探讨数字减影定位下经支气管镜肺活检对肺部周围型病变的诊断价值

摘要

目的 探讨数字减影(DSA)定位下经支气管镜肺活检(TBLB)对肺部周围型病变的诊断价值.方法 选择2009年11月至2013年12月期间的86例肺部周围病变的患者,平均分为A组和B组,A组患者在DSA的定位下进行经支气管镜肺活检,同时进行纤支镜刷片和支气管肺泡灌洗,B组患者在CT定位下进行经皮穿刺肺活检,对比A组三种方法诊断结果的阳性率、PCNA与TBLB、BB、BAL比较的诊断结果的阳性率,以及两组患者在治疗后并发症发生情况.结果 TBLB、BB、BAL三种方法两两比较x 2分别为0.84、0.54、0.16,差异无统计学意义(P＞0.05);PCNA与TBLB、BB、BAL三种方法对比x 2值分别为0.12、0.06、0.22,差异无统计学意义(P＞0.05);但是TBLB联合BB、BAL检查诊断结果阳性率为83.72％(36/43),明显高于PCNA诊断的阳性率69.77％(30/43),差异具有统计学意义(P＜0.05).A组并发症发生率(13.95％)显著低于B组患者(30.23％),差异具有统计学意义(P＜0.05).结论 TBLB、BB、BAL、PNCA均对肺部周围病变有较高的诊断价值,TBLB后常规进行BB和BAL能提高诊断结果的阳性率,并且DSA定位下能够降低并发症的发生.%Objective To explore the diagnostic value of transbronchial lung biopsy (TBLB) under digital subtraction (DSA) positioning in peripheral pulmonary lesions.Methods From November 2009 to December 2013,86 patients with peripheral pulmonary lesions were divided into group A and group B.Group A underwent transbronchial lung biopsy under DSA location,bronchoscopy brush (BB) and bronchoalveolar lavage (BAL),while group B underwent percutaneous lung biopsy under CT positioning.The positive rate of diagnosis results,the positive rate of group A than in the three methods of PCNA and TBLB,the diagnostic results of BB compared to BAL,and complications of two groups after the treatment were compared.Results There were no statistically significant differences in positive rate between any two of TBLB,BB,BAL (x2=0.84,0.54,0.16; P ＞ 0.05).There were no statistically significant differences in positive rate between PCNA and any one of TBLB,BB,BAL (x2=0.12,0.06,0.22; P ＞ 0.05).The positive rate of the combination of TBLB,BB and BAL was 83.72％ (36/43),significantly higher than 69.77％ (30/43) of PCNA,with statistically significant difference (P ＜ 0.05).The complication rate in group A was significantly lower than that in group B (13.95％ vs.30.23％),with statistically significant difference (P ＜ 0.05).Conclusion TBLB,BB,BAL,PNCA all have a high value in the diagnosis of peripheral pulmonary lesions.BB,BAL after TBLB can improve the positive rate of diagnosis,at the same time DSA positioning can significantly reduce the incidence of complications.