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支气管镜导航系统对肺周围型病变的诊断价值

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Author:: No author available

Journal Title:: Chinese Journal of Tuberculosis and Respiratory Diseases

Issue:: 8

DOI:: 10.3760/cma.j.issn.1001-0939.2017.08.016

Key Word:: No keyword available

Abstract：孤立性肺结节(solitary pulmonary nodule,SPN)或肿块的良、恶性鉴别,一直是临床和影像学诊断中面临的重大课题[1-2].传统的经支气管镜肺活检(transbronchial lung biopsy,TBLB)由于单纯根据胸部CT阅片协助判断病灶位置,因此检查时带有一定的盲目性,对周围型肺结节诊断率相对较低.此外,CT引导下经皮肺穿刺导致气胸、猝死的发生风险较高[3-4].虚拟支气管镜导航系统(virtual bronchoscopy navigation,VBN),包括Directpath VBN、Lungpoint VBN和电磁导航系统(electromagnetic navigation bronchoscopy,ENB),是一种基于CT的新型虚拟成像技术[5],其中电磁导航是在微磁场上的实时导航,不是完全意义上的虚拟导航.通过图像识别技术,VBN可以建立虚拟支气管路径,同时联合C型臂X线透视(X-ray fluoroscopy,X-Flu)或径向超声内镜(radial probe endobronchial ultrasound,RP-EBUS)等将支气管镜引导到目标病灶,能大大提高活检、穿刺部位的准确性并减少创伤性.近几年来,国内外学者尝试在VBN辅助下经支气管镜行肺活检术,本文就VBN的诊断应用综述如下,旨在评估VBN联合EBUS或X-Flu对肺周围型病灶(peripheral pulmonary lesions,PPLs)的诊断价值,进一步推动肺外周病变的快速诊断相关研究的发展.

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