气管内超声引导下针吸活检对肺门纵隔病变的诊断价值  

Evaluation of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of hilar and mediastinal tumors

作　　者：顾晔[1] 姜格宁[1] 周晓[1] 姜洪斌[1] 任胜祥[1] 李爱武[1] 张海平[1] 汪浩[1] 

机构地区：[1]同济大学医学院附属上海市肺科医院内窥镜室,200433

出　　处：《中华结核和呼吸杂志》2013年第1期22-26,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨气管内超声引导下针吸活检术（EBUS—TBNA）对肺门纵隔肿物的诊断价值。方法对837例胸部CT或正电子发射体层摄影术（PET）-CT提示肺门纵隔淋巴结肿大和（或）位于气管或支气管周围肿块的患者进行EBUS—TBNA检查。获取病理组织标本，同期进行有创检查或随访，得到最终结果，验证EBUS—TBNA的准确性。结果共穿刺淋巴结1631例次，平均1．95次／例，穿刺成功率100％，其中4R组与7组淋巴结分别占穿刺总数的43％和34％，肺癌诊断率为94．11％；其中鳞癌89例，占19．22％；腺癌150例，占32．40％；小细胞癌109例，占23．54％；非小细胞癌-织学类型不明确型44例，占9．50％；腺鳞癌35例，占7．56％；其他类型36例，占7．78％。结核病诊断率为85．50％；结节病诊断率为55．88％；经统计分析，得出EBUS—TBNA总体敏感度为94．02％，特异度为100％，阳性预测值100％，阴性预测值61．91％，准确率94．56％。除穿刺部位少许出血外，无其他并发症，未见气胸、纵隔气肿、大血管损伤等严重并发症。结论EBUS—TBNA作为一种微创，便利，低风险的操作，对于纵隔和肺门淋巴结以及肿块的穿刺诊断有着较高的实用价值。Objective To explore the diagnostic values of endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） in patients with hilar and mediastinal tumors. Methods A total of 837 patients with chest CT or PET/CT confirmed mediastinal/hilar lymphadenopathy and or tumors in （or around ） the trachea or bronchi, were evaluated by EBUS-TBNA examination. Pathological study or follow-up visit was carried out in the same period to make a final diagnosis, and therefore to verify the accuracy of EBUS-TBNA. Result The study punctured 1631 lymph nodes totally, with an average of 1.95 times per case. The 4R group and the 7th group of lymph nodes accounted for 43% and 34% , respectively. The success rate of TBNA was 100%. The diagnosis rates of lung cancer was 94. 11% , of which squamous cell carcinoma accounted for 19. 22% （89 cases）, adenocarcinoma 32. 40% （150 cases）, small cell carcinoma 23.54% （109 cases ）, non-small cell carcinoma of unknown histological type 9.50% （44 cases） , adenosquamous carcinoma 7.56% （35 cases） , and other types 7.78% （36 cases）. The diagnosis rate of tuberculosis was 85.50%, and that of sarcoidosis was 55.88%. The overall sensitivity of EBUS-TBNA was 94. 02% , specificity 100% , positive predictive value 100% , negative predictive value 61.91% , and the accuracy was 94. 56%. Besides mild bleeding in the puncture site, no other complications occurred, and there were no severe complications such as pneumothorax, pneumomediastinum, or major vascular injury. Conclusion EBUS-TBNA is of high value as a minimally invasive, convenient, and low- risk procedure for the diagnosis of mediastinal and hilar lymphadenopathy and tumors.

关 键 词：淋巴结 活组织检查 针吸 腔内超声检查 

分 类 号：R56[医药卫生—呼吸系统]