Chest:支气管内超声引导结节针吸术和纵隔镜检查的安全性及成本

2019-11-23 xiangting MedSci原创

与纵隔镜检查相比,当按照单独的手术进行时,EBUS的风险和成本较低。

关于纵隔淋巴结评估的最佳侵入性诊断方式仍存在争议。既往研究具有局限性,并且不足以发现罕见不良事件中的差异。这项研究在一个大型国家队列中比较了因任何指征进行的支气管内超声(EBUS)引导的结节针吸术和纵隔镜检查的风险和成本。

研究人员对MarketScan进行了一项回顾性研究(2007年至2015年),MarketScan是一个美国雇主提供保险的个人索赔数据库。排除接受多种纵隔评估方式(n=1,396)或当天肺切除(n=2,130)的患者。使用回归模型评估诊断方式与风险和成本的关联,同时针对患者特征、年龄、伴随的支气管镜检查手术和肺癌诊断进行调整。

30570名患者中,49%接受了EBUSEBUS和纵隔镜检查的严重不良事件(气胸、血胸、气道/血管损伤或死亡)很罕见并且没有差异(0.3vs 0.4%;P= .189)。EBUS的声带麻痹发生率较低(1.4vs 2.2%;P<.001)。EBUS与严重不良事件(OR0.42 95CI0.32-0.55)和声带麻痹的调整风险较低相关(OR0.57 95CI0.54-0.60)。EBUS的平均费用比纵隔镜检查少$ 2,211$ 6,816 vs $ 9,023P<.001)。调整后,这一差额降至$1,65095CI$1,525$1,776)。

与纵隔镜检查相比,当按照单独的手术进行时,EBUS的风险和成本较低。将来在整个社区中比较EBUS与纵隔镜检查有效性的研究将有助于确定哪种方法更好,或者是否存在取舍。

原始出处:

Francys C. Verdial. Safety and Costs of Endobronchial Ultrasound-Guided Nodal Aspiration and Mediastinoscopy. Chest. October 2019.

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    2019-12-09 Smile2680
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