摘要
目的分析经超声支气管镜引导下肺活检术(R-EBUS-TBLB)对肺外周病变(PPLs)的诊断阳性率、影响因素及安全性,探讨支气管刷检及肺泡灌洗对肺癌和肺结核的诊断价值。方法收集我院2019年10月到2020年10月行R-EBUS-TBLB检查的212例患者的临床资料,分析诊断阳性率与病灶大小、病灶与探头位置、有无支气管充气征、病灶性质、病灶位置的关系,观察有无出血、气胸等并发症。并分析支气管刷检送脱落细胞对肺恶性肿瘤的诊断价值、肺泡灌洗液送检TB-GeneXpert对肺结核的诊断价值。结果使用R-EBUS-TBLB对PPLs的诊断阳性率为76.4%(162/212)。直径>2cm的病灶阳性率高于直径≤2cm的病灶(P<0.05)。诊断阳性率与探头和病灶的关系、是否具有支气管充气征无关。右肺中叶的诊断率高于其他肺叶,但差异并无统计学意义。支气管刷检送检脱落细胞确诊肺恶性肿瘤的敏感性73.4%(36/49),阳性预测值100%。肺泡灌洗液送检TB-GeneXpert确诊肺结核的敏感性87.5%,特异性100%。212例患者中仅有17例(8.0%)需要镜下局部止血,3例(1.4%)活检后出现气胸。结论R-EBUS-TBLB诊断阳性率较高、安全性较好。病灶性质、大小、部位是影响R-EBUS-TBLB诊断效能的主要因素。联合支气管刷检和肺泡灌洗液可较好的作为肺恶性肿瘤及肺结核的补充诊断方法。
Objective To analyze the positive rate,influencing factors,and safety of radial endobronchial ultrasound-guided trans-bronchial lung biopsy(R-EBUS-TBLB)for peripheral pulmonary lesions(PPLs),and to explore the diagnostic value of bronchial brush examination and bronchoalveolar lavage fluid(BALF)for lung cancer and tuberculosis.Methods The clinical data of 212 patients who underwent R-EBUS-TBLB examination in our hospital from October 2019 to October 2020 were collected.The relationship between the positive rate of diagnosis and the size of the lesion,the position of the probe,the presence or absence of bronchial inflation sign,the nature of the lesion,and the location of the lesion were analyzed.Whether there was bleeding,pneumothorax and other complications were observed.In addition,the diagnostic value of exfoliated cells from the bronchial brush for lung malignant tumor and the diagnostic value of TB-GeneXpert from BALF for tuberculosis were analyzed.Results The diagnostic positive rate of R-EBUS-TBLB for PPLs was 76.4%(162/212),and the positive rate of lesions with a diameter>2cm was higher than that of lesions with a diameter≤2cm(P<0.05).There was no relationship between the diagnostic positive rate and the lesion and probe position and whether there had a bronchial inflation sign.The diagnosis rate of the right middle lobe was higher than that of the other lobes,but the difference was not statistically significant.The sensitivity and positive predictive value of bronchial brush were 73.4%(36/49)and 100%for the diagnosis of lung malignant tumor.The sensitivity and specificity of TB-Genexpert collected from BALF to detect pulmonary tuberculosis was 87.5%and the specificity was 100%.Only 17(8.0%)of 212 patients required microscopic local hemostasis,and 3(1.4%)developed pneumothorax after biopsy.Conclusion R-EBUS-TBLB has a diagnostic positive rate and good safety.The nature,size,and location of lesions are the main factors affecting the diagnostic performance of R-EBUS-TBLB.Combined bronchial brushing and BALF can be used as supplementary diagnostic methods for lung cancer and tuberculosis.
作者
冷再君
章俊强
夏淮玲
夏大庆
徐敏
操乐杰
LENG Zai-jun;ZHANG Jun-qiang;XIA Huai-ling;XIA Da-qing;XU Min;CAO Le-jie(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of USTC/Anhui Provincial Hospital,Hefei,Anhui 230000,China)
出处
《临床肺科杂志》
2022年第7期1020-1025,共6页
Journal of Clinical Pulmonary Medicine
关键词
超声支气管镜
外周肺病变
经支气管肺活检
肺泡灌洗液
支气管刷检
radial endobronchial ultrasound bronchoscope
peripheral pulmonary lesions
transbronchial lung biopsy
bronchoalveolar lavage fluid
bronchial brush biopsy
