电磁导航支气管镜辅助肺结节术前定位在HIV感染/AIDS患者中的临床应用

doi:10.19871/j.cnki.xfcrbzz.2025.06.008

摘要/Abstract

摘要： 目的通过分析电磁导航支气管镜辅助肺结节术前定位的HIV感染/AIDS患者的临床资料,总结其应用的安全性与有效性,为该技术在HIV感染/AIDS人群中的推广提供依据。方法回顾性选取2023年9月至2024年12月于成都市公共卫生临床医疗中心就诊的肺结节合并HIV感染/AIDS患者为研究对象。所有患者均先行电磁导航支气管镜辅助肺结节术前定位,再接受荧光胸腔镜辅助手术治疗。收集患者的基线资料、手术结果、肺结节位置及密度、手术方式与病理结果,对上述数据进行统计分析。结果本研究共纳入17例肺结节合并HIV感染/AIDS患者,其中患者单发肺结节8例,单侧肺多发结节8例,双侧肺多发结节1例。术前经电磁导航支气管镜辅助定位的肺结节共28枚,平均大小（7.61±3.16）mm。从解剖部位分布来看,右肺上叶11枚（39.29%）、右肺中叶3枚（10.71%）、右肺下叶6枚（21.43%）、左肺上叶6枚（21.43%）、左肺下叶2枚（7.14%）。从结节病理分型来看,纯磨玻璃结节10枚（35.71%）、混杂磨玻璃结节14枚（50.00%）,实性结节4枚（14.29%）。结节距脏层胸膜平均距离为（11.41±5.68）mm,定位操作平均耗时（21.29±5.49）min,定位成功率为96.4%（27/28）,所有患者均未发生定位相关并发症。术后病理结果显示,17例患者所对应的28枚肺结节中包括原位腺癌2枚（7.14%）、微浸润腺癌10枚（35.71%）、浸润性腺癌3枚（10.71%）、肉芽肿3枚（10.71%）、炎性结节10枚（35.71%）。结论肺结节合并HIV感染/AIDS患者,术前采用电磁导航支气管镜辅助肺结节定位,具有定位快速、安全有效的特点,且可降低术者职业暴露风险。

关键词: 肺结节, HIV感染, 艾滋病, 术前定位, 电磁导航支气管镜

Abstract: Objective To analyze the clinical data of HIV-infected/AIDS patients undergoing preoperative localization of pulmonary nodules with electromagnetic navigation bronchoscopy, summarize its safety and efficacy, and provide evidence for promoting this technique among HIV-infected/AIDS populations. Method A retrospective study included patients with pulmonary nodules and HIV infection/AIDS who visited Chengdu Public Health Clinical Medical Center from September 2023 to December 2024. All patients underwent electromagnetic navigation bronchoscopy-assisted preoperative localization of pulmonary nodules followed by fluorescence-guided thoracoscopic surgery. Baseline data, surgical outcomes, nodule location, density, pathological results, and surgical approaches were collected for statistical description and analysis. Result This study included 17 patients with pulmonary nodules and HIV infection/AIDS. Among them, 8 patients had solitary pulmonary nodules, 8 had unilateral multiple nodules, and 1 had bilateral multiple nodules. A total of 28 pulmonary nodules were preoperatively localized using electromagnetic navigation bronchoscopy, with an average size of (7.61±3.16) mm. In terms of anatomical distribution, there were 11 nodules (39.29%) in the right upper lobe, 3 nodules (10.71%) in the right middle lobe, 6 nodules (21.43%) in the right lower lobe, 6 nodules (21.43%) in the left upper lobe, and 2 nodules (7.14%) in the left lower lobe.In terms of pathological classification of nodules, there were 10 pure ground-glass nodules (35.71%), 14 mixed ground-glass nodules (50.00%), and 4 solid nodules (14.29%). The average distance from the pulmonary nodules to the visceral pleura was (11.41±5.68) mm, and the average procedure duration was (21.29±5.49) min. The localization success rate was 96.4% (27/28), with no related complications occurring. Postoperative pathological results showed that among the 28 preoperatively localized nodules from 17 patients, there were 2 cases of adenocarcinoma in situ (7.14%), 10 cases of minimally invasive adenocarcinoma (35.71%), 3 cases of invasive adenocarcinoma (10.71%), 3 cases of granuloma (10.71%), and 10 cases of inflammatory nodule (35.71%). Conclusion In patients with pulmonary nodules complicated by HIV infection/AIDS, electromagnetic navigation bronchoscopy-assisted preoperative localization of pulmonary nodules offers rapid, safe, and effective positioning while reducing occupational exposure risks for operators. It provides an optimal preoperative localization strategy for this special population and merits clinical promotion and application.

Key words: Pulmonary nodules, HIV infection, AIDS, Preoperative localization, Electromagnetic navigation bronchoscopy

中图分类号:

R511
R655.3

龚胜, 李丹, 王宁, 李刚, 刘玉, 蒋良双, 姚晓军. 电磁导航支气管镜辅助肺结节术前定位在HIV感染/AIDS患者中的临床应用[J]. 新发传染病电子杂志, 2025, 10(6): 52-56.

Gong Sheng, Li Dan, Wang Ning, Li Gang, Liu Yu, Jiang Liangshuang, Yao Xiaojun. Clinical application of electromagnetic navigation bronchoscopy-assisted preoperative localization of pulmonary nodules in HIV-infected/AIDS patients[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(6): 52-56.

参考文献

[1] XIN N, WU XY, CHEN ZH, et al.A new preoperative localiza-tion of pulmonary nodules guided by mixed reality: a pilot study of an animal model[J]. Transl Lung Cancer Res, 2023, 12(1): 150-157.
[2] 崔翔宇, 徐平, 戴锦朝, 等. CT引导下经皮肺穿刺定位在亚肺叶切除术中应用[J]. 青岛大学学报(医学版), 2023, 59(2):287-291.
[3] 程载兴, 梅培圆, 万黎, 等. 电磁导航定位与CT引导下经皮穿刺定位在肺结节手术中应用的系统评价与Meta分析[J]. 中国胸心血管外科临床杂志, 2022, 29(1): 23-29.
[4] SONG JY, SHIN SH, YOO H, et al.Efficacy of combining multi-ple electromagnetic navigation bronchoscopy modalities for diag-nosing lung nodules[J]. J Clin Med, 2022, 11(24): 7341.
[5] CHEN JX, PAN XF, GU CJ, et al.The feasibility of navigation bronchoscopy-guided pulmonary microcoil localization of small pulmonary nodules prior to thoracoscopic surgery[J]. Transl Lung Cancer Res, 2020, 9(6): 2380-2390.
[6] DING HD, SONG N, ZHANG P, et al.Wedge resection plus ade-quate lymph nodes resection is comparable to lobectomy for small-sized non-small cell lung cancer[J]. Front Oncol, 2022, 12: 1022904.
[7] 孟庆华, 张妺, 胡效坤. CT引导下微弹簧圈与Hookwire在肺小结节穿刺定位中的应用比较[J]. 影像研究与医学应用, 2022, 6(2): 179-181.
[8] LU CH, HSIAO CH, CHANG YC, et al.Percutaneous computed tomography-guided coaxial core biopsy for small pulmonary le-sions with ground-glass attenuation[J]. J Thorac Oncol, 2012, 7(1): 143-150.
[9] 焦思杨, 孙云刚, 张强, 等. 肺结节定位并发症的危险因素及列线图预测模型构建[J]. 中国胸心血管外科临床杂志, 2025, 1: 1-6.
[10] NOUR-ELDIN NEA, ALSUBHI M, NAGUIB NN, et al.Risk factor a-nalysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650 patients[J]. Eur J Radiol, 2014, 83(10): 1945-1952.
[11] DOMINGUEZ-KONICKI L, KARAM AR, FURMAN MS, et al.CT-guided biopsy of pulmonary nodules≤10 mm: Diagnostic yield based on nodules' lobar and segmental distribution[J]. Clin Imaging, 2020, 66: 7-9.
[12] 张晓华, 周冰, 李斌, 等. CT 引导下经皮穿刺 Hook-wire 定位肺磨玻璃结节的安全性及有效性研究[J]. 实用放射学杂志, 2022, 38(3): 475-479.
[13] 郑晓东, 聂世威, 周军正, 等. 电磁导航支气管镜引导下肺结节定位和CT引导下Hook-wire穿刺定位在肺癌根治术中的应用效果及安全性比较[J]. 癌症进展, 2024, 22(16): 1814-1817.
[14] 张娟, 史生华, 姜红, 等. 手术相关的HIV职业暴露的危险因素分析及防护管理[J]. 工业卫生与职业病, 2018, 44(4): 314-315.
[15] 姚源山, 项鲁婕, 陈春基, 等. 电磁导航支气管镜辅助下老年多发肺结节患者定位的临床应用[J]. 老年医学与保健, 2024, 30(1): 146-149.
[16] MCWILLIAMS A, TAMMEMAGI MC, MAYO JR, et al.Probability of cancer in pulmonary nodules detected on first screening CT[J]. N Engl J Med, 2013, 369(10): 910-919.
[17] WANG YQ, LIU X, JIA Y, et al.Impact of breathing exercises in subjects with lung cancer undergoing surgical resection: A systematic review and meta-analysis[J]. J Clin Nurs, 2019, 28(5/6): 717-732.
[18] 朱勇, 刘代强, 谢加伟, 等. 1984例HIV感染/AIDS患者抗病毒治疗后的死亡影响因素及列线图预测模型的构建[J]. 中国国境卫生检疫杂志, 2024, 47(6): 636-641.
[19] 王宁, 李刚, 龚胜, 等. 非小细胞肺癌合并HIV感染/AIDS手术患者病理和临床特征及术后并发症影响因素分析[J/CD]. 新发传染病电子杂志, 2024, 9(2): 29-33.
[20] ANDERSEN FD, DEGN KB, RIIS RASMUSSEN T.Electromagnetic navigation bronchoscopy for lung nodule evaluation. Patient selection, diagnostic variables and safety. Clin Respir J, 2020, 14(6): 557-563.
[21] 陈香, 张亚杰, 韩丁培, 等. 电磁导航支气管镜引导下肺结节术前定位183例的单中心临床分析[J]. 中国胸心血管外科临床杂志, 2023, 30(11): 1539-1544.