内镜超声引导下细针穿刺活检对纵隔和腹腔淋巴结结核的诊断价值  

Endoscopic Ultrasound-guided Fine-needle Aspiration for Diagnosis of Mediastinal and Intra-abdominal Tuberculous Lymphadenitis

作　　者：占义军[1,2] 童旭东[1,2] 丁祥武[1,2] 

机构地区：[1]湖北省襄阳市中心医院 [2]湖北文理学院附属医院消化内科,441021

出　　处：《胃肠病学》2015年第2期85-87,共3页Chinese Journal of Gastroenterology

基　　金：湖北省卫生厅青年人才项目(QJX-2010-57)[鄂卫函(2010)820号]

摘　　要：背景:结核病在中国的发病率居高不下,纵隔和腹腔淋巴结结核由于临床表现的非特异性以及活检取材困难,确诊难度较大。目的:探讨内镜超声引导下细针穿刺活检(EUS-FNA)对纵隔和腹腔淋巴结结核的诊断价值。方法:选取襄阳市中心医院2013年7月至2014年1月疑诊淋巴结结核、肿大淋巴结位于纵隔或腹膜后的患者12例行EUS-FNA。穿刺物行组织学和细胞学检查,根据病理诊断结果予患者相应处理并随访。结果:肿大淋巴结回声呈多样性;12例患者经穿刺均得到理想的组织标本并获得组织学和(或)细胞学诊断,其中7例诊断为结核,4例为转移性腺癌,1例考虑孤立性纤维性肿瘤。无患者发生穿刺相关并发症。7例结核患者行抗结核治疗后疗效确切,4例转移性腺癌患者进一步检查均有阳性发现,1例孤立性纤维性肿瘤经手术证实。结论:EUS-FNA对纵隔和腹腔淋巴结结核是一种安全、有效的诊断方法,对淋巴结结核与转移癌的鉴别诊断具有重要意义。Background： The incidence of tuberculosis is still not low in China. Diagnosis of mediastinal and intra-abdominal tuberculous lymphadenitis is challenging for clinicians due to the non-specific clinical manifestations and difficulties in biopsy. Aims： To assess the value of endoscopic ultrasound-guided fine-needle aspiration（ EUS-FNA） for diagnosis of mediastinal and intra-abdominal tuberculous lymphadenitis. Methods： Twelve suspected tuberculous lymphadenitis patients with enlarged lymph nodes located at mediastinum or retroperitoneum were enrolled from Jul. 2013 to Jan. 2014 at Xiangyang Central Hospital. EUS-FNA was performed for final diagnosis and the aspirated tissues underwent histological and cytological examinations. Patients were managed according to the pathological diagnosis and then a follow up was conducted. Results：The echoes of enlarged lymph nodes were diverse in character. EUS-FNA was successfully performed and optimal aspirated tissues for histological and / or cytological diagnosis were obtained in all these twelve patients. Seven patients were found to have tuberculosis, four were metastatic adenocarcinoma, and one was solitary fibrous tumor. No aspiration-related complications were observed. Seven patients diagnosed as tuberculosis accepted antituberculosis therapy and a definite curative effect was achieved; four patients with metastatic adenocarcinoma received further examinations and all had positive findings; one case of solitary fibrous tumor was proved by surgery. Conclusions： EUS-FNA is a safe and effective method for diagnosis of mediastinal and intra-abdominal tuberculous lymphadenitis, and has an important role in differentiating tuberculous lymphadenitis from metastatic carcinoma.

关 键 词：结核 淋巴结 内镜超声检查 活组织检查 细针 诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R529.0[医药卫生—诊断学]