虚拟导航联合径向超声引导下经支气管镜肺活检在早期周围型肺癌诊断中的应用价值

目的探讨虚拟导航(VBN)联合径向超声(EBUS)引导下经支气管镜肺活检(TBLB)在早期周围型肺癌诊断中的应用价值。方法回顾性分析2016年6月至2019年9月于绍兴市人民医院呼吸内科住院或门诊就诊,胸部CT高度怀疑为周围型肺癌的患者188例,根据操作设备不同,分为经支气管镜肺活检组(TBLB组),径向超声组(EBUS+TBLB组)及虚拟导航联合径向超声组(VBN+EBUS+TBLB组),评估三种不同检查方法的诊断阳性率、安全性,以及EBUS组及VBN+EBUS组操作时间。结果TBLB组、EBUS组及VBN+EBUS组三组患者的诊断率分别为32.2% .64.3%及67.1%,差异有统计学意义(P<005),特别是直径为2~3 em的病灶差异更为明显。亚组分析显示,诊断率与病变肺叶无关,VBN能明显缩短操作时间,超声探头在病灶内部或紧邻病灶诊断率高。结论在TBLB的基础上联合VBN及EBUS在不增加并发症的情况下能大大提高周围型肺癌诊断的阳性率。

The value of virtual bronchoscopic navigation combined with endo-bronchial ultrasound guided transbronchoscope lung biopsy in the diagno-sis of early peripheral lung cancer

Objective To explore the value of virtual bronchoscopic navigation (VBN) combined with endobronchial ul-trasound (EBUS) guided transbronchoscope lung biopsy (TBLB) in the diagnosis of early peripheral lung cancer. Meth-ods A total of 188 patients who were highly suspected of peripheral lung cancer by chest CT in the Department of Respiratory Medicine of Shaoxing People''s Hospital from June 2016 to September 2019 were retrospectively analyzed.The patients were divided into the transbronchoscope lung biopsy group (TBLB group), endobronchial ultrasound group(EBUS+TBLB group), and virtual bronchoscopic navigation combined with endobronchial ultrasound group (VBN+E-BUS+TBLB group) according to different operating equipment. The diagnostic positive rate and safety of three different inspection methods, and the comparison in operating time between EBUS group and the V BN+ EBUS group were evalu-ated. Results The diagnosis rates of patients in the TBLB group, EBUS group, and VBN+EBUS group were 32.2%,64.3%, and 67.1%, and the difference was statistically significant (P<0.05). The difference was more obvious especially for lesions with a diameter of 2~3 cm. Subgroup analysis showed that the diagnosis rate had nothing to do with the dis-eased lobes, VBN could significantly shorten the operation time, and the ultrasound probe had a high diagnostic rate in the lesion or near the lesion. Conclusion Combining VBN and EBUS on the basis of TBLB can greatly increase the positive rate of peripheral lung cancer diagnosis without increasing complications.