经气管镜超声引导针吸活检术在纵隔疾病诊断中的价值  

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in the mediastinal disease

作　　者：邵杨[1] 姜淑娟[1] 

机构地区：[1]山东大学附属省立医院呼吸内科,济南250021

出　　处：《中华肺部疾病杂志（电子版）》2011年第2期90-93,共4页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：山东省科技发展计划项目(2009GG10002061)

摘　　要：目的探讨经纤维支气管镜超声引导针吸活检术(endobronchial ultrasound-guided trans-bronchial needle aspiration,EBUS-TBNA)在纵隔疾病诊断中的价值。方法 2009年1月至2010年12月对326例经CT扫描发现有纵隔病变患者,在支气管镜检查过程中完成EBUS-TBNA操作,直接涂片送检。结果 326例患者中,192例常规气管镜检查无黏膜及管腔改变,47例局部黏膜增厚肿胀或有小结节样改变,62例管腔呈轻度外压型改变,25例气管局部软骨环消失。326例患者共穿刺486个位点,获得阳性诊断304例,阳性率为93.25%(304/326),其中恶性肿瘤260例(79.75%,260/326),分别为肺鳞癌81例、肺腺癌78例、肺大细胞未分化癌8例、肺小细胞未分化癌74例、肺淋巴瘤7例、难以分类的恶性肿瘤12例;良性病变44例,分别为结节病32例、结核病7例、慢性淋巴结炎5例。486个位点共穿刺576针,482针(83.6%,482/576)经纤维支气管镜针吸活检术(transbronchialneedle aspiration,TBNA)涂片获得阳性诊断,其中恶性肿瘤421针(肺鳞癌137针、肺腺癌124针、肺大细胞未分化癌19针、肺小细胞未分化癌117针、肺淋巴瘤11针、难以分类的恶性肿瘤13针),良性病变61针(分别为结节病43针、结核病11针、慢性淋巴结炎7针);48针涂片中可见多个淋巴细胞团,认为穿刺成功,但无阳性发现;29针涂片可见较多纤毛柱状上皮细胞,未穿透气管壁,穿刺失败;17针涂片未见明显的细胞成分。TBNA并发症:31例患者穿刺部位少量出血,勿需特别处理;5例穿刺针误刺入血管内抽出新鲜血液,及时更换穿刺点顺利完成操作;未出现纵隔气肿、纵隔感染等不良反应。患者均能很好耐受操作。结论 EBUS-TBNA创伤性小、安全性高,是诊断纵隔病变的有效方法。Objective To research the value of endobronchial ultrasound- guided transbronchial needle aspiration on the diagnosis of mediastinal disease. Methods From January 2009 to December 2010, EBUS-TBNA procedures were performed by using a flexible bronchoscope in 326 patients who whin chest CT examinations showed the existence of medi- astinal disease, directly smear and inspect. Results Among 326 patients, 192 patients had no mucosal and luminal changes after examing by routine bronchoscope, 47 patients had local mucosal thickening in swelling or small nodules ,62 patients had mild changes in lumen because of external pressure, and 25 cases with partial tracheal cartilage rings disappeared. 486 points were examined in 326 patients, 304 patients had positive diagnosis , with a positive rate of 93.25% （304/326）. ：260 cases were malignant tumors （79.75% ,260/326）, 81 cases were squamous cell carcinoma, 78 ca- ses were adenocarcinoma, 8 cases were large cell undifferentiated carcinoma, 74 cases were smallcell undifferentiated carcinoma, 7 cases were lymphoma, 12 cases were malignant tumors difficult to classify; 44 cases were benign, 32 cases were sarcoidosis, 7 cases were tuberculosis, 5 cases were chronic lymphadenitis. The total of 576 puncture were made from 486 sites, 482 had positive diag- nosis, with a positive rate of 83.6% （482/576）, 421 were malignant tumors, 137 were squamous cell carcinoma, 124 were adenocarcinoma, and 19 were large cell undifferentiated carcinoma. 117 were small cell undifferentiated carcinoma, 1 l were lymphoma, 13 of the malignancy were difficult to classify, 61 were benign diseases, 43 were sarcoidosis, 11 were tuberculosis, 7 were chronic lymphadenitis ; multiple cell groups can be seen during 48, which meaned the successful puncture with no positive findings; ciliated columnar epithelium could be seen during 29, which meaned puncture failure; no apparent cells were seen in 17. TBNA complications： 31 patients bleeding a little at the puncture site, who didn＇ t need speci

关 键 词：针吸活检术经气管镜超声引导 纵隔病变 诊断 

分 类 号：R563[医药卫生—呼吸系统]