Application Of Endobronchial Ultrasound-guided Transbronchial Biopsy With A Guided Sheath (EBUS-GS-TBLB) In The Elderly Patients With Peripheral Pulmonary Lesions

Purpose: Through the nearly 1 year of treatment in our hospital parallel endobronchial ultrasound guiding sheath tube under the guidance of patients with the elderly pulmonary bronchial lung biopsy(EBUS-GS-TBLB) peripheral lesion pathological results and complications were analyzed to assess the application value of the technique in the elderly patients with pulmonary peripheral lesions.Methods: Collected nearly a year to visit our hospital Respiratory by chest CT examination revealed peripheral pulmonary lesions in patients with a total of 505 cases, including 271 cases were male, female 234 cases, aged 60-84 years, mean age 67.16 years.236 cases of elderly patients underwent EBUS-GS-TBLB, including 127 cases of male, female 109 cases, aged 60-81 years, mean age 67.65 years; 269 cases of elderly patients underwent TBLB, including 144 cases of male, female 125 cases, age 60-84 years old, the average age of 66.67 years. Conventional bronchoscopy in all patients were generally normal, and all patients who underwent EBUS examination and obtain lesions EBUS image, subsequently underwent transbronchial lung biopsy guided by ultrasound.For patients who did not undergo EBUS examination according to the chest CT manifestation of focal position parallel bronchial lung biopsy. At the same time for all patients with complications were recorded,and the recorded results and pathological findings and diagnostic rate were analyzed.Results: 167 cases was diagnosed in accordance with the pre-inspection of 236 cases which patients underwent the EBUS-GS-TBLB,hence EBUS of peripheral pulmonary lesions overall diagnosis was 70.76%,158 cases was diagnosed in accordance with the pre-inspection of 269 cases which patients enderwent the conventional TBLB,hence the conventional TBLB of peripheral pulmonary lesions overall diagnosis was58.73%,the diagnosis rate of EBUS-GS-TBLB group was higher. The diagnosis rate of lung cancer in EBUS-TBLB group and TBLB group was respectively 71.63%( 101/141)、47.93(81/169), the difference was statistically significant(P<0.05)。The diagnosis rate of tuberculosis in EBUS-TBLB group and TBLB group was respectively 43.48%(10/23)、17.44%(15/86), the difference was statistically significant(P<0.05). Thus, whether the diagnosis of peripheral lung cancer and pulmonary tuberculosis diagnosis, diagnosis of EBUS guided transbronchial lung biopsy was significantly higher than that of conventional transbronchial lung biopsy. EBUS-TBLB group and TBLB group were diagnosed in patients with lung cancer accounted for 60.48%(101/167), 50.63%(80/158) respectively.Adenocarcinoma was the most common lung cancer in the two groups of patients,and the detection rate was 56.44%(57/101),50%(40/50) respectively. The overall incidence of complications in this study was 7.13%(30/505), and the complication rate in EBUS-GS-TBLB group was 4.24%(10/236), including pneumothorax in 2 cases(0.85%), 1 case of which needs chest drainage tube,1case of improvement in nature;Hemorrhage(>100ml) in 1 case(0.42%),giving intravenous blood clotting enzyme and stop bleeding,and stop bleeding,and stay in hospital for observation for 3 days in complete remission;7 patients needed cold saline to stop bleeding(2.97%),more than a small amount of blood in the sputum were within 48-72 hours of blood in the sputum disappeared, and there was no addition of other complications. Conventional TBLB complication rate was 9.67%(26/269), including pneumothorax in 10 patients(3.72%), of which 4 patients required indwelling chest tube, and the gas was absorbed after resting and oxygen therapy in the remaining patients; 8 patients needed cold saline to stop bleeding(2.97%); 8 patients had a chest pain(2.97%),and other patients have no other complications.Conclusion: Bronchial biopsy guided by ultrasound guided sheath tube is a kind of high positive rate of diagnosis of peripheral lung lesions. And for elderly patients is still a very highly security check means.