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作 者:常炜 李媛媛 刘志刚 钱俊锴 胡鸿[3] 车勇 CHANG Wei;LI Yuanyuan;LIU Zhigang;QIAN Junkai;HU Hong;CHE Yong(The Center of Thoracic Surgery,,Chest Hospital of Xinjiang Uyghur Autonomous Region,Urumqi 830049,China;The Third Department of Tuberculosis,Chest Hospital of Xinjiang Uyghur Autonomous Region,Urumqi 830049,China;Department of Thoracic Surgery,the Affiliated Tumor Hospital of Shanghai Medical College,Fudan University,Shanghai 200032,China)
机构地区:[1]新疆维吾尔自治区胸科医院胸外中心,乌鲁木齐830049 [2]新疆维吾尔自治区胸科医院结核三科,乌鲁木齐830049 [3]复旦大学上海医学院附属肿瘤医院胸外科,上海200032
出 处:《新疆医科大学学报》2018年第4期423-426,431,共5页Journal of Xinjiang Medical University
基 金:国家卫生计生委医药卫生科技发展研究中心项目(w2014RQ21)
摘 要:目的探讨经气管镜超声引导针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在诊断纵隔淋巴结肿大的应用价值。方法总结分析新疆维吾尔自治区胸科医院胸外中心自2016年2月—2016年5月33例实施EBUS-TBNA患者的临床资料,分析EBUS-TBNA诊断上皮性癌、胸内结核的敏感性、特异性、阳性预测值和阴性预测值以及技术操作的相关数据。结果 33例共穿刺淋巴结74组,平均穿刺2.24组,每组淋巴结平均直径为(2.5±3.8)mm(1.1~35 mm),其中穿刺1组淋巴结6例,穿刺2组淋巴结14例,穿刺3组淋巴结12例,穿刺4组淋巴结1例。平均每组淋巴结平均穿刺次数(3.1±0.5)次(2~5次),平均穿刺时间(14.1±4.7)min(2~25 min),穿刺成功率100%,无并发症。上皮性癌诊断准确率91.7%,敏感性90%,特异性100%,阳性预测值100%,阴性预测值66.7%,肺结核诊断的准确率85.7%,敏感性66.7%,特异性100%,阳性预测值100%,阴性预测值50.0%。结论 EBUS-TBNA技术操作简易、微创,可穿刺淋巴结区域广,在非小细胞肺癌纵隔淋巴结分期诊断中具有很高的敏感性、特异性,不仅如此,在胸内淋巴结结核的诊断中也具有一定的临床价值。Objective To explore the value of diagnosing enlargement of mediastinal lymph nodes with endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)in the areas with high incidence of tuberculosis(TB).Methods The clinical data of 33 EBUS-TBNA cases of a thoracic surgery center in Xinjiang Uyghur Autonomous Region during February 2016 and May 2016 were summarized and analyzed on the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and relevant data of technical operations when diagnose epithelial cancer and intrathoracic tuberculosis with EBUS-TBNA.Results 74 groups of lymph nodes in the 33 patients were punctured(averagely 2.24 groups/patient).The mean diameter of the lymph nodes was(2.5±3.8)mm(1.1~35 mm).Among the 33 patients,there were 6 case of lymph nodes in punctured Group 1,14 cases in Group 2,12 cases in Group 3 and 1 case in Group 4,respectively.The mean puncture frequency of lymph nodes of each group was(3.1±0.5)times(range 2-5 times)and the mean procedure time for puncture was(14.1±4.7)min(range 2-25 min).The achievement ratio of puncture was 100%.There was no complications induced by puncture.The accuracy,sensitivity,specificity,PPV and NPV of epithelial cancer diagnosis were 91.7%,90%,100%,100%and 66.7%respectively.As to diagnosis of pulmonary tuberculosis,the accuracy,sensitivity,specificity,PPV and NPV were 85.7%,66.7%,100%,100%and 50.0%,respectively.Conclusion EBUS-TBNA is an easy-to-operate and nondestructive technique that allows lymph node puncture with a wide area.It shows a relatively high degree of sensitivity and specificity in staging diagnosis of NSCLC mediastinal lymph node diseases.Besides,it also has clinical value for diagnosis of intrathoracic tuberculosis.
关 键 词:经气管镜超声引导针吸活检术 纵隔淋巴结肿大 肺肿瘤 肺结核 应用
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