高分辨率CT引导下超细支气管镜对周围型肺病变的诊断价值

The diagnostic value of high-resolution CT-guided ultra-fine bronchoscopy in peripheral pulmonary lesions

摘要:

目的 分析高分辨率CT引导下超细支气管镜对周围型肺病变（PPL）的诊断价值。方法 选取2024年1月—2024年12月开滦总医院132例经胸部CT检查提示PPL的患者为研究对象，按照随机数字表法分为对照组与观察组，每组66例。对照组采取高分辨率CT引导下常规支气管镜，观察组采取高分辨率CT引导下超细支气管镜。比较两组的诊断率及并发症发生率。结果 观察组与对照组的性别、年龄、病灶位置、病灶距胸壁距离、临床症状、病灶直径比较，差异均无统计学意义（P >0.05）。观察组恶性病变35例，其中腺癌12例，未分类恶性肿瘤10例，鳞癌6例，其他非小细胞肺癌4例，转移瘤2例，小细胞癌1例；良性病变25例，其中细菌性肺炎9例，肺结核8例，良性结节4例，真菌性肺炎2例，肺脓肿、机化性肺炎各1例。对照组恶性病变25例，其中腺癌9例，未分类恶性肿瘤6例，鳞癌5例，其他非小细胞肺癌3例，小细胞癌、转移瘤1例；良性病变23例，其中细菌性肺炎9例，肺结核6例，肺脓肿5例，良性结节3例。所有明确诊断的病变中，45.45%的患者为恶性病变，其中腺癌占比较高，为15.91%；36.36%的患者为良性病变，其中细菌性肺炎占比较高，为13.64%。观察组诊断率为90.90%（60/66），对照组为72.73%（48/66），观察组诊断率高于对照组（P <0.05）。所有气胸患者压缩体积<30%，未穿刺引流，且出院前胸部X射线检查结果显示气胸已有明显改善；出血患者的出血量<50 mL，镜下给予肾上腺素及凝血酶局部止血，出血未有进展。观察组并发症总发生率低于对照组（P <0.05）。结论 高分辨率CT引导下超细支气管镜技术在PPL的诊断中具有显著优势，临床应用安全性尚可。

Abstract:

Objective To analyze the diagnostic value of high-resolution CT-guided ultrafine bronchoscopy for peripheral pulmonary lesions (PPL).Methods A total of 132 patients with PPL indicated by chest CT examination in Kailuan General Hospital from January 2024 to December 2024 were selected and randomly divided into 2 groups, with 66 cases in each group, by the random number table method. The control group received conventional bronchoscopy guided by high-resolution CT, and the observation group received ultrafine bronchoscopy guided by high-resolution CT. The diagnostic rates and complication rates of the two groups were compared.Results When comparing the gender composition, age, lesion location composition, distance composition from the lesion to the chest wall, clinical symptom composition and lesion diameter composition between the observation group and the control group, there were no statistically significant differences (P > 0.05). In the observation group, there were 35 cases of malignant lesions, including 12 cases of adenocarcinoma, 10 cases of unclassified malignant tumors, 6 cases of squamous cell carcinoma, 4 cases of other non-small cell lung cancers, 2 cases of metastatic tumors, and 1 case of small cell carcinoma. There were 25 cases of benign lesions, including 9 cases of bacterial pneumonia, 8 cases of pulmonary tuberculosis, 4 cases of benign nodules, 2 cases of fungal pneumonia, 1 case each of lung abscess and organized pneumonia. In the control group, there were 25 cases of malignant lesions, including 9 cases of adenocarcinoma, 6 cases of unclassified malignant tumors, 5 cases of squamous cell carcinoma, 3 cases of other non-small cell lung cancers, and 1 case of small cell carcinoma and metastatic tumor. There were 23 cases of benign lesions, including 9 cases of bacterial pneumonia, 6 cases of pulmonary tuberculosis, 5 cases of lung abscess and 3 cases of benign nodules. Among all the clearly diagnosed lesions, 45.45% of the patients had malignant lesions, among which adenocarcinoma accounted for a relatively high proportion, at 15.91%. 36.36% of the patients had benign lesions, among which bacterial pneumonia accounted for a relatively high proportion, at 13.64%. The diagnosis rate of the observation group was 90.90% (60/66), and that of the control group was 72.73% (48/66). The diagnostic rate of the observation group was higher than that of the control group (P < 0.05). All patients with pneumothorax had a compressed volume of less than 30%, no puncture and drainage, and chest X-rays before discharge showed that the pneumothorax had been significantly absorbed. The bleeding volume of the patient was less than 50 mL. Epinephrine and thrombin were given for local hemostasis under the microscope, and the bleeding did not progress further. The comparison of the incidence of complications between the observation group and the control group was conducted. The incidence of complications in the observation group was lower than that in the control group (P < 0.05).Conclusion The ultrafine bronchoscopy technique guided by high-resolution CT has significant advantages in the diagnosis of PPL, and its clinical application safety is acceptable.