国产电磁导航支气管镜检查定位系统引导经支气管镜肺活检术对肺外周病灶的诊断价值

Objective To evaluate the diagnostic value and safety of domestic electromagnetic navigation bronchoscopy (ENB) guided transbronchial lung biopsy (TBLB) for peripheral pulmonary lesions.Methods Sixty-four patients with peripheral pulmonary lesions shown by thoracic CT in Zhongshan Hospital,Fudan University between Jul. and Dec.,2014 were collected.The patients were randomly assigned to test group (underwent ENB in combination with X-ray guided TBLB) and control group (underwent X-ray guided TBLB).The final diagnosis was confirmed by pathologic examination of surgically removed lesions or by 24 months clinical follow-up.The operative time as well as the intraoperative and postoperative complications were also recorded.Results Sixty-four patients had 70 peripheral pulmonary lesions.There was no difference in age,sex,the lesion size or location between the two groups.Pathology results showed that the diagnostic yield of test group and control group were 88.6% and 62.9%,respectively,with statistical significance (P=0.012).Subgroup analysis showed that if the lesion’s diameter was ≤2 cm,the diagnosis yield of test group was higher than control group (66.7% vs.20.0%,P=0.266);if the lesion was ＞2 and ≤3 cm,the diagnosis yield of test group and control group were 100% and 81.8%,respectively (P=0.485).But if the lesion was＞3 cm,the diagnostic yield of the 2 group was significantly different (94.4% in test group,63.1% in control group,P=0.042).Mean operation duration of the 2 group was (966±372)s and (1 040±470)s,respectively,with no statistical difference (P=0.600).However,there was statistical difference between the 2 groups on the X-ray time needed to find the pulmonary lessions ［(7.0±4.8)s vs. (37.0±37.5)s,P=0.008).There was no pneumothoraxes and excessive bleeding in patients undergoing ENB.Conclusions Compared with X-ray guide TBLB,ENB guided TBLB for peripheral pulmonary lesions has a certain degree of security,and has superiority in reducing the X-ray time required to find the lesion and improving diagnostic yield especially when the lesion′s diameter was ＞3 cm.