支气管内超声引导针吸活检术在胸部疾病中的临床应用价值  

The Value of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Evaluation of Thoracic Diseases

作　　者：赵辉[1] 王俊[1] 李剑锋[1] 李运[1] 周足力[1] 卜梁[1] 隋锡朝[1] 陈克终[1] 李晓 温焕舜[1] 

机构地区：[1]北京大学人民医院胸外科,北京100044

出　　处：《中国胸心血管外科临床杂志》2010年第5期353-356,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：首都医学发展科研基金资助项目(2009-3032)~~

摘　　要：目的介绍支气管内超声引导针吸活检术(Endobronchial ultrasound-guided transbronchial needleaspiration,EBUS-TBNA)用于肺癌分期及胸部疾病诊断的新方法,探讨EBUS-TBNA在胸部疾病中的临床应用价值。方法回顾性分析2009年9月至2010年5月106例患者经EBUS-TBNA检查的临床资料,其中男75例,女31例;平均年龄62.3岁。根据适应证的不同,将106例患者分为3种情况行EBUS-TBNA,以进一步明确诊断:(1)已明确诊断或怀疑肺癌(76例),胸部CT示:纵隔淋巴结肿大(≥1.0 cm);(2)不明原因的纵隔和(或)肺门淋巴结肿大以及纵隔肿物(22例);(3)大气道旁肺实质内占位(8例)。结果 (1)已明确诊断或怀疑肺癌76例,经EBUS-TBNA检查证实纵隔淋巴结转移58例,未见纵隔淋巴结转移18例。EBUS-TBNA检查阴性者中16例接受胸腔镜或开胸手术,行肺叶切除或肺楔形切除加纵隔淋巴结清扫,术后病理证实12例肺癌纵隔淋巴结未见转移,2例肺癌纵隔淋巴结可见癌转移(EBUS-TBNA检查假阴性),其余2例为肺内良性病变;EBUS-TBNA在肺癌纵隔淋巴结分期中的敏感性、特异性和准确性分别为96.66%(58/60),100.00%(12/12)和97.22%(70/72)。(2)不明原因的纵隔和(或)肺门淋巴结肿大以及纵隔肿物22例,经EBUS-TBNA检查后明确恶性病变7例,良性病变13例;EBUS-TBNA在纵隔病变良恶性诊断和鉴别诊断方面的敏感性为87.50%(7/8)。(3)大气道旁肺实质内占位8例,经EBUS-TBNA检查后7例明确诊断,其中6例肺癌;EBUS-TBNA在大气道旁肺实质内占位中诊断的敏感性和准确率分别为85.71%(6/7)和87.50%(7/8)。所有患者检查耐受良好,无任何相关并发症发生。结论 EBUS-TBNA是一种安全有效的诊断技术,应成为胸部疾病诊断和分期的常用方法。Objective To introduce the new procedure of endobronchial ultrasound-guided transbronchial needle aspiration（EBUS-TBNA） for staging lung cancer and diagnosing thoracic diseases,in order to determine its value in the evaluation of thoracic diseases. Methods We retrospectively reviewed the data of all patients examined with EBUS-TBNA our institution between September 2009 and May 2010.Among the patients,there were 75 males and 31 females with an average age of 62.3 years old.Based on their primary indication,we divided all the 106 patients into three categories.（1） There were 76 patients with known or strongly suspected lung cancer.Enlarged mediastinal lymph nodes on radiographic examination of the chest（≥1.0 cm） were detected in all the patients.（2） There were 22 patients with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin.（3） There were 8 patients with pulmonary mass located close to the central airways. Results （1） 76 patients underwent EBUS-TBNA for known or strongly suspected lung cancer.Among them,58 patients were confirmed to have mediastinal lymph nodes metastasis on EBUS-TBNA.Sixteen in the 18 patients with negative EBUS-TBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection.Postoperative pathology confirmed that 12 patients did not have metastatic nodes,2 patients had metastatic nodes and 2 other patients had benign lesions within the lung.The diagnostic sensitivity,specificity and accuracy of EBUS-TBNA for the mediastinal staging of lung cancer were 96.66%（58/60）,100.00%（12/12） and 97.22%（70/72）,respectively.（2） 22 patients underwent EBUS-TBNA for the evaluation of mediastinal adenopathy or mass in the absence of any identifiable pulmonary lesion.Among them,7 had malignancy,13 had benign diseases on EBUS-TBNA and the sensitivity of EBUS-TBNA in distinguishing malignant mediastinal diseases was 87.50%（7/8）.（3） 8 patients with pulmonary mass located close to the central airways were

关 键 词：支气管内超声 经支气管针吸活检 肺癌 纵隔 分期 诊断 

分 类 号：R734.2[医药卫生—肿瘤] R734.5[医药卫生—临床医学]