本文選題：支氣管鏡檢查　切入點(diǎn)：支氣管內(nèi)超聲檢查　出處：《第三軍醫(yī)大學(xué)學(xué)報》2017年17期 　論文類型：期刊論文

【摘要】：目的探討氣道內(nèi)徑向超聲(radial endobronchial ultrasound,R-EBUS)引導(dǎo)下經(jīng)支氣管鏡檢查在診斷周圍性肺部病變(peripheral pulmonary lesions,PPLs)中的應(yīng)用價值,評估其診斷成功率、安全性及影響因素。方法回顧性分析2015年1月至2017年3月在我院呼吸內(nèi)鏡室行徑向超聲引導(dǎo)下經(jīng)支氣管鏡活檢(R-EBUS transbronchial biopsy,R-EBUS TBB)和刷檢的140例患者的臨床資料,篩選出83例PPLs患者,觀察EBUS對病變的定位能力,分析其診斷成功率及影響因素,觀察有無并發(fā)癥,進(jìn)行安全性評估。結(jié)果 83例患者中男性55例,女性28例,年齡(59.81±11.85)歲。R-EBUS引導(dǎo)下經(jīng)支氣管鏡檢查總診斷成功率59.04%(49/83),其中肺惡性病變診斷率50.94%(27/53),非惡性病變診斷率73.33%(22/30);R-EBUS TBB診斷率(56.92%,37/65)高于經(jīng)支氣管鏡刷檢診斷率(30.12%,25/83)(χ2=10.76,P=0.001);支氣管鏡下超聲引導(dǎo)聯(lián)合測量技術(shù)(EBUS-D)診斷率為60.00%(45/75),經(jīng)導(dǎo)向鞘引導(dǎo)的超聲支氣管鏡(EBUS-GS)診斷率為50.00%(4/8),二者相比差異無統(tǒng)計學(xué)意義(χ2=0.03,P=0.87)。病灶直徑10.0~52.4 mm,其中直徑≤20 mm者診斷率(36.84%,7/19)低于直徑20 mm者(65.62%,42/64)(χ2=5.02,P=0.03);各葉段病灶診斷率分別為右上葉46.15%(12/26),右中葉100.00%(8/8),右下葉53.85%(7/13),左上葉固有段37.50%(3/8),左上葉舌段63.64%(7/11),左下葉70.59%(12/17),差異無統(tǒng)計學(xué)意義(χ2=10.05,P=0.07);而上葉(22/45,48.89%)診斷率低于中/下葉(27/38,71.05%)(χ~2=4.18,P=0.04)。R-EBUS明確病變位置者74例(89.16%,74/83),9例超聲下未發(fā)現(xiàn)目標(biāo)病變,超聲探頭位于病變區(qū)域內(nèi)者診斷率(81.58%,31/38)明顯高于病變偏離探頭者(50.00%,18/36)(χ~2=8.24,P=0.004)。并發(fā)癥僅為經(jīng)氣管鏡取材部位少量出血,無氣胸等的發(fā)生。結(jié)論 R-EBUS可準(zhǔn)確定位肺部周圍性病變,提高PPLs的診斷率,安全可行;EBUS-D對PPLs診斷具有較高陽性率,且節(jié)約成本;病灶大小、徑向超聲探頭與靶病變的位置關(guān)系是影響其診斷率的主要因素。
[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 鹵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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