全身麻醉及现场快速评价在EBUS-TBNA诊断肺癌中的价值  

Role of General Anesthesia and Rapid On-site Evaluation in the Diagnosis of Lung Cancer with EBUS-TBNA

作　　者：胡雨禾 李玉英 Yuhe HU;Yuying LI(Department of Respiratory and Critical Care Medicine,The Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院呼吸与危重症医学科,泸州646000

出　　处：《中国肺癌杂志》2024年第2期96-101,共6页Chinese Journal of Lung Cancer

基　　金：西南医科大学校级科研项目(No.2022QN052)资助。

摘　　要：背景与目的肺癌是常见的呼吸系统恶性肿瘤。超声引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)是诊断肺癌和评估分期的重要工具。EBUS-TBNA大多在局部麻醉或清醒镇静下进行,而在全身麻醉下行EBUS-TBNA以及同时应用快速现场评价(rapid on-site evaluation,ROSE)能否进一步提高诊断效能目前仍未可知,本研究拟探索全身麻醉及ROSE在EBUS-TBNA诊断肺癌中的价值。方法回顾性分析164例于2018年1月至2022年12月于西南医科大学附属医院呼吸与危重医学科就诊患者的资料,所有患者术前均疑诊为肺癌并行EBUS-TBNA,根据是否行全身麻醉及ROSE将患者分为局麻组(n=54)、全麻组(n=67)和全麻ROSE组(n=43),分析各组的穿刺情况以及在疾病诊断方面的差异。结果局麻组的淋巴结穿刺针数高于全麻ROSE组(P<0.01)。三组患者的疾病总诊断率分别为87.04%、89.55%和90.70%,恶性肿瘤的诊断率分别为88.24%、88.89%和94.74%,均无统计学差异(P>0.05)。三组中没有患者出现严重并发症及麻醉相关不良反应。结论与局部麻醉联合静脉镇痛镇静相比,全身麻醉下实施EBUS-TBNA无论是否联合ROSE均可得到同样准确的结果,全身麻醉联合ROSE可以减少淋巴结穿刺针数。Background and objective Lung cancer is a common malignant tumor of respiratory system.Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)is a valuable tool for the diagnosis and staging of lung cancer.EBUS-TBNA is predominantly performed under local anesthesia or conscious sedation.However,the diagnostic performance of EBUS-TBNA under general anesthesia and in conjunction with rapid on-site evaluation(ROSE)remains uncertain.This study aims to investigate the value of general anesthesia and ROSE in the diagnosis of lung cancer with EBUS-TBNA.Methods A retrospective analysis was conducted on 164 patients treated in the Department of Respiratory and Critical Care Medicine of The Affiliated Hospital of Southwest Medical University from January 2018 to December 2022.All patients were preoperatively suspected of lung cancer and underwent EBUS-TBNA.Based on whether they received general anesthesia and ROSE,the patients were divided into three groups:local anesthesia group(LA group)(n=54),general anesthesia group(GA group)(n=67)and general anesthesia with ROSE group(GA-ROSE group)(n=43).The puncture characteristics and diagnostic differences were analyzed among the groups.Results The number of lymph node puncture needles in the LA group was higher than in GA-ROSE group(P<0.01).The overall diagnostic rates of EBUS-TBNA for the three groups were 87.04%,89.55%and 90.70%,respectively,with malignant tumor diagnostic rates of 88.24%,88.89%and 94.74%.No statistically significant differences were observed among the three groups(P>0.05).There were no instances of severe complications or adverse anesthesia reactions in any of the groups.Conclusion Compared to the combination of local anesthesia with intravenous analgesia and sedation,the implementation of EBUS-TBNA under general anesthesia,with or without ROSE,achieves equally accurate results,and general anesthesia combined with ROSE can reduce in the number of lymph node puncture needles.

关 键 词：肺肿瘤 超声引导下经支气管针吸活检 全身麻醉 快速现场评价 

分 类 号：R734.2[医药卫生—肿瘤] R614[医药卫生—临床医学]