,女6例,平均年龄(53±14)岁,病灶平均直径为(1.8 ±0.7)cm;其中11例患者行手术治疗,6例患者经内科治疗并随诊超过12个月均达到临床治愈.肺活检组织病理结果与最后诊断符合率:电磁导航组为80.0％ (16/20),X线透视组为45.0％(9/20),两组确诊率差异有统计学意义(x2=5.227,P=0.048).亚组分析:病灶直径为2～3 cm时两组确诊率差异无统计学意义(x2 =0.000,P=1.000);病灶直径＜2 cm时,两组确诊率差异有统计学意义(x2=8.224,P=0.012).使用ENB方法时,病灶直径为2～3 cm与＜2 cm时确诊率差异无统计学意义(x2=0.208,P=1.000);导航计划图的胸部CT层厚为1 cm时确诊率高于层厚为2 cm时(x2 =6.111,P=0.026);病灶具有“支气管征”时确诊率高于不具有“支气管征”(x2 =6.111,P=0.026).结论 电磁导航支气管镜实时引导定位下对肺外周微小病灶行肺活检是安全的,并且具有较高的确诊率.
目的 評價電磁導航支氣管鏡實時引導定位下肺活檢(ENB guide TBLB)對肺外週小病竈(直徑＜3 cm)的診斷價值及其安全性.方法 對廣州醫科大學附屬第一醫院2011年9月1日至2012年5月30日收治的胸部螺鏇CT顯示為孤立性肺外週微小病變(直徑＜3 cm)的患者進行電磁導航支氣管鏡實時引導定位下肺活檢,同時以床徬X線定位肺活檢作為對照,比較兩種方法活檢病理結果與最後診斷的符閤程度,最後診斷通過外科手術切除病竈行病理檢查或隨診12箇月至臨床治愈確診.記錄術中及術後的相關併髮癥以評價其安全性.結果 17例患者共20箇肺外週微小病竈進行電磁導航實時引導下完成活檢,其中男11例,女6例,平均年齡(53±14)歲,病竈平均直徑為(1.8 ±0.7)cm;其中11例患者行手術治療,6例患者經內科治療併隨診超過12箇月均達到臨床治愈.肺活檢組織病理結果與最後診斷符閤率:電磁導航組為80.0％ (16/20),X線透視組為45.0％(9/20),兩組確診率差異有統計學意義(x2=5.227,P=0.048).亞組分析:病竈直徑為2～3 cm時兩組確診率差異無統計學意義(x2 =0.000,P=1.000);病竈直徑＜2 cm時,兩組確診率差異有統計學意義(x2=8.224,P=0.012).使用ENB方法時,病竈直徑為2～3 cm與＜2 cm時確診率差異無統計學意義(x2=0.208,P=1.000);導航計劃圖的胸部CT層厚為1 cm時確診率高于層厚為2 cm時(x2 =6.111,P=0.026);病竈具有“支氣管徵”時確診率高于不具有“支氣管徵”(x2 =6.111,P=0.026).結論 電磁導航支氣管鏡實時引導定位下對肺外週微小病竈行肺活檢是安全的,併且具有較高的確診率.
목적 평개전자도항지기관경실시인도정위하폐활검(ENB guide TBLB)대폐외주소병조(직경＜3 cm)적진단개치급기안전성.방법 대엄주의과대학부속제일의원2011년9월1일지2012년5월30일수치적흉부라선CT현시위고립성폐외주미소병변(직경＜3 cm)적환자진행전자도항지기관경실시인도정위하폐활검,동시이상방X선정위폐활검작위대조,비교량충방법활검병리결과여최후진단적부합정도,최후진단통과외과수술절제병조행병리검사혹수진12개월지림상치유학진.기록술중급술후적상관병발증이평개기안전성.결과 17례환자공20개폐외주미소병조진행전자도항실시인도하완성활검,기중남11례,녀6례,평균년령(53±14)세,병조평균직경위(1.8 ±0.7)cm;기중11례환자행수술치료,6례환자경내과치료병수진초과12개월균체도림상치유.폐활검조직병리결과여최후진단부합솔:전자도항조위80.0％ (16/20),X선투시조위45.0％(9/20),량조학진솔차이유통계학의의(x2=5.227,P=0.048).아조분석:병조직경위2～3 cm시량조학진솔차이무통계학의의(x2 =0.000,P=1.000);병조직경＜2 cm시,량조학진솔차이유통계학의의(x2=8.224,P=0.012).사용ENB방법시,병조직경위2～3 cm여＜2 cm시학진솔차이무통계학의의(x2=0.208,P=1.000);도항계화도적흉부CT층후위1 cm시학진솔고우층후위2 cm시(x2 =6.111,P=0.026);병조구유“지기관정”시학진솔고우불구유“지기관정”(x2 =6.111,P=0.026).결론 전자도항지기관경실시인도정위하대폐외주미소병조행폐활검시안전적,병차구유교고적학진솔.
Objective To evaluate the diagnostic value and safety of electromagnetic navigation bronchoscopy real-time guidance lung biopsy (ENB-guided TBLB) of small peripheral lung lesions (diameter ＜ 3 cm).Methods Patients were selected by small peripheral pulmonary lesions (diameter ＜ 3cm) on thoracic CT in our hospital between September 1,2011 and May 30,2012.ENB-guided TBLB was performed by flexible bronchoscope,while fluoroscopy-guided lung biopsy was performed as a control.Then the diagnostic yield of ENB-guided and fluoroscopy-guided lung biopsy was compared.The final diagnosis was confirmed by pathologic examination of surgically removed lesions or by 12 month follow-up until clinical cure being confirmed.The intraoperative and postoperative complications were recorded.Results Seventeen patients (11 males,6 females) with 20 small peripheral pulmonary lesions all underwent ENB-guided TBLB.The patients' average age was (53 ± 14) yrs,and the lesions' average diameter was (1.8 ± 0.7) cm.Eleven patients finally received surgical resection,while other 6 patients received medical treatment and follow-up for more than 12 months to achieve clinical cure.Pathologic results showed that the diagnostic yield of ENB group was 80.0％ (16/20) and that of the fluoroscopy group was 45.0％ (9/20),the difference between the 2 groups being statistically significant (c2 =5.227,P =0.048).Subgroup analysis showed that,if the lesion diameter was 2-3 cm,the diagnostic yield between the 2 groups had no statistical difference (x2 =0.000,P =1.000),but if the lesion diameter was ＜ 2 cm,the diagnostic yield of the 2 groups was statistically different (x2 =8.224,P =0.012).In the ENB method,the diagnostic yield between the diameter of 2-3 cm group and the ＜ 2 cm group had no statistical difference (x2 =0.208,P =1.000).Analysis of the diagnostic yield of different navigation plan CT graph layer thickness showed that,the 1 cm group was higher than the 2 cm group (x2 =6.111,P =0.026).The diagnostic yield of lesions with "air bronchogram" was higher than that of lesions without "air bronchogram" (x2 =6.111,P =0.026).Conclusion Electromagnetic navigation bronchoscopy real-time guidance lung biopsy for small peripheral pulmonary lesions is safe,and has higher diagnostic rate.
