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

doi:10.3877/cma.j.issn.1674-6902.2017.02.002

中华肺部疾病杂志(电子版) ›› 2017, Vol. 10 ›› Issue (02) : 124 -129. doi: 10.3877/cma.j.issn.1674-6902.2017.02.002

所属专题：文献；

论著

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

潘蕾¹, 薄丽艳¹, 李王平¹, 刘伟¹, 穆德广¹, 傅恩清¹, 谢永宏¹, 南岩东¹, 金发光¹^,^†(

)

^1. 710038　西安，第四军医大学唐都医院呼吸内科

收稿日期:2017-02-10 出版日期:2017-04-20
通信作者: 金发光
基金资助:
国家公益性行业科研专项(201402024)

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

Lei Pan¹, Liyan Bo¹, Wangping Li¹, Wei Liu¹, Deguang Mu¹, Enqing Fu¹, Yonghong Xie¹, Yandong Nan¹, Faguang Jin¹^,^†()

^1. Department of Pulmonary and Critical Care Medicine, Tangdu Hospital, the Fourth Military Medical University, Xi′an 710038, China

Received:2017-02-10 Published:2017-04-20
Corresponding author: Faguang Jin
About author:
Corresponding author: Jin Faguang, Email: jinfag@fmmu.edu.cn

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引用本文：

潘蕾, 薄丽艳, 李王平, 刘伟, 穆德广, 傅恩清, 谢永宏, 南岩东, 金发光. 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[J]. 中华肺部疾病杂志(电子版), 2017, 10(02): 124-129.

Lei Pan, Liyan Bo, Wangping Li, Wei Liu, Deguang Mu, Enqing Fu, Yonghong Xie, Yandong Nan, Faguang Jin. Clinical study on diagnosis of peripheral lung cancer with virtual bronchoscopic navigation combined with endobronchial ultrasonography with a guide sheath[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2017, 10(02): 124-129.

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≤30 mm)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%, P>0.05)。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%, P<0.05)。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。

关键词: 经支气管超声导向鞘引导, 虚拟支气管镜导航, 支气管肺癌, 经支气管镜活检

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.

Key words: Endobronchial ultrasonography with a guide sheath, Virtual bronchoscopic navigation, Bronchus lung cancer, Transbronchial biopsy

表1 三组的基线特征以及最终诊断[n(%)]

临床资料		VBN＋EBUS-GS(n＝97)	EBUS-GS(n＝107)	常规支气管镜(n＝90)
年龄(岁)		43～88	45～87	56～85
男性		58 (59.8)	69(64.5)	56(62.2)
病变位置	上叶	50	58	45
?	中叶或舌叶	10	11	9
?	下叶	37	38	36
病变大小，mm		8～29	8～30	8～30
≤20mm，n(%)		45 (46.4)	47 (43.9)	40(44.4)
>20～30mm, n(%)		52 (53.6)	60 (56.1)	50(55.6)
CT支气管征象		?	?	?
?	阳性	78	85	72
?	阴性	19	22	18
超声探头位置		?	?	?
?	病变内部	46	51	41
?	紧邻病变	33	37	32
?	病变之外	18	19	17
最后诊断		?	?	?
?	腺癌	66 (68.0)	74(69.2)	61(67.8)
?	鳞癌	13(13.4)	15(14.0)	11(12.2)
?	小细胞肺癌	7(7.2)	9(8.4)	7(7.8)
?	非小细胞肺癌	8(8.2)	9(8.4)	7(7.8)
?	大细胞肺癌	2(2.1)	0(0)	3(3.3)
?	腺鳞癌	1(1.0)	0(0)	1(1.1)

表1 三组的基线特征以及最终诊断[n(%)]

临床资料		VBN＋EBUS-GS(n＝97)	EBUS-GS(n＝107)	常规支气管镜(n＝90)
年龄(岁)		43～88	45～87	56～85
男性		58 (59.8)	69(64.5)	56(62.2)
病变位置	上叶	50	58	45
?	中叶或舌叶	10	11	9
?	下叶	37	38	36
病变大小，mm		8～29	8～30	8～30
≤20mm，n(%)		45 (46.4)	47 (43.9)	40(44.4)
>20～30mm, n(%)		52 (53.6)	60 (56.1)	50(55.6)
CT支气管征象		?	?	?
?	阳性	78	85	72
?	阴性	19	22	18
超声探头位置		?	?	?
?	病变内部	46	51	41
?	紧邻病变	33	37	32
?	病变之外	18	19	17
最后诊断		?	?	?
?	腺癌	66 (68.0)	74(69.2)	61(67.8)
?	鳞癌	13(13.4)	15(14.0)	11(12.2)
?	小细胞肺癌	7(7.2)	9(8.4)	7(7.8)
?	非小细胞肺癌	8(8.2)	9(8.4)	7(7.8)
?	大细胞肺癌	2(2.1)	0(0)	3(3.3)
?	腺鳞癌	1(1.0)	0(0)	1(1.1)

表2 每个参数下三组的诊断率[n(%)]

临床资料及变量		VBN＋EBUS-GS(n＝97)	EBUS-GS(n＝107)	常规支气管镜(n＝90)	P值
总诊断率		80/97(82.5)	87/107(81.3)	39/90(43.3)	^eP＝0.487；^fP<0.001
男性		48/58(82.8)	56/69(81.2)	24/56(42.9)	^aP＝0.568
女性		32/39(82.1)	31/38(81.6)	15/34(44.1)	^bP＝0.587；^cP＝0.492
病变位置	上叶	41/50(82.0)	47/58(81.0)	19/45(42.2)	^aP＝0.967
?	中叶或舌叶	8/10(80.0)	9/11(81.8)	4/9(44.4)	^bP＝0.993
?	下叶	30/37(81.1)	31/38(81.6)	16/36(44.4)	^cP＝0.978
病变大小		?	?	?	^aP＝0.001
?	≤20 mm	31/45(68.9)	31/47(66.0)	11/40(27.5)	^bP<0.001
?	>20～30 mm	49/52(94.2)	56/60(93.3)	28/50(56.0)	^cP＝0.006
CT支气管征象	阳性	70/78(89.7)	76/85(89.4)	35/72(48.6)	^aP＝0.001
?	阴性	10/19(52.6)	11/22(50.0)	4/18(22.2)	^bP<0.001；^cP＝0.037
超声探头位置	病变内部	45/46(97.8)	49/51(96.1)	无	^aP<0.001
?	紧邻病变	31/33(93.9)	33/37(89.2)	?	^bP<0.001
?	病变之外	4/18(22.2)	5/19(26.3)	?	?

表2 每个参数下三组的诊断率[n(%)]

临床资料及变量		VBN＋EBUS-GS(n＝97)	EBUS-GS(n＝107)	常规支气管镜(n＝90)	P值
总诊断率		80/97(82.5)	87/107(81.3)	39/90(43.3)	^eP＝0.487；^fP<0.001
男性		48/58(82.8)	56/69(81.2)	24/56(42.9)	^aP＝0.568
女性		32/39(82.1)	31/38(81.6)	15/34(44.1)	^bP＝0.587；^cP＝0.492
病变位置	上叶	41/50(82.0)	47/58(81.0)	19/45(42.2)	^aP＝0.967
?	中叶或舌叶	8/10(80.0)	9/11(81.8)	4/9(44.4)	^bP＝0.993
?	下叶	30/37(81.1)	31/38(81.6)	16/36(44.4)	^cP＝0.978
病变大小		?	?	?	^aP＝0.001
?	≤20 mm	31/45(68.9)	31/47(66.0)	11/40(27.5)	^bP<0.001
?	>20～30 mm	49/52(94.2)	56/60(93.3)	28/50(56.0)	^cP＝0.006
CT支气管征象	阳性	70/78(89.7)	76/85(89.4)	35/72(48.6)	^aP＝0.001
?	阴性	10/19(52.6)	11/22(50.0)	4/18(22.2)	^bP<0.001；^cP＝0.037
超声探头位置	病变内部	45/46(97.8)	49/51(96.1)	无	^aP<0.001
?	紧邻病变	31/33(93.9)	33/37(89.2)	?	^bP<0.001
?	病变之外	4/18(22.2)	5/19(26.3)	?	?

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