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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2023, Vol. 16 ›› Issue (01) : 11 -14. doi: 10.3877/cma.j.issn.1674-6902.2023.01.003

论著

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
王旖旎1, 汤玲一1, 黄赞胜2, 陈慧1, 张明周2, 王苹2, 王爽2, 周培花2, 范晔2, 赵静1,†(), 边巴多杰3,†(), 张春兰4,†()   
  1. 1. 400037　重庆，陆军（第三）　军医大学第二附属医院教学办临床技能培训中心
    2. 400037　重庆，陆军（第三）　军医大学第二附属医院呼吸与危重症医学中心
    3. 857000　日喀则，陆军第九五三医院呼吸内科
    4. 400021　重庆，重庆市中医院放射科
  • 收稿日期:2022-11-25 出版日期:2023-02-25
  • 通信作者: 赵静, 边巴多杰, 张春兰
  • 基金资助:
    "十四五"规划项目-临床技能培训中心条件项目建设(145BXL090034097X); 陆军军医大学临床技术创新培育项目

Opeerative difficulty and safety of ultrasound-guided transbronchial mediastinal cryobiopsy

Yiyi Wang1, Lingyi Tang1, Zansheng Huang2, Hui Chen1, Mingzhou Zhang2, Ping Wang2, Shuang Wang2, Peihua Zhou2, Ye Fan2, Jing Zhao1,†(), Duojie Bianba3,†(), Chunlan Zhang4,†()   

  1. 1. Clinical Skills Training Center, Teaching Office of the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
    2. Respiratory and Critical Care Medicine Center, The Second Hospital Affiliated to Army Medical University, Chongqing 400037, China
    3. Department of Respiratory Medicine, 953 Army Hospital, Xigaze 857000, China
    4. Radiology Department, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
  • Received:2022-11-25 Published:2023-02-25
  • Corresponding author: Jing Zhao, Duojie Bianba, Chunlan Zhang
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王旖旎, 汤玲一, 黄赞胜, 陈慧, 张明周, 王苹, 王爽, 周培花, 范晔, 赵静, 边巴多杰, 张春兰. 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[J]. 中华肺部疾病杂志(电子版), 2023, 16(01): 11-14.

Yiyi Wang, Lingyi Tang, Zansheng Huang, Hui Chen, Mingzhou Zhang, Ping Wang, Shuang Wang, Peihua Zhou, Ye Fan, Jing Zhao, Duojie Bianba, Chunlan Zhang. Opeerative difficulty and safety of ultrasound-guided transbronchial mediastinal cryobiopsy[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(01): 11-14.

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。

关键词: 支气管超声, 冷冻活检, 操作难度, 纵膈疾病
Objective

To assess the operative difficulty and safety of ultrasound guided transbronchial mediastinal cryobiopsy.

Methods

Randomly 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.

Results

All 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.

Conclusion

Ultrasound 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.

Key words: Bronchial ultrasound, Cryobiopsy, Operative difficulty, Mediastinal diseases
表1 支气管镜操作时间、难度与穿刺及冷冻活检比较[(±s)，min]
操作时间 支气管镜操作 穿刺活检 冷冻活检 P值
总时间 31.9±7.6 － － －
病灶探及 2.6±0.7 － － －
穿刺时间 － 8.7±1.8 － －
开窗时间 － － 2.1±2.0 －
冷冻时间 － － 7.3±4.0 －
活检时间 － 8.7±1.8 9.3±4.3 0.470
术中引导 无 22 23 1.000
  有 3 2  
术中暂停 无 22 21 1.000
  有 3 4  
操作难度 － 0.7±0.9 0.8±1.2 0.860
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