经电子气管镜冷冻肺活检在肺外周结节诊断中的价值

doi:10.3969/j.issn.2096-8493.20210038

摘要/Abstract

摘要：

目的探讨经电子气管镜径向超声引导下冷冻肺活检对肺结节的诊断价值。方法收集2019年1月至2021年1月河南省人民医院经胸部CT检查证实为肺结节(结节直径为8~30mm)且接受电子气管镜检查的97例患者。采用随机数字表法分为冷冻肺活检组(TBCB组;47例)和常规活检钳组(TBLB组;50例)。观察两种检查方法诊断率、操作时间、组织取材是否满意,以及两种检查方法并发症发生率的差异。结果 TBCB组诊断率为87.2%(41/47),高于TBLB组的70.0%(35/50),差异有统计学意义(χ²=4.240,P=0.039);TBCB组平均操作时间为(32.5±11.2)min,与TBLB组的(34.2±10.3)min比较,差异无统计学意义(t=0.938,P=0.351)。TBCB组取材满意率为87.2%(41/47),高于TBLB组的56.0%(28/50),差异有统计学意义(χ²=11.510,P<0.001)。所有患者均能耐受电子气管镜检查,未发生胸闷、胸痛等严重不良反应。TBCB组有13例(27.7%,13/47)患者出现少量至中等量出血,TBLB组有5例(10.0%,5/50)患者出现少量至中等量出血,均在给予球囊封堵、吸引或局部药物治疗后出血停止,TBCB组出血并发症的发生率高于TBLB组,差异有统计学意义(χ²=4.999,P=0.025)。结论经电子气管镜冷冻肺活检能够提高肺外周结节诊断的阳性率。冷冻肺活检最常引起的并发症为出血,可采用预置球囊或者在硬镜鞘管下进行操作。

关键词: 支气管镜检查, 活组织检查, 肺肿瘤, 诊断

Abstract:

Objective To investigate the diagnostic value of ultrasound-guided bronchoscopic cryobiopsy in diagnosing peripheral lung nodule. Methods From January 2019 to January 2021, 97 patients whose chest CT test showed lung nodules (8 mm < nodule diameter ≤30 mm) and then took electric bronchoscope were enrolled in He’nan Provincial People’s Hospital. Random number table method was used to allocate them into cryobiopsy group (TBCB group; 47 patients) and conventional forceps biopsy group (TBLB group; 50 patients). The difference of diagnosis rate, operation time, tissue sample satisfaction and complication occurrence between the two methods were observed. Results Diagnostic rate of TBCB group was 87.2% (41/47), significantly higher than the TBLB group (70.0%, 35/50; χ ²=4.240, P=0.039). Average total operating time of TBCB group was (32.5±11.2) min, no significant difference was observed compared with TBLB group ((34.2±10.3) min, t=0.938, P=0.351). Tissue sample satisfaction rate of TBCB group was 87.2% (41/47), significantly higher than the TBLB group (56.0%, 28/50; χ ²=11.510, P<0.001). All patients were able to tolerate bronchoscopy, no serious adverse reactions such as chest tightness, chest pain occurred. Thirteen (27.7%, 13/47) patients in the TBCB group had a mild to moderate amount of bleeding, while the TBLB group had 5 (10.0%, 5/50) patients experienced this. All of them stopped bleeding after receiving balloon occlusion, suction or local medication. The incidence of bleeding in TBCB group was significantly higher than the TBLB group (χ ²=4.999, P=0.025). Conclusion Cryobiopsy could be used to improve the positive rate of peripheral nodule diagnosis. The most common complication caused by cryobiopsy was bleeding, it should be performed with a preset balloon or using rigid bronchoscope sheath.

Key words: Bronchoscopy, Biopsy, Lung neoplasms, Diagnosis

张群成, 李向南, 徐志伟, 孙冠男, 杨会珍, 程东军, 张晓菊. 经电子气管镜冷冻肺活检在肺外周结节诊断中的价值[J]. 结核与肺部疾病杂志, 2021, 2(3): 205-209. doi: 10.3969/j.issn.2096-8493.20210038

ZHANG Qun-cheng, LI Xiang-nan, XU Zhi-wei, SUN Guan-nan, YANG Hui-zhen, CHENG Dong-jun, ZHANG Xiao-ju. Diagnostic value of bronchoscopic cryobiopsy for diagnosing peripheral lung nodule[J]. Journal of Tuberculosis and Lung Disease, 2021, 2(3): 205-209. doi: 10.3969/j.issn.2096-8493.20210038

图/表 3

表1

基线时期各临床特征在两组患者中的分布情况

临床特征	常规活检钳组(50例)	冷冻肺活检组(47例)	统计检验值	P值
年龄(岁, $x ¯$ ±s)	66.5±10.2	65.8±7.9	t=0.376	0.354
性别[例(构成比,%)]			χ²=0.006	0.936
男性	27(54.0)	25(53.2)
女性	23(46.0)	22(46.8)
吸烟[例(构成比,%)]			χ²=0.485	0.486
是	28(56.0)	23(48.9)
否	22(44.0)	24(51.1)
结节大小(mm, $x ¯$ ±s)	21.2±8.5	22.3±9.1	t=0.616	0.540
结节中心距离胸膜的距离(mm, $x ¯$ ±s)	25.2±14.6	24.6±11.2	t=0.226	0.822
结节的位置[例(构成比,%)]			χ²=3.429	0.634
右肺上叶	15(30.0)	11(23.4)
右肺中叶	4(8.0)	2(4.3)
右肺下叶	8(16.0)	13(27.6)
左肺上叶	8(16.0)	5(10.6)
左肺舌叶	3(6.0)	2(4.3)
左肺下叶	12(24.0)	14(29.8)

表1

图1~6

表2

参考文献 16

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分类	常规活检钳组	冷冻肺活检组	χ²值	P值
总诊断	70.0(35/50)	87.2(41/47)	4.240	0.039
超声探头位置
结节内部	93.5(29/31)	93.1(27/29)	0.005	0.945
临近结节	33.3(5/15)	76.9(10/13)	5.320	0.021
结节之外	1/4	1/5	0.667	0.414
结节的性质
实性结节	76.7(33/43)	92.1(35/38)	32.750	<0.001
磨玻璃结节	2/7	6/9	1.016	0.313
结节大小(mm)
10~19	25.0(3/12)	5/8	1.467	0.226
20~30	84.2(32/38)	89.7(35/39)	0.147	0.702
结节中心距离胸膜的距离(mm)
<20	44.4(8/18)	64.3(9/14)	1.245	0.265
>20	84.4(27/32)	93.9(31/33)	0.711	0.399
取材满意率^a	56.0(28/50)	87.2(41/47)	11.510	<0.001
最终诊断
恶性肿瘤	83.3(35/42)	89.7(35/39)	3.023	0.082
良性疾病	4/8	5/8	15.320	<0.001
并发症
出血	10.0(5/50)	27.7(13/47)	4.999	0.025
气胸	2.0(1/50)	2.1(1/47)	0.450	0.502