气管内超声实时引导经支气管针吸术对肺癌纵隔肺门淋巴结的诊断价值  

Real-time endobronchial ultrasound-guided transbronchial needle aspiration： preliminary study on mediastinal and hilar lymph nodes of lung cancer

作　　者：李时悦[1] 陈小波[1] 何颖[1] 汪金林[1] 陈愉[1] 钟南山[1] 

机构地区：[1]广州医学院第一附属医院广州呼吸疾病研究所呼吸疾病国家重点实验室,510120

出　　处：《中华医学杂志》2009年第24期1672-1675,共4页National Medical Journal of China

摘　　要：目的研究气管内超声实时引导经支气管针吸术（EBUS—TBNA）对肺癌纵隔和肺门淋巴结的诊断价值及安全性。方法2008年7-12月，对25例[男18例，女7例，年龄（68±9）岁]诊断为肺癌或疑为肺癌且CT检查显示纵隔或肺门淋巴结肿大患者的28组淋巴结行EBUS—TBNA（EBUS-TBNA组）。以2008年1-6月由同一操作者因相同适应证而进行常规经支气管针吸术（C-TBNA）的26例患者[男18例，女8例，年龄（66±8）岁）]的28组淋巴结为对照（C—TBNA组）。以穿刺针抽吸物检查找到特异性细胞物质或淋巴细胞为阳性结果。比较2组的诊断阳性率及并发症发生情况。结果EBUS—TBNA组诊断阳性率为92．9％（26／28），明显高于C—TBNA组（60．7％，17／28，Х^2=8．114，P=0．004）。2组均未发现气胸、气道撕裂、出血（〉5ml）等并发症。结论气管内超声实时引导可显著提高经支气管针吸术对肺癌患者纵隔和肺门淋巴结的诊断阳性率，且安全性高，应进一步开展应用研究。Objective To observe the value and safety of real-time endobronchial ultrasound （EBUS）-guided transbronchial needle aspiration （TBNA） on mediastinal and hilar lymph nodes of lung cancer. Methods During July 2008 to December 2008, 25 patients （ 18 males, 7 females） , （68 ±9） years old, with proven or radiologically suspected lung cancer were enrolled. EBUS-TBNA was performed to obtain samples from 28 lymph nodes of these patients. And 28 lymph nodes of 26 same eligible patients [ （ 18 males, 8 females, （66 ＋ 8 ） years old] were sampled with conventional TBNA by the same operator during January 2008 to June 2008. A positive result was either a specific diagnosis （eg, malignant cells） or a lymphocyte-positive specimen. The results and complications of EBUS-TBNA versus conventional TBNA were compared. Results The yield of EBUS-TBNA, 92. 9% , was significantly higher than 60. 7% （ 17/28 nodes） of conventional TBNA （ Х^2 = 8. 114, P = 0. 004）. No pneumothorax, airway rupture, hemorrhage （〉 5 ml ） and other complications were observed for the patients operated with EBUS-TBNA and conventional TBNA. Condusions Real-time EBUS guidance significantly increases the yield of TBNA on mediastinal and hilar lymph nodes of lung cancer, and EBUS-TBNA is safe. Further application studies are needed.

关 键 词：肺肿瘤 腔内超声检查 支气管镜检查 活组织检查 针吸 淋巴转移 诊断 

分 类 号：R686[医药卫生—骨科学]