High-frequency jet ventilation in bronchoscopic biopsy of peripheral pulmonary nodules
Objective To observe the application of high-frequency jet ventilation(HFJV)in LungPro-guided bronchoscopic biopsy in patients with peripheral pulmonary nodules,and to investigate its safety.Methods In 160 patients with peripheral pulmonary nodules receiving LungPro-guided bronchoscopic biopsy in Henan Provincial People's Hospital from January 2022 to June 2023,80 patients used routine navigation(routine navigation group)and 80 patients used HFJV(HFJV group).According to chest CT scan results,3D digital lung model was reconstructed in both groups,and the bronchoscopic path to the lesion was automatically generated.HFJV was applied after general anesthesia in HFJV group,and ventilation was connected to the general anesthesia machine after anesthesia in routine navigation group.The bronchoscopic biopsy of peripheral pulmonary nodules were performed according to the navigation path in both groups.The arrival time,total operation time,navigation success rate,matching rate between the actual biopsy site and the navigation path,intraoperative bleeding and pneumothorax were recorded in two groups.All patients with bronchoscopic biopsy confirmed malignant or undefined diagnosis were performed thoracoscopic surgery.The results of histopathology were recorded,and the diagnostic rates of bronchoscopic biopsy and the diagnostic accuracies of malignant and benign nodules were compared between two groups.Results(1)There were no significant differences in the gender ratio,age,nodule size,nodule nature,bronchial classification of nodules,and relationship between the nodule and the position of the bronchi between two groups(P＞0.05).(2)Bronchoscope reached the lesions successfully in 66 patients in routine navigation group and 77 patients in HFJV group.The actual biopsy sites of 3 patients among whom bronchoscope reached the lesions successfully in each group did not match the navigation path.The arrival time and total operation time were shorter in HFJV group[(3.4±1.1),(14.5±3.7)min]than those in routine navigation group[(5.7±1.6),(16.8± 4.2)min](t=10.595,P＜0.001;t=3.675,P＜0.001),and the navigation success rate and the matching rate between biopsy site and navigation path were higher in HFJV group(96.25％,92.50％)than those in routine navigation group(82.50％,78.75％)(x2=7.964,P=0.005;x2=6.144,P=0.013).(3)In routine navigation group,59 patients were pathologically diagnosed by bronchoscopic biopsy and 21 patients got no pathological diagnosis(bronchoscope did not reach the lesion successfully in 14 patients,and bronchoscope reached the lesion successfully but did not obtain valid tissues in 7 patients).In HFJV group,71 patients were pathologically diagnosed by bronchoscopic biopsy,and 9 patients were not diagnosed(bronchoscope did not reach the lesion successfully in 3,and bronchoscope reached the lesion successfully but did not obtain valid tissues in 6).The definite diagnostic rate was higher in HFJV group(88.75％)than that in routine navigation group(73.75％)(x2=5.908,P=0.015).(4)Bronchoscopy confirmed malignancy in 48 patients in routine navigation group,and 62 in HFJV group,which were consistent with the postoperative pathological results.Postoperative histopathologic malignancy was found in 17 patients with undefined bronchoscopic diagnosis in routine navigation group and 5 in HFJV group.The diagnostic accuracy of malignancy was higher in HFJV group(92.54％)than that in routine navigation group(73.85％)(x2=6.324,P=0.012),and there was no significant difference in the diagnostic accuracy of benign nodules between two groups(P＞0.05).(5)The incidence of bleeding was lower in HFJV group(2.5％)than that in routine navigation group(11.25％)(x2=4.783,P=0.029),and there was no significant difference in the incidence of pneumothorax between two groups(P＞0.05).Conclusion HFJV guided by LungPro can shorten the operation time of bronchoscopic biopsy of peripheral pulmonary nodules,improve the diagnostic rate and reduce the occurrence of bleeding,and it has high security.
NETL
NSTL
万方数据
维普
