CT引导下经纤维支气管镜肺活检对肺孤立结节诊断的应用研究

目的探讨CT引导下经纤维支气管镜肺活检（TBLB）对肺孤立结节诊断的应用价值。方法对60例肺孤立结节病例随机分为CT引导下TBLB组和CT引导下经皮肺穿刺活检组，分别统计两组病例在活检阳性率及并发症发生率方面是否有差异。结果在所有病例中，CT引导下TBLB阳性率为83．3％，CT引导下经皮肺穿刺活检阳性率为76．6％，两者差异无统计学意义伊〉0．051但对病灶距离胸膜面大于3cm者，CT引导下TBLB阳性率为93．8％，经皮肺穿刺活检阳性率为64．7％，两者差异有统计学意义（P〈0．05）。CT引导下TBLB气胸发生率为3．3％，CT引导下经皮肺穿刺活检气胸发生率为30％，两者差异有高度统计学意义（P〈0．01）CT引导下TBLB出血发生率为13．3％，CT引导下经皮肺穿刺活检出血发生率为20％，两者差异无统计学意义垆〉0．05）。结论CT引导下TBLB可应用于肺孤立结节的诊断，特别是对于病灶距离胸膜面大于3cm者，该技术可靠安全，值得在临床推广应用。

The diagnostic application of the transbronchial lung biopsy by CT-guide in the solitary pulmonary nodule

Objective To evaluate the diagnosis application of the transbronchial lung biopsy (TBLB) by CT-guide in solitary pulmonary nodule.Methods Sixty patients with solitary pulmonary nodule were randomized into CT-guided TBLB group and CT-guided percutaneous needle lung biopsy (NLB) group, biopsy positive rate and complications incidence were respectively analyzed.Results Pathological diagnostic positive rate were 83.3% , 76.6% in CT-guided TBLB group and CT_NLB group retrospectively, there were no significant differences betwent the two groups(p > 0.05); But in patients with solitary pulmonary nodule more than 3cm to pleura, diagnostic positive rate were 93.8 , 64.7% in CT-guided TBLB group and CT_NLB group respectively, there were significant differences betwent the two groups(p < 0.05). Pneumothorax incidence was 3.3% in CT-guided TBLB group, pneumothorax incidence was 30.0% in CT-guided NLB group, there were significant differences betwent the two groups (p < 0.01) Hemoptysis incidence were 13.3% in CT-guided NLB group and 20.0% in CT-guided TBLB group, there were no significant differences betwent the two groups(p > 0.05). Conclusion The CT-guided TBLB are reliable to the diagnose of solitary pulmonary peripheral nodule ,especially pulmonary nodule more than 3cm to pleura, the method may be widely used in clinic because of the higher accuracy and lower complication.