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目的 评价引导鞘管(guide sheath,Gs)在非X线下支气管内径向超声引导经支气管肺活检(EBUS-TBLB)中对肺外周病灶的诊断价值.方法 回顾性分析2012年7月至2015年6月在北京大学第一医院行胸部CT检查发现肺外周病灶,并在支气管内径向超声引导下行经支气管肺活检的患者.根据活检操作,将患者分为GS组、非GS组、双活检组,对比分析三组的诊断率情况.结果 入选118例患者,共126个肺外周病灶,总诊断率为60.3％ (76/126).GS组、非GS组、双活检组诊断率分别为65.4％ (36/55)、61.5％ (8/13)、59.6％ (31/52),差异均无统计学意义(x2=0.394,P=0.821).GS组、非GS组、双活检组在病灶≤20 mm诊断率分别为66.7％ (18/27)、0.0％(0/3)、78.6％ (11/14),非GS组诊断率明显低于其他二组,差异有统计学意义(x2=6.8,P=0.033);病灶＞20 mm诊断率分别为64.3％ (18/28)、80.0％(8/10)、54.1％ (20/37),三组间差异无统计学意义(x2=2.301,P=0.301).结论 EBUS-TBLB中使用GS在≤＜20 mm的肺外周病灶中能明显提高诊断率,＞20 mm的病灶中不能提高诊断率,GS活检后更换普通活检钳重复活检不能进一步提高诊断率.“,”Objective To evaluate the role of guide sheath (GS) utilization in radial endobronchial ultrasound guided transbronchial lung biopsy (EBUS-TBLB) for diagnosis of peripheral pulmonary lesions (PPLs).Methods The clinical data of patients who underwent EBUS-TBLB in Peking University First Hospital from July 2012 to June 2015 were retrospectively reviewed.The patients were divided into three groups,ie.a GS group,a non-GS group,and a double biopsy group.Results A total of 118 patients with 126 PPLs were collected.The overall diagnostic yield of EBUS-guided bronchoscopy was 60.3％.The diagnostic yield of GS group,non-GS group and double biopsy group was 65.4％(36/55),61.5％(8/13),59.6％(31/52),respectively.The diagnostic yield of the non-GS group was significantly lower than other two groups when PPLs≤20 mm (x2=6.8,P=0.033),whereas no significant difference was observed when PPLs＞20 mm (x2=2.301,P=0.301).Conclusion GS significantly improves diagnostic yield in EBUS-TBLB when PPLs≤20 mm.