超声内镜引导下经支气管针吸穿刺活检术在胸部病变诊断中的应用价值  

Value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of thoracic lesions

作　　者：廖慧斌 李汝 朱苗娟 杨亦斌[1] 程真顺[1] 陈毅斐[1] LIAO Huibin;LI Ru;ZHU Miaojuan;YANG Yibin;CHENG Zhenshun;CHEN Yifei(Dept.of Respiratory and Critical Care Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China;Macheng Second People's Hospital,Huanggang 438300,Hubei,China)

机构地区：[1]武汉大学中南医院呼吸与危重症学科,湖北武汉430071 [2]麻城市第二人民医院,湖北黄冈438300

出　　处：《武汉大学学报（医学版）》2024年第7期820-824,共5页Medical Journal of Wuhan University

基　　金：武汉大学中南医院医学人才攀登计划资助项目(编号:PDJH202205)。

摘　　要：目的:探索超声内镜引导下经支气管针吸穿刺活检术(EBUS-TBNA)的诊断价值。方法:回顾总结2019年9月至2022年8月于武汉大学中南医院呼吸与危重症学科进行EBUS-TBNA操作的所有病人资料。对通过EBUS-TBNA诊断为良性及未分类病变的病例,进一步行有创操作或结合治疗及临床随诊至少6个月后确定最终诊断。结果:本研究纳入618名患者,年龄为(61.9±10.5)岁,其中女性182名(29.4%),男性436名(70.6%)。618名患者EBUS-TBNA均穿刺均成功获得病理标本,成功率为100%。最终诊断为良性病变133例(21.5%),恶性病变485例(78.5%)。其中通过EBUS-TBNA明确诊断良性病变102例(16.5%),恶性病变464例(75.1%)。EBUS-TBNA的灵敏度为91.3%(546/598),特异度为100%(20/20),阳性预测值为100%(546/546),阴性预测值为27.8%(20/72),诊断率为91.6%(566/618)。仅1例术中出现穿刺点活动性出血,未出现严重并发症。结论:EBUS-TBNA在胸部病变中具有良好的诊断准确性和安全性,值得临床推广。Objective:To explore the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA).Methods:All EBUS-TBNA procedures performed at the Department of Respiratory and Critical Care Medicine,Zhongnan Hospital of Wuhan University from September 2019 to August 2022 were summarized retrospectively.For the cases diagnosed as benign and unclassified lesions by EBUS-TBNA,the final diagnoses were determined by further invasive procedures or combined with treatment and clinical follow-up for at least 6 months.Results:Overall 618 patients were included in the analysis with a mean age of(61.9±10.5)years,of whom 182(29.4%)were female and 436(70.6%)were male.The pathological specimens of 618 patients were successfully obtained by EBUS-TBNA,and the puncture success rate was 100%.The final diagnosis was 133 cases(21.5%)of benign lesions and 485 cases(78.5%)of malignant lesions.Among them,102(16.5%)of benign lesions and 464(75.1%)of malignant lesions were clearly diagnosed by EBUS-TBNA.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of EBUS-TBNA were 91.3%(546/598),100%(20/20),100%(546/546),27.8%(20/72),91.6%(566/618),respectively.Only one case had active bleeding without serious complications during the EBUS-TBNA procedure.Conclusion:The good diagnostic accuracy and safety of EBUS-TBNA in thoracic lesions are worthy of clinical promotion.

关 键 词：超声内镜引导下经支气管针吸活检术 胸部病变 诊断率 

分 类 号：R734[医药卫生—肿瘤]