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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) ›› 2026, Vol. 19 ›› Issue (02) : 205 -211. doi: 10.3877/cma.j.issn.1674-6902.2026.02.004

论著

电磁导航支气管镜引导亚甲蓝术前定位肺结节的可行性及影响因素分析
王凯, 任清泉, 曹强, 刘强, 杨帅, 王佳†()   
  1. 716000　延安，延安大学附属医院胸外科
  • 收稿日期:2025-12-23 出版日期:2026-04-25
  • 通信作者: 王佳
  • 基金资助:
    国家自然科学基金项目(82060452)

Feasibility and influencing factors analysis of electromagnetic navigation bronchoscopy guided methylene blue preoperative localization of pulmonary nodules

Kai Wang, Qingquan Ren, Qiang Cao, Qiang Liu, Shuai Yang, Jia Wang†()   

  1. Department of Thoracic Surgery, Affiliated Hospital of Yan′an University, Yan'an 716000, China
  • Received:2025-12-23 Published:2026-04-25
  • Corresponding author: Jia Wang
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引用本文：

王凯, 任清泉, 曹强, 刘强, 杨帅, 王佳. 电磁导航支气管镜引导亚甲蓝术前定位肺结节的可行性及影响因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(02): 205-211.

Kai Wang, Qingquan Ren, Qiang Cao, Qiang Liu, Shuai Yang, Jia Wang. Feasibility and influencing factors analysis of electromagnetic navigation bronchoscopy guided methylene blue preoperative localization of pulmonary nodules[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(02): 205-211.

目的

分析电磁导航支气管镜(electromagnetic navigation bronchoscopy, ENB)引导亚甲蓝定位在肺结节胸腔镜手术中的有效性和安全性，与计算机断层扫描(computed tomography, CT)经皮引导定位比较，探讨临床可行性和影响因素。

方法

回顾性纳入2022年10月至2024年10月我院行肺结节定位并接受电视辅助胸腔镜手术患者248例，倾向性匹配1︰1，ENB定位组124例，CT定位组124例。记录定位时间、定位成功率和并发症。采用LASSO回归和Logistic回归分析影响ENB定位时间的因素。

结果

ENB定位组实性结节占比(12.10%比4.03%，P＝0.048)和支气管征象占比(15.32%比7.26%，P＝0.045)高于CT定位组。ENB定位组定位时间(15.00 min比16.15 min，P＝0.086)和胸腔镜手术时间(81.50 min比90.00 min，P＝0.068)较CT定位组降低(P>0.05)。ENB定位组肺结节定位成功122例(98.39%)高于CT定位组121例(97.58%)(P＝0.651)。ENB定位组血气胸(0.00%比4.84%，P＝0.013)和并发症发生率(4.84%比17.74%，P＝0.001)低于CT定位组。ENB定位组并发症6例(4.84%)，未发现血气胸或咯血。多因素Logistic回归分析显示，肺结节位置(OR＝4.084，P＝0.005)、肺结节直径(OR＝2.452，P＝0.032)、术者经验(OR＝3.227，P＝0.005)是影响ENB定位时间的危险因素。

结论

ENB引导亚甲蓝定位较CT引导定位成功率无差异，并发症风险低，临床考虑肺结节位置、肺结节直径和术者经验优化ENB定位效果。

关键词: 肺结节, 电磁导航支气管镜, 计算机断层扫描, 定位时间
Objective

To analyze the effectiveness and safety of electromagnetic navigation bronchoscopy (ENB)-guided methylene blue localization in thoracoscopic surgery for pulmonary nodules, compare it with computed tomography (CT)-guided percutaneous localization, and explore its clinical feasibility and influencing factors.

Methods

A retrospective study was conducted on 248 patients who underwent pulmonary nodule localization and video-assisted thoracoscopic surgery at our hospital from October 2022 to October 2024. Propensity score matching at a 1︰1 ratio resulted in 124 cases in the ENB localization group and 124 cases in the CT localization group. Localization time, localization success rate, and complications were recorded. LASSO regression and logistic regression were used to analyze factors affecting ENB localization time.

Results

The proportion of solid nodules (12.10% vs. 4.03%, P=0.048) and the proportion of bronchus sign (15.32% vs. 7.26%, P=0.045) were higher in the ENB localization group than in the CT localization group. Localization time (15.00 min vs. 16.15 min, P=0.086) and thoracoscopic surgery time (81.50 min vs. 90.00 min, P=0.068) were lower in the ENB localization group compared to the CT localization group (P>0.05). Successful localization of pulmonary nodules was achieved in 122 cases (98.39%) in the ENB localization group, which was higher than the 121 cases (97.58%) in the CT localization group (P=0.651). The rates of hemopneumothorax (0.00% vs. 4.84%, P=0.013) and overall complications (4.84% vs. 17.74%, P=0.001) were lower in the ENB localization group than in the CT localization group. In the ENB localization group, there were 6 cases (4.84%) of complications, with no cases of hemopneumothorax or hemoptysis. Multivariate logistic regression analysis showed that pulmonary nodule location (OR=4.084, P=0.005), pulmonary nodule diameter (OR=2.452, P=0.032), and operator experience (OR=3.227, P=0.005) were risk factors affecting ENB localization time.

Conclusion

ENB-guided methylene blue localization has a success rate comparable to CT-guided localization, with a lower risk of complications. Clinical optimization of ENB localization outcomes should consider pulmonary nodule location, pulmonary nodule diameter, and operator experience.

Key words: Pulmonary nodules, Electromagnetic navigation bronchoscopy, Computed tomography, Localization time
图1 ENB引导下亚甲蓝定位右上叶后段小结节。图A为肺结节呈蓝色；图B为ENB引导肺结节全切除
图2 CT定位组典型患者肺部影像学图。图A为术中CT图；图B为术后CT图
表1 两组肺结节患者临床资料结果
临床资料 CT定位组(n＝124) ENB定位组(n＝124) t/χ2/Z值 P值
吸烟史[n(%)]     0.895 0.639
从不 109(87.90) 111(89.52)    
既往 8(6.45) 9(7.26)    
现在 7(5.65) 4(3.23)    
慢性阻塞性肺疾病[n(%)] 13(10.48) 15(12.10) 0.161 0.688
ASA分级[n(%)]     0.107 0.744
Ⅰ/Ⅱ 100(80.6) 102(82.26)    
Ⅲ/Ⅳ 24(19.3) 22(17.74)    
平均动脉压[mmHg，(±s)] 101.42±14.69 99.53±12.12 1.105 0.270
肺结节数量[n(%)]     0.107 0.744
1 100(80.5) 102(82.26)    
≥2 24(19.35) 22(17.74)    
肺结节位置[n(%)]     1.967 0.579
右上叶 58(46.77) 69(55.65)    
右下叶 25(20.16) 21(16.94)    
左上叶 26(20.97) 22(17.74)    
左下叶 15(12.10) 12(9.68)    
肺结节直径[mm，M(Q25，Q75)] 10.00(8.00，12.00) 10.00(7.00，14.00) －0.210 0.834
距胸膜距离[mm，M(Q25，Q75)] 5.00(3.00，14.38) 5.00(2.14，14.95) －0.756 0.450
肺结节密度[n(%)]     6.059 0.048
纯磨玻璃结节 43(34.68) 34(27.42)    
混合型磨玻璃结节 76(61.29) 75(60.48)    
实性结节 5(4.03) 15(12.10)    
支气管征[n(%)] 9(7.26) 19(15.32) 4.026 0.045
恶性CT征象[n(%)] 62(50.0) 50(40.32) 2.345 0.126
表2 两组肺结节患者手术情况比较
手术情况 CT定位组(n＝124) ENB定位组(n＝124) χ2/Z值 P值
病理亚型[n(%)]     2.373 0.796
非典型腺瘤样增生 1(0.81) 1(0.81)    
原位腺癌 42(33.87) 42(33.87)    
微浸润腺癌 45(36.29) 37(29.84)    
浸润性腺癌 26(20.97) 29(23.39)    
转移性腺癌 1(0.81) 3(2.42)    
良性 9(7.26) 12(9.68)    
亚甲蓝剂量[ml，M(Q25，Q75)] 0.40(0.30，0.60) 0.40(0.30，0.50) －1.400 0.162
手术类型[n(%)]     1.203 0.548
Wedge切除 63(50.81) 59(47.58)    
肺段切除 61(49.19) 64(51.61)    
肺叶切除 0(0.0) 1(0.81)    
手术切缘[mm，M(Q25，Q75)] 20.00(12.25，25.00) 20.00(15.00，20.00) －0.701 0.483
单肺通气时长[mm，M(Q25，Q75)] 56.00(34.25，82.00) 52.50(30.00，72.75) －1.670 0.095
术者经验[n(%)]     1.362 0.243
≤100例 45(36.29) 54(43.55)    
>100例 79(63.37) 70(56.45)    
定位时间[mm，M(Q25，Q75)] 16.15(12.88，23.16) 15.00(12.80，18.35) －1.718 0.086
胸腔镜手术时间[mm，M(Q25，Q75)] 90.00(69.25，120.00) 81.50(61.00，107.00) －1.822 0.068
表3 两组肺结节患者手术定位成功率比较[n(%)]
肺结节特征 CT定位组(n＝124) ENB定位组(n＝124) 组间成功率
定位失败(n＝3) 定位成功(n＝121) χ2值 P值 定位失败(n＝2) 定位成功(n＝122) χ2值 P值 χ2值 P值
距胸膜距离     0.374 0.541     0.165 0.684 0.243 0.622
≤10 mm 2(66.67) 81(66.94)     1(50.0) 78(63.93)        
>10 mm 1(33.33) 40(33.06)     1(50.0) 44(36.07)        
肺结节位置     3.073 0.381     9.970 0.019 1.875 0.599
右上叶 0(0.0) 58(47.93)     0(0.0) 69(56.56)        
右下叶 1(33.33) 24(19.83)     2(100.0) 19(15.57)        
左上叶 1(33.33) 25(20.66)     0(0.0) 22(18.03)        
左下叶 1(33.33) 14(11.57)     0(0.0) 12(9.84)        
肺结节直径     0.489 0.485     － 0.217 1.485 0.223
≤10 mm 1(33.33) 65(53.72)     2(100.0) 56(45.90)        
>10 mm 2(66.67) 56(46.28)     0(0.0) 66(54.10)        
肺结节密度     0.140 0.932     1.328 0.515 5.845 0.054
纯磨玻璃结节 1(33.33) 42(34.71)     0(0.0) 34(27.87)        
混合型磨玻璃结节 2(66.67) 74(61.16)     2(100.0) 73(59.84)        
实性结节 0(0.0) 5(4.13)     0(0.0) 15(12.30)        
表4 多因素Logistic回归分析ENB定位时间的影响因素
自变量 B SE(B) Walds值 OR(95%CI) P值
肺结节位置(肺下叶vs.肺上叶) 1.407 0.499 7.950 4.084(1.536~10.862) 0.005
肺结节直径(≤10 mm vs. >10 mm) 0.897 0.417 4.621 2.452(1.082~5.555) 0.032
距胸膜距离(>10 mm vs. ≤10 mm) 0.537 0.431 1.550 1.711(0.735~3.986) 0.213
术者经验(≤100例vs. >100例) 1.172 0.417 7.884 3.227(1.424~7.310) 0.005
图2 多因素Logistic回归森林图
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