肺周围型病灶应用EBUS-TBLB、CT引导肺活检的对比研究

Comparison of endobronchial ultrasound-guided transbronchial lung biopsy and CT-guided percutaneous lung biopsy of peripheral pulmonary lesions

摘要:

探究常规CT引导、强化CT引导经皮肺穿刺活检，以及支气管内超声引导经支气管镜肺穿刺活检（EBUS-TBLB）在肺周围型病变的诊断价值。方法选取2012 年1 月-2014 年1 月该院452 例肺周围型病灶患者的临床资料。根据肺活检方法不同，分为常规CT 引导组180 例、强化CT 引导组132 例、EBUSTBLB组140 例，比较3 种活检方法取材满意率、肺癌确诊率、并发症发生率、敏感性、特异性、准确性及相关影响因素。结果EBUS-TBLB 组和强化CT 引导组在气胸发生率、咯血或咯血增大率方面低于常规CT引导组（ p<0.05）并且EBUS-TBLB 组气胸发生率低于强化CT 引导组（ p<0.05）；3 种穿刺活检方法敏感性、特异性、准确性均较高。影响因素分析：在常规CT引导组，病灶大小与气胸发生率及咳血或咳血增大率相关（p <0.05），在常规CT 和强化CT引导组，病灶和胸壁的距离与气胸发生率相关（ p<0.05）。结论常规CT 引导、强化CT引导经皮肺穿刺及EBUS-TBLB均可作为肺周围型病变的诊断手段，其中EBUS-TBLB损伤小、安全性高。

关键词:肺周围型病变;CT 引导经皮肺穿刺;支气管内超声引导经支气管镜肺穿刺活检;诊断价值

Abstract:

To study diagnostic value of CT-guided and enhanced CT-guided percutaneous lung biopsy and endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) in patients with pulmonary peripheral lesions. Methods In this study 452 patients suspected as pulmonary peripheral lesions from January 2012 to January 2014 were divided into conventional CT-guided group (180 cases), enhanced CT-guided group(132 cases) and EBUS-TBLB group (140 cases). Tissue-obtaining accuracy rate, accuracy rate of lung cancer diagnosis, incidences of complications, sensitivity, accuracy and specificity were compared among the three biopsy methods. Results The incidences of pneumothorax and hemoptysis or the increasing rate of hemoptysis in the EBUS-TBLB and enhanced CT-guided groups were significantly lower than those in the conventional CT-guided group ( p< 0.05). The incidence of pneumothorax in the EBUS-TBLB group was significantly lower than that in the enhanced CT-guided group (p < 0.05). The sensitivity, specificity and accuracy of the three detection methods were high. The lesion diameter was in close correlations with pneumothorax incidence, and hemoptysis or hemoptysis increasing rate in the conventional CT-guided group (p < 0.05), and there was a close correlation between pneumothorax incidence and the lesion location in the conventional CT-guided and the enhanced CT-guided groups ( p< 0.05). Conclusions Conventional CT-guided and enhanced CT-guidedpercutaneous lung biopsy and EBUS-TBLB can be used as diagnostic methods of pulmonary peripheral lesions, among them EBUS-TBLB has the advantages of little injury and high safety.

Key words:pulmonary peripheral lesion; CT-guided percutaneous lung biopsy; endobronchial ultrasoundguided transbronchial lung biopsy; diagnostic value