Diagnostic Utility of Virtual Bronchoscopic Navigation Assisted Endobronchial Ultrasonography with Guide Sheath for Peripheral Pulmonary Lesions

: 【中文题目：虚拟支气管镜导航联合支气管超声导向鞘
引导肺活检术在肺周围性病变诊断中的应用】 【中文摘要：背景与目的 虚拟支气管镜导航（virtual bronchoscopic navigation, VBN）联合支气管超声导向鞘技术（endobronchial ultrasonography with guide sheath, EBUS-GS）用于经支气管肺活检术（transbronchus lung biopsy, TBLB），能够减少甚至避免射线暴露。本研究拟评价VBN联合EBUS-GS对肺周围性病变（pulmonary peripheral lesions, PPLs）的诊断价值及安全性。方法 回顾性分析2016年1月-2017年12月在北京大学肿瘤医院内镜中心接受EBUS-GS-TBLB患者的临床病理资料，评价诊断率及安全性，并对影响诊断率的因素进行分析。结果 121例患者纳入本研究，男性65例，女性56例；平均年龄（58.8±10.3）岁。108例（89.3%）可在EBUS图像中显示，共有89例（73.5%）经EBUS-GS-TBLB获得明确诊断。EBUS-GS-TBLB对恶性病变的诊断率为82.5%。联合刷检、活检及肺泡灌洗中两种或三种方式取检的诊断率（87.2%）高于仅采用单一方式取检（58.8%）（χ²=6.084, P=0.014）。影响EBUS-GS-TBLB诊断率的因素包括超声探头位于病灶内部（χ²=20.372, P=0.000）、病灶位于肺野内带及中带（χ²=10.810, P=0.001）。1例（0.8%）患者术中出血量较多。结论 VBN联合EBUS-GS-TBLB是一种诊断PPLs安全且有效的方法。
】 【中文关键词：肺周围性病变；支气管超声导向鞘；虚拟支气管镜导航】. METHODS: We performed a retrospective analysis of the patients with PPLs who received VBN assisted EBUS-GS-TBLB in Peking University Cancer Hospital from January 2016 to December 2017. Their clinicopathologic data and complications were assessed. RESULTS: A total of 121 patients were enrolled in the study. The patients included 65 men and 56 women, with a mean age of (58.8±10.3) years. A total of 121 PPLs were examined, and 108 lesions of which could be detected by EBUS. The overall diagnostic yield of EBUS-GS was 73.5%. The diagnostic yield of malignancy was 82.5%. The combination of transbronchial lung biopsy, brush smear and bronchoalveolar lavage fluid provided the greatest diagnostic yield (χ²=6.084, P=0.014). Factors that significantly affected and predicted diagnostic success were EBUS probe within the lesions (χ²=20.372, P=0.000) and PPLs located in the central two-thirds of the lung (χ²=10.810, P=0.001). 1 patient (0.8%) suffered from intraoperative bleeding which could be managed under endoscopy. CONCLUSIONS: VBN assisted EBUS-GS-TBLB for PPLs was an effective and safe procedure.