摘要
背景与目的:经气管肺部病变活检具有并发症低的优点,但对于周围型肺结节,传统支气管镜的诊断率极低。目前常用的提高周围型肺结节诊断率的导航技术在在诊断率及安全性方面的差异还不十分清楚,比较径向支气管内超声(radial endobronchial ultrasound,R-EBUS)引导支气管镜、LungPro导航支气管镜、R-EBUS联合LungPro导航支气管镜对周围型肺结节的诊断率和安全性的差异并探讨快速现场细胞学评估(cytological rapid on-site evaluation,C-ROSE)在诊断中的价值。方法:将2018年11月—2019年4月在昆明医科大学第三附属医院行气管镜检查且符合纳入及排除标准的255例周围型肺结节患者随机分为3组:R-EBUS组(85例)、LungPro导航组(85例)和R-EBUS+LungPro导航组(85例),3组均行C-ROSE,比较3组之间的导航时间、手术操作时间、出血量、诊断率及并发症的发生率。结果:LungPro导航组和R-EBUS+LungPro导航组诊断率分别为85.9%(73/85)和87.1%(74/85),显著高于R-EBUS组的诊断率[72.9%(62/85)](P<0.05),但LungPro导航组和R-EBUS+LungPro导航组之间差异无统计学意义(P>0.05)。R-EBUS组病灶导航时间为(11.34±12.95)min,手术时间为(28.37±1.98)min,显著长于LungPro导航组[(3.72±0.71)min,(19.35±1.53)min]和R-EBUS+LungPro导航组[(6.12±1.14)min,(21.00±1.97)min](P<0.001),LungPro导航组导航时间及手术时间均显著低于R-EBUS+LungPro组(P<0.001)。R-EBUS组出血量为(4.18±1.42)mL,LungPro导航组为(4.26±1.00)mL,R-EBUS+LungPro导航组为(4.41±1.19)mL,3组间差异无统计学意义(P>0.05)。R-EBUS组发生气胸2例(2.3%,2/85),LungPro导航组发生气胸2例(2.3%,2/85),胸膜反应1例(1.2%,1/85),R-EBUS+LungPro导航组发生气胸1例(1.2%,1/85),未见其他严重并发症。C-ROSE评估与病理学检查结果诊断符合率为83.9%,灵敏度为83.7%、特异度为84.3%、阳性预测值87.9%,阴性预测值为79.1%。结论:LungPro导航可精确抵达病灶取得病理组织,有较高的诊断率,且有导航及手术时间短、安全、并发症少等优点,与C-ROSE结合可提高取样质量,减少活检、穿刺次数从而减少并发症发生。
Background and purpose:Transbronchial lung biopsy has the advantage of low complications.However the diagnostic rate of conventional bronchoscopy is extremely low for peripheral pulmonary nodules.The current differences in the diagnostic rate and safety of navigation techniques for improving the diagnosis rate of peripheral pulmonary nodules are not well understood.Therefore,this study compared the diagnostic yield and safety of radial endobronchial ultrasound(R-EBUS),LungPro Virtual Bronchoscopy Navigation System and combination of LungPro Virtual Bronchoscopy Navigation System and R-EBUS.At the same time,usefulness of cytological rapid on-site evaluation(C-ROSE)for the diagnosis of peripheral pulmonary lesions was evaluated.Methods:From Nov.2018 to Apr.2019,a total of 255 patients with pulmonary lesions who underwent bronchoscopy and met the criteria of inclusion and exclusion in the Third Affiliated Hospital of Kunming were enrolled.The subjects were randomly divided into one of three groups:radial endobronchial ultrasound group(R-EBUS group)(85 patients),LungPro Virtual Bronchoscopy Navigation System group(LungPro group)(85 patients)and combination of LungPro Virtual Bronchoscopy Navigation System and R-EBUS group(combined group)(85 patients).C-ROSE was carried out in these three groups.Sampling was performed by transbronchial lung biopsy.The diagnostic yield,complications,procedure time and operative blood loss were observed.Results:The diagnostic yields for peripheral pulmonary lesions of LungPro group and combined group were 85.9%(73/85)and 87.1%(74/85),significantly higher than that of R-EBUS group[72.9%(62/85)](P<0.05).There was no significant difference in diagnostic yield between LungPro group and combined group(P>0.05).The navigation time and operation time of R-EBUS group were(11.34±12.95)min and(28.37±1.98)min,significantly longer than those of LungPro group[(3.72±0.71)min and(19.35±1.53)min]and combined group[(6.12±1.14)min and(21.00±1.97)min](P<0.001).The navigation time and operation time of LungPro group were shorter than those of combined group(P<0.001).The operative blood loss was(4.18±1.42)mL in R-EBUS group,(4.26±1.00)mL in LungPro group and(4.41±1.19)mL in combined group.There was no significant difference in operative blood loss among three groups(all P>0.05).Two cases of pneumothorax were observed in R-EBUS group,2 cases of pneumothorax and 1 case of pleural reaction were observed in LungPro group,and 1 case of pneumothorax was observed in combined group.No severe adverse event occurred.The diagnostic accordance rate of C-ROSE was 83.9%.The diagnostic sensitivity,specificity,positive predictive value and negative predictive value of C-ROSE were 83.7%,84.3%,87.9%and 79.1%,respectively.Conclusion:LungPro Virtual Bronchoscopy Navigation System can help to improve the diagnostic yield for peripheral pulmonary lesions with a very low complication rate,short navigation time and operation time.Combination of LungPro Virtual Bronchoscopy Navigation System and C-ROSE can significantly improve specimen adequacy and decrease the number of biopsy and needle passes necessary to achieve an adequate pathological diagnosis with lower complication rate.
作者
陈琬玲
马煜辉
张祥武
黄秋博
赵光强
雷玉洁
彭薇
尹新
杨艳芬
谭慧
张磊
黄云超
CHEN Wanling;MA Yuhui;ZHANG Xiangwu;HUANG Qiubo;ZHAO Guangqiang;LEI Yujie;PENG Wei;YIN Xin;YANG Yanfen;TAN Hui;ZHANG Lei;HUANG Yunchao(Department of Thoracic SurgeryⅠ(Yunnan Lung Cancer Institute,Yunnan Provincial Key Laboratory of Lung Cancer Research),Yunnan Province Tumor Hospital(The Third Affiliated Hospital of Kunming Medical University,Yunnan Cancer Center),Kunming 650118,Yunnan Province,China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2020年第2期135-141,共7页
China Oncology
基金
国家重点研发计划共同开发肺癌早期诊断标志物谱及关键技术（2016YFE0103400）
关键词
支气管镜
全肺诊疗导航系统
径向支气管内超声
快速现场细胞学评价
周围型肺部病变
Bronchoscope
LungPro Virtual Bronchoscopy Navigation System
Radial endobronchial ultrasound
Cytological rapid on-site evaluation
Peripheral pulmonary lesions
