摘要目的 评价支气管超声下经引导鞘肺活检术(EBUS-GS-TBLB)对肺周围性病变(PPL)的诊断价值和安全性.方法 对2012年8月至2013年3月在上海市第十人民医院就诊的气管镜下未发现异常的肺周围性病变的患者行EBUS-GS-TBLB,观察诊断率和安全性,并总结影响诊断率的因素.结果 共有75例患者入选了本次研究,男46例,女29例,年龄34～ 81岁,平均(62±11)岁.气管镜检查时间为(15±6)min,平均每个PPL取得活检标本为(4.6±0.8)个.75例患者总计检查了78处PPL,其中65例患者的68处PPL可以在EBUS上显示.78处PPL中经EBUS-GS确诊58处,诊断率为74.4％,其中恶性疾病的诊断率为84.4％ (27/32),良性疾病的诊断率为67.4％ (31/46).提高EBUS-GS-TBLB诊断率的因素包括:病灶直径＞20 mm、超声下病灶包绕探头、CT影像见支气管征和病灶近中心.患者均能很好耐受EBUS-GS-TBLB操作,仅在操作时镜下见少许出血,无气胸、咯血等并发症.结论 EBUS-GS-TBLB创伤小、诊断率高、并发症少,用于诊断PPL安全有效,选择合适的病例可以提高诊断率.

abstractsObjective To evaluate the diagnostic yield and safety of endobronchial ultrasound transbronchial lung biopsy with guide-sheath (EBUS-GS-TBLB) in peripheral pulmonary lesions (PPL).Methods Between August 2012 and March 2013,EBUS-GS-TBLB was performed in patients with PPL inaccessible by conventional bronchosopy in Shanghai Tenth People' s Hospital.The diagnostic yield,safety and the associated factors were analyzed.Results Seventy five patients [46 males and 29 females,mean age (62.4 ± 11.4) years,ranged from 34 to 81 years] with PPL confirmed by computed tomography and conventional bronchosopy were recruited in this study.Mean bronchoscopic procedure time lasted for (15.4 ± 6.3) min.The average number of biopsy specimens obtained in each PPL was 4.6 ± 0.8.A total of 78 PPL were examined in 75 patients,and 68 PPL from 65 patients were detected by EBUS.Fifty eight PPL were diagnosed by EBUS-GS and the diagnostic rate was 74.4％.The diagnosis rate of malignancy was 84.4％ (27/32) while that of benign disease was 67.4％ (31/46).The most important factors that helped enhance EBUS-GS-TBLB diagnostic accuracy included lesion diameter greater than 20mm,EBUS probe within the lesions,the presence of a bronchus sign on CT imaging and central lesions.All the patients tolerated the procedure well.Mild bleeding was observed when performing biopsy in some patients.No pneumothorax,hemoptysis or other serious complications were observed.Conclusions The procedure of EBUS-GS-TBLB was minimally invasive,had higher diagnostic rate and fewer complications.It was a safe and effective method to diagnose PPL,while careful selection of suitable cases could further improve the diagnostic accuracy.