经支气管针吸活检术并发出血的临床分析  

Clinical analysis of bleeding during transbronchial needle aspiration

作　　者：聂云强[1] 王琴[2] 李翠云[1] 周洪[3] 黄海东[2] 

机构地区：[1]临沂市人民医院呼吸内科,临沂276003 [2]第二军医大学长海医院呼吸内科,上海200433 [3]北京电力医院消化内科,北京100073

出　　处：《第二军医大学学报》2012年第12期1339-1343,共5页Academic Journal of Second Military Medical University

摘　　要：目的通过对经支气管针吸活检术(TBNA)并发出血的回顾性临床分析,探讨出血的防治策略。方法对临沂市人民医院收治的178例纵隔和(或)肺门淋巴结肿大患者开展TBNA,共穿刺248个部位淋巴结:气管前腔静脉后淋巴结组(4R)穿刺数100个,左气管旁主动脉-肺动脉窗淋巴结组(4L)穿刺数10个,隆突前淋巴结组(7)穿刺数13个,隆突下淋巴结组(7)穿刺数90个,隆突远端淋巴结组(7)穿刺数12个,右肺门淋巴结组(11R)穿刺数12个,左下肺门淋巴结组(11L)穿刺数11个。以WANG氏TBNA定位及穿刺法实施操作,统计及分析穿刺后并发出血的部位及发生率。结果隆突下淋巴结组(7)穿刺出血率最高(20%),气管前腔静脉后淋巴结组(4R)穿刺出血率最低(2%)。穿刺部位间出血率的差异均有统计学意义(χ2=17.035,P=0.009)。结论气管前腔静脉后和隆突下淋巴结是TBNA最常穿刺的淋巴结,隆突下淋巴结组(7)行TBNA时出血发生率高。行TBNA前采用肺部CT增强扫描或内镜超声可显示肿大淋巴结区域内血供情况,避免穿刺后并发大出血。Objective To retrospectively analyze the incidence of bleeding during transbronchial needle aspiration （TBNA） procedures, so as to provide evidence for prevention and treatment of the condition. Methods TBNA procedures were performed in 178 patients with enlarged mediastinal and/or hilar lymph nodes, who were treated in the People＇s Hospital of Linyi. A total of 248 lymph node sites were punctured, including 100 for the groups of pretracheal and post-superior vena cava lymph nodes （4R）, 10 for the groups of left paratracheal （aorta pulmonary artery windows） lymph nodes （4L）, 13 for the groups of pre-carinal lymph nodes （7）,90 for the groups of sub-carinal lymph nodes （7）, 12 for the groups of sub-subcarinal lymph nodes （7）, 12 for the groups of right lung hilar lymph nodes （llR）, and 11 for the groups of left lung hilar lymph nodes （llL）. TBNA procedures were performed according to WANG^s TBNA positioning and punctured method. The sites and incidence rates of bleeding sites during the procedures were analyzed. Results The highest incidence rate of bleeding （20%） was found during TBNA procedures in the sub-carinal lymph node groups （7） , and the lowest incidence rate was found （2%） in the pretracheal and post-superior vena cava lymph node groups （4R） . The incidence rates of bleeding were significantly different between different puncture sites as demonstrated by chi-square test （x2 =17. 035,P=0. 009）. Conclusion Pretracheal and post-superior vena cava lymph nodes （4R） and sub-carinal lymph nodes （7） are the most common TBNA puncture position in the airway. TBNA procedure at sub-carinal lymph nodes （7） has the highest risk of bleeding. The massive bleeding during TBNA procedures can be avoided by prior enhanced CT and/or endobronchial ultrasound （EBUS）-TBNA of the lung.

关 键 词：经支气管针吸活组织检查 出血 隆突 淋巴结 X线计算机体层摄影术 

分 类 号：R446.8[医药卫生—诊断学]