虚拟支气管镜导航联合经支气管超声导向鞘引导技术与常规支气管镜诊断周围型肺癌的临床研究

目的探讨虚拟支气管镜导航(VBN)联合经支气管超声导向鞘引导(EBUS-GS)探查技术在,诊断周围型肺癌中的价值。方法随机将385例周围型肺癌(高分辨CT诊断,8 mm≤结节直径≤30mm)患者分为3组,一组为VBN联合EBUS-GS组,一组为EBUS-GS组,另一组为常规支气管镜组。在VBN联合EBUS-GS组,支气管镜经VBN引导到达靶支气管,并用超声探头探查;EBUS-GS组只有超声探头探查,无VBN辅助;常规支气管镜组,则既无VBN辅助,亦无超声探查,仅有胸部CT片作为参考。结果可供分析的研究对象为最后诊断为原发性周围型肺癌的294例患者。VBN联合EBUS-GS组与EBUS-GS组在诊断率方面无显著差异(82.5%/81.3%,P0.05)。而与常规支气管镜组相比,诊断率有显著差异(82.5%/81.3%/43.3%,P0.05)。亚组分析显示,影响VBN联合EBUS-GS组和EBUS-GS组诊断率的因素,可能为CT影像显示有支气管直通病变,病变直径大于20 mm,超声探头是否在病变内。结论 VBN联合EBUS-GS或EBUS-GS可提高周围型肺癌的诊断率;提高其诊断率的影响因素可能包括,CT影像显示有支气管直通病变,病变直径大于20 mm,超声探头是否在病变内。

Clinical study on diagnosis of peripheral lung cancer with virtual bronchoscopic navigation combined with endobronchial ultrasonography with a guide sheath

Objective Virtual bronchoscopic navigation (VBN) can guide a bronchoscope under direct observation using virtual bronchoscopic images,VBN may be useful in diagnosing pulmonary lesions when combined with Endobronchial ultrasonography with a guide sheath (EBUS-GS).To evaluate the value of VBN-assisted EBUS-GS for diagnosing peripheral lung cancer.Methods All 385 patients with peripheral lung cancer diagnosed with HRCT(8 mm ≤ diameter ≤ 30 mm)were randomly assigned to VBN-assisted EBUS-GS group,non-VBN-assisted EBUS-GS group or conventional bronchoscopy group.Results Subjects for analysis include 294 patients diagnosed as primary lung cancer finally.There was no significant difference in the diagnostic yield between the VBN-assisted EBUS-GS group and the non-VBN-assisted EBUS-GS group(82.5％/ 81.3％,P＞0.05),but compared with conventional bronchoscopy group,the VBN-assisted EBUS-GS group and the non-VBN-assisted EBUS-GS group had a significantly higher diagnostic yield(82.5％/81.3％/43.3％,P＜ 0.05).The subgroup analysis showed that the following factors were associated with a significantly higher diagnostic yield:CT bronchus sign positivity,a lesion of ＞ 20 mm in diameter and a probe position that was within the lesion.Conclusions VBN-assisted EBUS-GS or EBUS-GS improves the diagnostic yield for peripheral lung cancer.The significant factors that were significantly associated with a successful diagnosis using EBUS-GS-guided TBB in peripheral lung cancer were as follows:CT bronchus sign positivity,a lesion of ＞20 mm in diameter and a probe position that was within the lesion.