摘要目的 评价使用细支气管镜行支气管内超声引导联合测量技术诊断肺周围病变的有效性、安全性和影响因素.方法 回顾性分析2013年10月至2014年9月在苏州大学附属第三医院进行支气管内超声引导联合测量技术经支气管活检的肺周围性病变117例患者临床资料.其中男67例,女50例,年龄(62.2±10.9)岁,病灶直径(22.9 ±9.5)mm.支气管内超声检查使用外径4 mm细支气管镜和外径1.4 mm超声小探头.测量技术是指超声发现病灶后测量病灶与目标支气管开口或者病灶与支气管镜活检通道入口的距离,根据所测距离在活检钳相应部位做标记,从而指导活检钳进入深度的方法.结果 支气管内超声小探头病灶发现率77.8％ (91/117),超声引导经支气管活检总诊断率65.0％ (76/117),恶性肿瘤诊断率75.0％(66/88),良性病变诊断率34.5％(10/29).直径＞2 cm的病灶诊断率(78.7％,48/61)高于直径≤2 cm者(50.0％,28/56),差异有统计学意义(x2=10.56,P=0.001).不同部位病灶诊断率分别为右上叶61.8％ (21/34),右中叶91.7％(11/12),右下叶59.1％ (13/22),左上固有支57.1％(12/21),左舌叶80％ (4/5),左下叶65.2％(15/23),差异无统计学意义(x2=5.31,P=0.38).贴近胸膜的病灶且直径≤2 cm者诊断率18.2％(2/11).超声探头能穿过的病灶诊断阳性率(63.0％,17/27)低于探头不能穿过者(92.2％,59/64),差异有统计学意义(x2=11.78,P=0.001).不良反应为出血和胸痛,无需特殊处理.结论 细支气管镜下超声引导联合测量技术经支气管活检可明确大部分肺周围病变的诊断,并发症少,费用低廉.病灶大小、是否贴近胸膜以及超声探头能否穿过病灶影响诊断率.

abstractsObjective To evaluate the efficacy,safety and factors related to diagnostic yield of transbronchial biopsy(TBB) using thin bronchoscopy to endobronchial ultrasonography with distance(EBUS-D) for peripheral pulmonary lesions (PPLs).Methods Between October 2013 to September 2014,117patients [67 males and 50 females,aged (62.2 ± 10.9) years] underwent EBUS-D-guided TBB for the diagnosis of PPLs [mean size (22.9 ± 9.5) mm] and their medical records were retrospectively reviewed and analysed.EBUS was performed using a 4-mm thin bronchoscope and a 1.4 mm radial ultrasound probe.EBUS-D was to measure the distance between the PPL to the target bronchial orifice or to the outer orifice of the working channel of the bronchoscope when an EBUS image of the PPL was observed,and then the biopsy forceps were advanced to this measured distance and biopsy followed.Results The visualization yield of EBUS was 77.8％ (91/117).The overall diagnostic yield was 65.0％ (76/117) by EBUS-D-guided TBB,and the diagnostic yield in malignant and benign lesions was 75.0％ (66/88) and 34.5％ (10/29),respectively.The diagnostic yield for PPLs ＞ 20 mm in diameter was significantly higher than that for those ≤20 mm in diameter (78.7％,48/61 versus 50.0％,28/56) (x2 =10.56,P =0.001).There was no significant difference in diagnostic yield between lobar distribution (right upper lobe 61.8％,21/34;right middle lobe 91.7％,11/12;right lower lobe 59.1％,13/22;left upper lobe 57.1％,12/21;lingula 80.0％,4/5;left lower lobe 65.2％,15/23) (x2 =5.31,P =0.38).The diagnostic sensitivity was only 18.2％ for lesions close to visceral pleura with mean size ≤ 20 mm.Sometimes radial probe could pass through the PPL without resistance,and the diagnostic yield was lower in this situation.Complications including bleeding and chest pain recovered spontaneously.Conclusion Using EBUS-D-TBB with a thin bronchoscope,the vast majority of peripheral pulmonary lesions could be identified.The modality was far more cost-effective than EBUS-GS and there were no significant complications associated with this procedure.Lesion size,connection to the visceral pleura and radial probe through the lesion influenced the diagnostic yield.