超声支气管镜引导下经支气管纵膈冷冻活检术的操作难度及安全性

目的分析超声支气管镜(endobronchail ultrasound, EBUS)引导下经支气管纵膈冷冻活检术的操作难易程度和安全性。 方法选取2019年10月至2019年12月我院收治的25例纵膈病变患者,术前根据胸部CT等检查评估患者病变大小和位置,与周围组织关系,以及基础疾病情况。患者序贯接受EBUS引导下经支气管针吸活检术和纵膈冷冻活检术,对比两种术式的操作时间、术中指引情况、操作难度评分和围手术期并发症。 结果患者顺利完成EBUS引导下纵膈病变的活检操作。EBUS引导下纵膈活检的操作总体时间为(31.9±7.6)min。冷冻活检与针吸活检相比,两者的操作时间无统计学差异,穿刺活检(8.7±1.8)min vs.冷冻活检(9.3±4.3)min(P>0.05)。两种活检方式的术中指引情况和操作难度评分无统计学差别。患者未出现严重气道出血、纵膈气肿等围手术期并发症。 结论EBUS引导下经支气管纵膈冷冻活检术的操作难度与传统针吸活检无明显差异,安全性好,适合临床开展的纵膈活检新术式。

Opeerative difficulty and safety of ultrasound-guided transbronchial mediastinal cryobiopsy

ObjectiveTo assess the operative difficulty and safety of ultrasound guided transbronchial mediastinal cryobiopsy. MethodsRandomly selected 25 patients with mediastinal diseases hospitalized in the Second Affiliated Hospital of the Army Military Medical University from October 2019 to December 2019, and assessed the size and location of the lesions, the relationship with the surrounding tissues, and the underlying diseases according to chest CT and other examinations before surgery. All patients received ultrasound bronchoscope guided transbronchial needle aspiration biopsy and mediastinal cryobiopsy sequentially. The operation time, intraoperative guidance, operation difficulty score and perioperative complications of the two methods were compared. ResultsAll patients successfully completed ultrasound bronchoscopy guided mediastinal biopsy. The total operation time of mediastinal biopsy guided by ultrasound bronchoscope was (31.9±7.6)minutes. There was no significant difference in the operation time between cryobiopsy and needle aspiration biopsy (8.7±1.8)minutes for needle aspiration biopsy vs.(9.3±4.3)minutes for cryobiopsy; P>0.05). In addition, there was no statistical difference in intraoperative guidance and operation difficulty scores between the two biopsy methods. No perioperative complications such as severe airway bleeding and mediastinal emphysema occurred in any patients. ConclusionUltrasound bronchoscope guided transbronchial mediastinal cryobiopsy has no significant difference in operation difficulty compared with traditional needle aspiration biopsy, and is safe. It is a new method of mediastinal biopsy suitable for clinical development.