摘要目的 探讨虚拟导航支气管镜(VBN)辅助导向鞘引导的超声支气管镜(EBUS-GS)对早期周围型肺癌的诊断价值.方法 收集2015年12月至2016年12月第四军医大学唐都医院呼吸科经胸部CT疑诊为早期周围型肺癌(8 mm<结节直径≤30 mm)且接受支气管镜检查的患者,采用随机数字表法分为VBN辅助EBUS-GS组(VBNA组)及EBUS-GS组(NVBNA组).观察两种检查方法对病灶的可视率、诊断率、影响因素、操作时间及并发症的差异,采用独立样本t检验或 χ2检验对实验数据进行分析.结果 共有134例患者完成了本项研究,男74例,女60例,VBNA组64例,NVBNA组70例.VBNA组的可视率、诊断率分别为87.5％(56/64)和78.1％(50/64),操作总时间及确认病灶位置的时间分别为(25±5)和(5.8±1.3)min;NVBNA组对病灶的可视率、诊断率分别为81.4％(57/70)和75.7％(53/70),操作总时间及确认病灶位置的时间分别为(27±6)和(9.8±1.5)min.两组间可视率、诊断率的差异无统计学意义(χ2=0.933,P=0.334;χ2=0.109,P=0.838),操作总时间差异无统计学意义(t=0.633,P=0.524),但确认病灶位置的时间差异有统计学意义(t=17.41,P<0.01).亚组分析结果显示,EBUS-GS肺活检的诊断率可能与超声探头与病灶位置关系及病变大小有关.所有患者均能耐受检查,无气胸、胸痛等严重不良反应发生,VBNA组有3例活检部位出血,NVBNA组7例有少量的活检部位出血,并发症的发生率差异无统计学意义(χ2=1.366,P=0.330).结论 应用VBN辅助EBUS-GS不能提高肺外周孤立结节的诊断率和可视率,但可以明显缩短EBUS-GS探及病灶位置的时间.VBN联合EBUS-GS是一种并发症少、安全性高的诊断方法.

abstractsObjective To explore the diagnostic value and safety of endobronchial ultrasonography with guide-sheath (EBUS-GS) combined with virtual bronchoscopy navigation (VBN) in peripheral lung cancer.Methods Between Dec.2015 to Dec.2016, patients with pulmonary solitary nodule suspected of early lung cancer on computed tomography (CT) in Department of Respiratory, Tangdu Hospital, Fourth Military Medical University were enrolled for this study . The patients underwent EBUS -GS transbronchoscopic lung biopsy ( TBLB ) with or without VBN.The visibility rate, diagnostic yield, influencing factors, the operation time and complications were evaluated in the 2 groups.The data were compared using independent sample t test or chi-squared test.Results A total of 134 patients were enrolled and completed this study.Among them 74 were males and 60 were females.There were 64 cases in the group of EBUS-GS with VBN (VBNA), and 70 in the group without VBN (NVBNA).The visibility rate and diagnosis rate of VBNA group were 87.5％ (56 /64) and 78.1％ (50 /64), respectively.The mean time of operation and confirming the target lesions were (25 ±5), (5.8 ±1.3) min, respectively.The visibility rate and diagnosis rate of NVBNA group were 81.4％(57 /70) and 75.7％(53/70), respectively. The mean time of operation and confirming the target lesions were (27 ±6),(9.8 ±1.5)min .There was no significant difference in the visibility rate and diagnosis rate between the 2 groups (χ2 =0.933,P =0.334;χ2 =0.109,P =0.838) .There was no significant difference in the mean operation time between the 2 groups(t =0.633,P =0.524) .But the time of confirming the target lesions between the 2 groups was statistically different (t =17.41,P <0.01).EBUS-GS-TBLB was well tolerated.No severe complications such as pneumothorax or chest pain were observed .There were 3 patients in the VBNA group and 7 patients in the NVBNA group experiencing a small amount of biopsy site bleeding .The incidence of complications did not differ between the 2 groups ( χ2 =1.366, P =0.330) .Conclusions VBN could not improve the diagnostic yield of EBUS-GS.However, it could shorten the time needed to confirm the target lesions and did not increase the incidence of EBUS -GS complications, indicating that EBUS-GS with VBN was a safe and effective method.