天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (9): 925-930.doi: 10.11958/20170631

• 临床研究 • 上一篇    下一篇

虚拟内镜、GS 外周超声探头联合快速现场评价对孤立性肺结节的诊断价值

赵亚萍，王娟，谢巍，张鹏，冯靖，董丽霞，曹洁   

  1. 天津医科大学总医院呼吸科（邮编 300052）
  • 收稿日期:2017-06-02 修回日期:2017-06-21 出版日期:2017-09-15 发布日期:2017-09-25
  • 通讯作者: 赵亚萍 E-mail:1521594190@qq.com
  • 基金资助:
    国家自然科学基金委员会资助项目;天津市卫生行业重点攻关项目

The diagnostic value of virtual bronchoscopic navigation, endobronchial ultrasonography with a guide sheath and rapid on-site evaluation for solitary pulmonary nodules

ZHAO Ya-ping, WANG Juan, XIE Wei, ZHANG Peng, FENG Jing, DONG Li-xia, CAO Jie   

  • Received:2017-06-02 Revised:2017-06-21 Published:2017-09-15 Online:2017-09-25
  • Contact: Ya-Ping ZHAO E-mail:1521594190@qq.com

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摘要： 摘要：目的 探讨虚拟内镜、GS 外周超声探头下经支气管镜肺活检联合快速现场评价（ROSE）对孤立性肺结节 的诊断价值。方法 回顾性分析行纤维支气管镜检查的患者 178 例，所有患者胸 CT 表现为被肺组织包绕的孤立结 节且术中均行 ROSE。根据临床医师评估及患者意愿，行不同操作设备辅助下气管镜检查并按照操作设备不同分为 常规支气管镜（C-TBLB）组、虚拟内镜（VBN）组、GS 外周超声探头（GS）组、虚拟内镜联合 GS 外周超声探头组（联合组）。比较 4 组诊断率的差异，病灶位置、性质对诊断率的影响；比较 ROSE 和组织病理结果的符合率，并进一步评估ROSE 对疾病早期诊断的价值。结果 C-TBLB 组、VBN 组、GS 组和联合组的诊断率分别为 32.5%（13/40）、66.7%（24/36）、68.2%（30/44）、75.8%（44/58），C-TBLB 组与 VBN 组、GS 组、联合组比较差异均有统计学意义（χ2 分别为8.853，10.677，18.293，P＜0.008）；但后 3 组间比较差异无统计学意义（均 P＞0.008）；C-TBLB 组、VBN 组、GS 组和联合组肺外周区域结节诊断率分别为 12.5%（2/16）、42.9%（6/14）、40.0%（4/10）、75.9%（22/29），联合组高于其他 3 组（χ2=17.434，P＜0.05）。ROSE 与组织病理学结果一致性好（Kappa=0.775，P＜0.01）。ROSE 对孤立性肺结节诊断敏感度为 90.7%，特异度为 87.0%，阳性预测值为 86.7%，阴性预测值为 90.9%，准确率为 88.8%。所有患者无气胸、出血、继发感染等操作相关并发症。结论 虚拟内镜、GS 外周超声探头联合 ROSE 更适用于肺外周区域中孤立性结节的诊断。

关键词: 超声检查, 结节病, 肺, 肺肿瘤, 虚拟支气管镜导航, GS 外周超声探头, 快速现场评价, 孤立性肺结节, 外 周肺病变

Abstract: Abstract: Objective To investigate the diagnostic value of transbronchial lung biopsy (TBLB) under virtual bronchoscopic navigation (direct path), endobronchial ultrasonography with a guide sheath (GS) and rapid on-site evaluation (ROSE) for solitary pulmonary nodules (SPNs). Methods One hundred and seventy- eight patients who were underwent transbronchial lung biopsy in the Tianjin Medical University General Hospital between January 2015 to December 2016 were retrospectively evaluated. CT images of all patients showed solitary pulmonary nodules surrounded by lung tissue, and ROSE was undergone during the procedure. The patients were divided into conventional (C- TBLB) group, virtual bronchoscopic navigation (VBN) group, endobronchial ultrasonography with a guide sheath (GS) group, and virtual bronchoscopic navigation combined with endobronchial ultrasonography with a guide sheath group (combination) depending on the different devices. The diagnostic yield and the location or the effect of lesion on the diagnostic rate were compared between four groups. The coincidence rate of ROSE and the histopathological findings of TBLB were compared. The value of ROSE for the early diagnosis of disease was further evaluated. Results The diagnostic rates were 32.5% (13/40), 66.7% (24/36), 68.2% (30/44) and 75.8% (44/58) for C-TBLB group, VBN group, GS group and combination group, respectively. There were significant differences in diagnostic rates between C-TBLB group and other tree groups (χ2=8.853, 10.677 and 18.293, P＜ 0.008). But there were no significant differences in diagnostic rates between VBN group, GS group and combination group (P＞0.008). The diagnostic rates for peripheral pulmonary nodules were 12.5% (2/16), 42.9% (6/14), 40.0% (4/10) and 75.9% (22/29) in C-TBLB group, VBN group, GS group and combination group. The diagnostic rate was significantly higher in combination group than that of other three groups (χ2=17.434, P＜0.05). The result of ROSE was consistent with result of histopathology (Kappa = 0.775, P＜0.001). The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ROSE during transbronchial biopsy for solitary pulmonary nodules were 90.7%, 87.0%, 86.7%, 90.9% and 88.8% , respectively. No pneumothorax, hemoptysis or other serious complications were found in patients. Conclusion Virtual bronchoscopic navigation, endobronchial ultrasonography with a guide sheath for solitary pulmonary nodules by transbronchial lung biopsy can improve the diagnostic rate of solitary pulmonary nodules.

Key words: ultrasonography, sarcoidosis, pulmonary, lung neoplasms, virtual bronchoscopic navigation, endobronchial ultrasonography with guide sheath, rapid on-site evaluation, solitary pulmonary nodules, peripheral pulmonary lesion