经支气管镜超声引导针吸活检术在纵隔病变诊断中的应用价值  

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in paratrachealmediastinal lesions

作　　者：王栋[1] 马卫霞[1] 姜淑娟[1] 侯晓霞[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：《中华医学杂志》2013年第20期1563-1566,共4页National Medical Journal of China

基　　金：山东省科学技术发展计划医药卫生项目（2009GGl0002061）

摘　　要：目的探讨经支气管镜超声引导针吸活检术（EBUS-TBNA）在纵隔病变诊断中的应用价值。方法选取2010年1月至2012年4月就诊于山东大学附属省立医院呼吸内科，并经胸部CT检查显示纵隔淋巴结肿大而常规支气管镜检查未发现病变的患者264例，淋巴结长轴〉1．5cm者共222例，其中174例只行经支气管镜针吸活检术（TBNA）检查（A组），48例只行EBUS-TBNA检查（B组）。另将42例淋巴结长轴〈1．5cm的患者作为C组，同时行TBNA（结果计为C1组）和EBUS-TBNA（结果计为C2组）检查。对各组患者的细胞学或病理学检查结果、诊断阳性率及并发症发生情况进行统计分析。结果A组确诊154例（88．5％），其中恶性肿瘤135例，良性病变19例，损伤血管5例；B组确诊45例（93．8％），其中恶性肿瘤33例，良性病变12例；C1组确诊31例（73．8％），其中恶性肿瘤23例，良性病变8例，损伤血管2例；C2组确诊39例（92．8％），其中恶性肿瘤30例，良性病变9例。A、B两组诊断阳性率差异无统计学意义（X2=0．621，P=0．431）；A组的诊断阳性率明显高于C1组（X2=5．945，P=0．015）；B、C2两组诊断阳性率差异无统计学意义（X2=0．065，P=0．320）；C1、C2两组诊断阳性率差异有统计学意义（X2=5．486，P=0．019）。结论EBUS-TBNA对纵隔较小淋巴结的诊断阳性率较高且较安全。Objective To explore the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration（EBUS-TBNA） in diagnosing mediastinal lesions. Methods A total of 264 patients with mediastinal lesions on chest CT at Provincial Hospital Affiliated to Shandong University between January 2010 and April 2012 were retrospectively enrolled. Their cytopathological results were difficult to be assessed by conventional bronehoseopy. There were 222 cases whose lymph nodes long axis was 〉 1.5 era. Among them, 174 cases underwent TBNA alone （group A） and the other 48 cases EBUS-TBNA alone （ group B）. The remaining 42 cases whose lymph nodes long axis was 〈 1.5 em belonged to group C and underwent TBNA （group C1） and EBUS-TBNA （group C2） sequentially as a combined procedure. The associations of pathologic examinations, diagnostic positive rate and complications were analyzed. Results Among 174 cases in group A, 154 cases were diagnosed with a positive diagnostic rate of 88.5%. There were 135 malignant lesions while 19 cases were diagnosed with benign diseases and 5 cases had accidental vascular injury. Among 48 cases in group B, 45 cases were diagnosed with a positive diagnostic rate of 93.8%. There were 33 malignant lesions while 12 cases were diagnosed with benign diseases. Among 42 patients in group CI, 31 cases were diagnosed by TBNA with a positive diagnostic rate of 73.8%. There were 23 malignant lesions while 8 cases were diagnosed with benign diseases and 2 cases had accidental vascular injury. Among 42 patients in group C2, 39 cases were diagnosed with a positive diagnostic rate of 92. 8%. There were 30 malignant lesions while 9 cases had benign diseases. No difference existed in diagnostic positive rate between groups A and B （X2 =0. 621, P =0. 431 ） while the diagnostic positive rate in group A was much higher than group C1 （X2 =5. 945, P =0. 015）. The difference between groups B and C2 was mslgmficant（X2=0. 065, P =0. 320）while there was significant difference betwe

关 键 词：活组织检查 针吸 支气管镜检查 超声检查 纵隔疾病 

分 类 号：R737.11[医药卫生—肿瘤]