经支气管镜穿刺针吸活检术在纵膈或肺门淋巴结肿大疾病病因诊断中的价值  

The value of transbronchoscopic needle aspiration in the diagnosis of mediastinal or hilar lymphadenopathy

作　　者：吴勇德 何德全 唐治君 汪治山 WU Yongde;HE Dequan;TANG Zhijun;WANG Zhishan(Respiratory Department,The People′s Hospitals of Nanchuan,Chongqing 408400,China;Respiratory Department,Nantong Mining Bureau General Hospital of Wansheng,Chongqing 408400,China)

机构地区：[1]重庆市南川区人民政府医院呼吸内科,重庆408400 [2]重庆市万盛区南通矿务局总医院呼吸内科,重庆4008000

出　　处：《西部医学》2020年第1期49-52,共4页Medical Journal of West China

基　　金：重庆市自然科学基金(CSTC,2015BB5021)

摘　　要：目的探讨经支气管镜穿刺针吸活检术(TBNA)在纵膈或肺门淋巴结肿大疾病病因诊断中的价值。方法选取2016年12月~2017年12月于南川区人民政府医院就诊的70例纵膈或肺门淋巴结肿大且行常规支气管纤维支气管镜检查显示管腔未见明显外压及肿物的患者,所有患者均进行纵膈淋巴结针吸活检,涂片后送检。完成TBNA后,穿刺点处采用毛刷刷检,如发现充血水肿与局部黏膜增厚再进行活检。比较TBNA与黏膜活检联合刷检的诊断率差异,分析不同淋巴结大小以及不同部位淋巴结TBNA诊断率的差异,评价TBNA的安全性与有效性。结果 70例患者经TBNA检查确诊43例,诊断率61.43%,其中17例小细胞癌,14例未分型,6例腺癌,5例鳞癌;黏膜活检联合刷检确诊15例,诊断率21.43%,TBNA显著高于黏膜活检联合刷检(P<0.05);淋巴结直径>2cm者的TBNA诊断率显著高于淋巴结直径≤2cm(P<0.05);隆突下淋巴结患者的TBNA诊断率显著高于非隆突下淋巴结者(P<0.05);41例患者穿刺点少量出血,5例出血量较多,但未特殊止血出血自行停止,无纵膈气肿、出血、纵膈感染、气胸等并发症发生,各组患者不良反应及并发症发生情况无明显差异(P>0.05)。结论 TBNA对纵膈或肺门淋巴结肿大疾病,特别是淋巴结直径>2cm和隆突下淋巴结肿大患者的病因诊断具有重要价值,且穿刺活检安全,无严重并发症发生。Objective To explore the value of transbronchoscopic needle aspiration(TBNA) in the diagnosis of mediastinal or hilar lymphadenopathy. Methods From December 2016 to December 2017, 70 patients with mediastinal or hilar lymphadenopathy and no obvious external pressure or mass in lumen were selected. All patients underwent needle aspiration biopsy of mediastinal lymph nodes and were sent for examination after smear. After completion of TBNA, brush examination was performed at the puncture point. If congestion and edema were found and local mucosa thickening was found, biopsy was performed. The diagnostic rate of TBNA and mucosal biopsy complicated with brush mucosal examination. The safety and effectiveness of TBNA and the difference of TBNA diagnosis rate in different lymph nodes were evaluated. Among the 70 patients, 17 cases were small cell carcinoma, 14 cases were not classified, 6 cases were adenocarcinoma and 5 cases were squamous carcinoma. The diagnosis rate of mucosal biopsy complicated with brush mucosal examination was 21.43%(15 cases). The diagnosis rate of TBNA was significantly higher than t mucosal biopsy complicated with brush mucosal examination(P<0.05). The diagnostic rate of TBNA in patients with lymph node diameter >2 cm was significantly higher than those with lymph node diameter ≤ 2 cm(P<0.05). The diagnostic rate of TBNA in patients with subcarinal lymph nodes was significantly higher than that in patients without subcarinal lymph nodes(P<0.05). There was little bleeding in the puncture site of 41 patients, and more bleeding in 5 patients, but no special hemostasis and bleeding stopped by itself. No mediastinal emphysema, bleeding, mediastinal infection, pneumothorax and other complications occurred. There was no significant difference in adverse reactions and complications of each group(P>0.05). Conclusion TBNA plays an important role in the etiological diagnosis of mediastinal or hilar lymphadenopathy, especially in patients with lymphadenopathy greater than 2 cm in diameter and subcarinal

关 键 词：经支气管镜穿刺针吸活检术 纵膈淋巴结肿大 肺门淋巴结肿大 淋巴结直径 隆突下淋巴肿大 

分 类 号：R561[医药卫生—呼吸系统]