评价无X线监视下支气管超声导向鞘技术（EBUS-GS）对肺周围性病变（PPLs）的诊断价值及安全性。

回顾性分析2016年3月至2017年2月在北京大学肿瘤医院内镜中心接受EBUS-GS的52例PPLs患者的临床病理资料，评价EBUS-GS的诊断率及安全性，并对影响诊断率的因素进行分析。本研究对多种情况下的诊断率的比较采用χ²检验。

52例PPLs患者中男26例，女26例；年龄22~78岁，平均（55.6±10.0）岁。52例患者中47例患者（90.4%）的病灶可在支气管超声图像中显示，共有39例（75.0%）经EBUS-GS获得明确诊断。在EBUS-GS诊断PPLs方面：EBUS-GS对恶性病变的诊断率高于对良性病变的诊断率，差异具有统计学意义（82.2% vs 28.6%，χ²=6.658，P=0.010）；联合刷检、活检及肺泡灌洗中2种或3种方式取检的诊断率高于仅采用单一方式取检的诊断率，差异具有统计学意义（80.4% vs 33.3%，χ²=4.019，P=0.045）；超声探头位于病灶内部者的诊断率明显高于位于病灶边缘或病灶外部者，差异具有统计学意义（85.3% vs 55.6%，χ²=4.078，P=0.043）；病灶位于肺野内带及中带者的诊断率明显高于位于肺野外带者，差异具有统计学意义（86.1% vs 50.0%，χ²=5.898，P=0.015）。CT测得的不同大小病灶的诊断率比较，不同肺叶病灶诊断率比较，最终确诊的45例恶性病例中前15例与后30例诊断率的比较差异均无统计学意义（P均>0.05）。1例（1.9%）患者术中出血量较多，7例患者（13.5%）术中出现一过性低氧血症，提高鼻导管氧流量后缓解；22例患者（42.3%）术后24 h内出现咳痰，可见少量血丝，未予特殊处理；无气胸、感染等情况发生。

在单纯使用VBN而不联合X线监视的条件下，EBUS-GS是一种诊断PPLs安全且有效的方法。

To evaluate the feasibility and safety of endobronchial ultrasonography (EBUS) with a guide sheath (EBUS-GS) in the diagnosis of peripheral pulmonary lesions (PPLs) without fluoroscopic monitoring.

We performed a retrospective analysis of 52 patients with PPLs who underwent EBUS-GS at Peking University Cancer Hospital from March 2016 to February 2017. Their clinicopathologic data and complications were assessed. According to diagnostic ratio, categorical data are presented as frequencies and were analyzed using the chi-square test.

There were 26 men and 26 women in this group, with a mean age of 55.6±10.0 years (range, 22-78 years). A total of 52 PPLs were examined, of which 47 could be detected by EBUS. The overall diagnostic yield of EBUS-GS was 75.0% (39/52). The diagnostic yield for malignancy was higher than that for benign lesions (82.2% vs 28.6%, χ²=6.658, P=0.010). The combination of transbronchial lung biopsy, brush smear, and bronchoalveolar lavage fluid provided higher diagnostic yield than any singer way (80.4% vs 33.3%, χ²=4.019, P=0.045). Factors that significantly affected and predicted diagnostic success were EBUS probe within the lesion (85.3% vs 55.6%, χ²=4.078, P=0.043) and PPLs located in the central two-thirds of the lung (86.1% vs 50.0%, χ²=5.898, P=0.015). There was no significant difference in the diagnosis rate among lung lobes and lesion sizes measured by CT, and the learning curve also had no significant impact on the diagnosis rate. One (1.9%) patient suffered from intraoperative bleeding which could be managed under endoscopy. Seven (13.5%) patients had transient hypoxemia during surgery, which was relieved after improving the nasal catheter oxygen flow. Twenty-two (42.3%) patients had a small amount of bloody sputum within 24 h after surgery, but no special treatments were needed.

EBUS-GS without fluoroscopic monitoring for PPLs is an effective and safe procedure.