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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≤30mm)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。
Objective To investigate the value of virtual bronchoscopy (VBN) combined with transbronchial ultrasound-guided sheath guidance (EBUS-GS) in the diagnosis of peripheral lung cancer. Methods 385 patients with peripheral lung cancer (high resolution CT diagnosis, 8 mm ≤ nodules ≤30 mm) were randomly divided into three groups: one group was VBN combined with EBUS-GS group, the other group was EBUS-GS group, the other group For the conventional bronchoscopy group. In the VBN combined with EBUS-GS group, the bronchoscope reached the target bronchus with VBN guidance and was probed with an ultrasound probe. The EBUS-GS group was only probed with an ultrasound probe without VBN assistance. In the conventional bronchoscopy group, neither VBN nor ultrasonography , Only chest CT film as a reference. Results The study population available for analysis was 294 patients who were finally diagnosed with primary peripheral lung cancer. VBN combined with EBUS-GS group and EBUS-GS group in the diagnosis rate was no significant difference (82.5% / 81.3%, P> 0.05). Compared with the conventional bronchoscopy group, the diagnostic rate was significantly different (82.5% / 81.3% / 43.3%, P <0.05). Subgroup analysis showed that the factors affecting the diagnosis rate of VBUS in combination with EBUS-GS group and EBUS-GS group might be that the CT images showed bronchial thrombus lesions with diameter greater than 20 mm and whether the ultrasound probe was within the lesion. Conclusions VBN combined with EBUS-GS or EBUS-GS can improve the diagnosis rate of peripheral lung cancer. The influencing factors of improving the diagnosis rate may include that the CT image shows bronchial thrombus, the diameter of the lesion is greater than 20 mm, and the ultrasound probe is within the lesion.