目的 评价经支气管镜腔内超声(endobronchial ultrasonography,EBUS)非实时引导下行肺活检对菌阴肺结核的诊断价值和安全性. 方法 对2014年12月至2016年12月在福州肺科医院就诊、且行常规电子支气管镜检查未能发现病变的46例菌阴肺结核患者,行EBUS非实时引导下的肺活检,观察诊断阳性率、不同部位肺部病灶发现率及安全性. 结果 通过EBUS非实时引导下经支气管镜肺活检,46例菌阴肺结核患者中,40例肺部周边发现病变,病变总体发现率为86.96%(40/46).40例通过EBUS技术发现病灶的患者中,32例经支气管镜肺活检明确诊断,诊断阳性率为80.00%(32/40);6例通过EBUS技术未发现病灶的患者,再次行常规支气管镜肺活检,常规支气管镜肺活检诊断阳性者3例(3/6);其余的11例患者,7例通过CT引导下肺穿刺病理检查明确诊断,4例通过胸腔镜手术病理检查明确诊断.40例通过EBUS技术发现病灶的患者中,病灶位于右上叶者诊断阳性11例(11/13),病灶位于右中叶者诊断阳性2例(2/3),病灶位于右下叶者诊断阳性8例(8/10),病灶位于左上叶者诊断阳性7例(7/8),病灶位于左下叶者诊断阳性4例(4/6).46例患者支气管镜肺活检后的主要并发症为咯血(39.13%,18/46)和胸痛(13.04%,6/46),未出现气胸等并发症;均未进行特殊处理,自行缓解. 结论 EBUS非实时引导下经支气管镜肺活检诊断率高,并发症少,适用于菌阴肺结核的诊断.%Objective To evaluate diagnostic value and safety of lung biopsy non-realtime guided by endobronchial ultrasonography (EBUS) in patients with smear negative pulmonary tuberculosis.Methods Diagnostic rate, detection rate of lesion and safety were observed via lung biopsy non-realtime guided by endobronchial ultrasonography (EBUS) in 46 cases with smear negative pulmonary tuberculosis, admitted in Fuzhou Pulmonary Hospital during Dec.2014 to Dec.2016, who didn't find lesion via routine electronic brochoscopy.Results Of 46 cases with smear negative pulmonary tuberculosis, 40 cases were found peripheral lesion via lung biopsy non-realtime guided by EBUS.The detection rate of lesion was 86.96% (40/46).Thirty-two cases were diagnosed definitely by pulmonary biopsy via electronic brochoscopy in 40 cases who found lesion by EBUS, the diagnostic rate was 80.00% (32/40), 3 cases were diagnosed definitely by pulmonary biopsy via routine electronic brochoscopy in 6 cases who didn't find lesion by EBUS, 7 cases were diagnosed definitely by pathological examination via percutaneous lung puncture guided by CT and 4 cases were diagnosed definitely by pathological examination via video-assisted thoracoscopic surgery (VATS).The positive diagnosis were in 11 cases (11/13) with lesions located in the right upper lobe, in 2 cases (2/3) with lesions located in the right middle lobe, in 8 cases (8/10) with lesions located in the right lower lobe, in 7 cases (7/8) with lesions located in the left upper lobe and in 4 cases (4/6) with lesions located in the left lower lobe among 40 cases found peripheral lesion via lung biopsy non-realtime guided by EBUS.The complications were found in 18 cases with hemoptysis (39.13%, 18/46) and in 6 cases with chest pain (13.04%, 6/46) among 46 cases via lung biopsy non-realtime guided by EBUS.There were no cases with the complication of pneumothorax.All complications were self relief without special management.Conclusion The lung biopsy non-realtime guided by EBUS is fit for diagnosis in patients with smear negative pulmonary tuberculosis due to its high diagnostic rate and less complications.
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