EBUS-TBNA与EBUS-GS-TBLB对合并肺门及纵隔淋巴结肿大的肺占位性病变诊断效能比较  

Comparison of diagnostic efficacy between EBUS-TBNA and EBUS-GS-TBLB for lung space occupying lesions with hilar and mediastinal lymph node enlargement

作　　者：杜焰家 石晓雁 张伟强[1] 钟子双 DU Yanjia;SHI Xiaoyan;ZHANG Weiqiang;ZHONG Zishuang(Department of Respiratory and Critical Care Medicine,Meizhou People's Hospital,Meizhou 514000,China)

机构地区：[1]梅州市人民医院呼吸与危重症医学科,广东梅州514000

出　　处：《山东医药》2022年第8期34-37,共4页Shandong Medical Journal

基　　金：广东省医学科研基金立项项目(B2021286)。

摘　　要：目的对比超声引导下经支气管针吸活检(EBUS-TBNA)和导向鞘引导支气管超声经支气管针吸活检(EBUS-GS-TBLB)对合并肺门及纵隔结肿大的肺占位性病变的诊断效能。方法胸部CT检查提示肺部占位性病变(肿瘤直径≥2 cm)合并有肺门及纵隔淋巴结肿大(直径≥1.5 cm)的患者145例,70例行EBUS-TBNA,75例行EBUSGS-TBLB,比较两种检查方式诊断阳性率及并发症发生率,比较两种检查方式的安全性及诊断效能。结果145例患者最终确诊为恶性肿瘤132例,其中肺癌128例、淋巴瘤及其他转移瘤4例;良性病变13例。行EBUS-TBNA检查的70例患者中,确诊恶性肿瘤60例,肺癌56例、其他转移瘤4例;确诊良性病变7例;3例患者未取材成功;并发症发生率为2.9%。EBUS-TBNA对病灶诊断的总阳性率为95.7%,对恶性肿瘤的诊断阳性率为85.7%。行EBUS-GSTBLB检查的75例患者中,确诊恶性肿瘤72例,肺癌71例、其他来源的恶性肿瘤1例;确诊良性病变3例;所有患者取材成功;并发症发生率为8.0%。EBUS-GS-TBLB对病灶诊断的总阳性率为78.7%,对恶性肿瘤的诊断阳性率为74.7%。与EBUS-GS-TBLB相比,EBUS-TBNA对恶性肿瘤诊断的阳性率及对病灶诊断的总阳性率更高,并发症发生率更低(P均<0.05)。结论对同时有肺部占位性病变及肺门、纵隔淋巴结肿大的患者,EBUS对良恶性病变都有一定的诊断价值,但与EBUS-GS-TBLB相比,EBUS-TBNA对恶性肿瘤的诊断阳性率及安全性更高,对该类患者可能是更为理想的选择。Objective To compare the diagnostic efficacy between ultrasound-guided transbronchial needle aspiration biopsy(EBUS-TBNA)and sheath-guided bronchial ultrasound transbronchial needle aspiration biopsy(EBUS-GSTBLB)for lung space-occupying lesions with hilar and mediastinal nodule enlargement.Methods A total of 145 patients with lung space-occupying lesions(cancer diameter≥2 cm)combined with hilar and mediastinal lymph node enlargement(diameter≥1.5 cm)were screened by chest CT examination.Among them,70 underwent EBUS-TBNA and 75 underwent EBUS-GS-TBLB examination.Then the positive rate of diagnosis and the incidence of complications were separately calculated to compare the safety and diagnostic efficiency of the two examination methods.Results Among 145 patients,132 patients were diagnosed with malignant tumors,including 128 patients with lung cancer and 4 patients with lymphoma and other metastases.Benign lesions were observed in 13 cases.Among the 70 patients who underwent EbusTBNA examination,60 were diagnosed with malignant tumor,56 with lung cancer,and 4 with other metastases.Benign lesions were confirmed in 7 cases,and 3 patients were not sampled successfully.The complication rate was 2.9%.The overall positive rate of EBUS-TBNA for the diagnosis of lesions was 95.7%,and 85.7%for malignant tumors.Among the75 patients who underwent EBUS-GS-TBLB,72 were diagnosed with malignant tumor,71 with lung cancer,and 1 with other malignant tumor;3 cases were diagnosed with benign lesions,and all patients were successfully sampled;8.0%of these patients experienced complications related to the examination.The complication rate was 8.0%.The overall positive rate of EBUS-GS-TBLB was 78.7%for lesions and 74.7%for malignant tumors.Compared with EBUS-GS-TBLB,EBUSTBNA had higher positive rate in malignant tumor diagnosis and overall positive rate in lesion diagnosis(all P<0.05),and lower incidence of complications.Conclusion For patients with pulmonary space occupying lesions and hilar and mediastinal lymph node enlargement,E

关 键 词：肺占位性病变 纵隔淋巴结肿大 超声支气管镜检查 超声引导下经支气管针吸活检 导向鞘引导支气管超声经支气管针吸活检 

分 类 号：R446.8[医药卫生—诊断学]