超声支气管镜引导下经支气管针吸活检70例临床分析  

The application of endobronchial ultrasound-guided transbronchial needle aspiration： report of 70 cases

作　　者：孙加源[1] 韩宝惠[1] 赵珩[1] 张俭[1] 冯久贤[1] 张杰[1] 沙慧芳[1] 戚大江[1] 顾爱琴[1] 沈洁[1] 冯运[1] 

机构地区：[1]上海交通大学附属胸科医院呼吸内科,200030

出　　处：《中华结核和呼吸杂志》2010年第10期738-741,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：上海市级医院新兴前沿技术项目（SHDC12010101）;上海市科委科研计划项目（10411967800）

摘　　要：目的 评价超声支气管镜引导下的经支气管针吸活检（EBUS-TBNA）对纵隔和肺门淋巴结肿大和肺内肿块的诊断价值和安全性.方法 对2009年7月至2010年1月上海市肺科医院胸部CT检查显示胸腔内肿物和（或）纵隔-肺门淋巴结肿大的门诊或住院患者行EBUS-TBNA,观察诊治效果.结果 入选患者70例,男47例,女23例,年龄22～84岁,平均55.7岁.其中门诊患者25例,住院患者45例.穿刺肺门淋巴结120组,肺内肿块11例次.70例患者中,在没有采用现场细胞学诊断的条件下,46例初诊肺癌患者通过EBUS-TBNA明确诊断44例,假阴性2例,诊断肺癌的敏感度为96%,特异度为100%,阳性预测值为100%,阴性预测值为92%,准确率为97%;10例临床诊断为结节病的患者中,5例镜下可见上皮细胞形成的非干酪样肉芽肿改变;4例结核患者中,1例淋巴结涂片中找到抗酸杆菌,淋巴结活枪病理示凝固性坏死.所有患者手术期间未发生并发症.结论 EBUS-TBNA是诊断肺癌和其他不明因纵隔-肺门淋巴结肿大的一种安全、有效的方法.Objective To evaluate the diagnostic yield and the safety of endobronchial ultrasoundguided transbronchial needle biopsy （EBUS-TBNA） in mediastinal and hilar lymph nodes and lung tumors. Methods EBUS-TBNA was performed in 70 patients with thoracic masses or mediastinal-hilar lymphoadenopathy proved by CT scan. Results From July 2009 to January 2010, 70 patients were included in the study. EBUS-guided TBNA was performed to obtain samples from mediastinal and hilar lymph nodes （120 stations） and lung tumors （11 masses）. In 46 cases of newly diagnosed lung cancer, 44 were confirmed by EBUS-TBNA without on site cytology assistance, with 2 false negative cases. The sensitivity,specificity, positive predictive value, negative predictive value, and accuracy of EBUS-TBNA in the diagnosis of lung cancer were 96%, 100% , 100% , 92% and 97% respectively. Non-caseous granuloma formed by epithelioid cells was found in EBUS-TBNA histological specimen from 5 out of 10 patients with clinically diagnosed sarcoidosis. TBNA cytological smear showed acid-fast bacilli and histology of the lymph node demonstrated coagulatory necrosis from 1 out of 4 tuberculous cases. The procedure was uneventful, and there were no complications. Conclusion EBUS-TBNA is an effective and safe method for the diagnosis of bronchogenic carcinoma and unknown mediastinal-hilar lymphadenopathy.

关 键 词：支气管镜检查 超声检查 介入性 肺肿瘤 

分 类 号：R686[医药卫生—骨科学]