经支气管镜针吸活检在纵隔及支的敢管腔外病变中的临床研究

发布时间：2018-06-28 16:33

本文选题：支气管镜 + TBNA　；参考：《河南大学》2014年硕士论文

【摘要】：研究背景:传统的支气管镜检查在气管支气管的病变中发挥着重要的作用，由于传统气管镜检查范围的局限性，对单纯纵隔淋巴结肿大或纵隔淋巴结肿大合并肺内占位经传统支气管镜检查手段管腔内未见明确病变患者的明确诊断中存在很大困难，无创检查如增强CT或PET-CT可以提供倾向性诊断，不能提供病理学诊断依据，对最终治疗决策的帮助很有限，而且由于纵隔镜、胸腔镜及开胸肺活检创伤大、费用高，在临床使用中受到很大的限制。经支气管针吸活检术(transbronchial needle aspiration,TBNA)就是应用特制的穿刺针，经纤维支气管镜活检通道进入气管内，然后穿透支气管壁对腔外病变组织部分，比如肿块、淋巴结、炎症等进行穿刺抽吸获得细胞学或组织学标本的技术，这项检查技术极大的减少了患者的痛苦，并降低了手术风险，在诊断纵隔及支气管腔外病变方面是一种非常简单有效的方法。研究目的:探讨支气管镜针吸活检术（TBNA）与传统支气管镜检查方法相比在纵隔及支气管腔外病变组织中的诊断价值。研究方法:本文选择自2010年09月到2013年10月期间，由于胸部CT扫描发现纵隔淋巴结增大和/或肺内肿块、结节，或因阻塞性肺炎等导致的肺不张，然后就诊于河南大学淮河医院呼吸内科，在常规支气管检查管腔内未见明显新生物或仅见外压性狭窄、局部粘膜充血水肿的患者，患者共87名。对其进行TBNA检查,TBNA检查后,每名患者均于病变部位行刷检、活检、灌洗，然后将患者进行TBNA检查、刷检及活检、灌洗的阳性率进行系统的统计学分析,从而研究分析经支气管针吸活检技术在纵隔病变及支气管腔外病变中的诊断意义。87例病例中男性患者57例,女性患者30例,年龄19-80岁，根据胸部320增强CT,按照WANG氏TBNA穿刺法确定穿刺部位。使用的电子支气管镜为OLYMPUS BF一1T60， MW-319型WANG氏TBNA组织学穿刺针。检查前患者要签署气管镜检查知情同意书，，局部麻醉后,将电子支气管镜经鼻腔插入气管内，按气管、支气管树顺序检查气管管腔，观察管腔内有无明显新生物，将气管镜插入检查位置确定穿刺部位,将WANG氏针经支气管镜活检孔（FOB）送入，直视下尽可能垂直于支气管壁方向刺入病变，确定刺入病变组织后，在维持负压的情况下抽取标本。抽吸完毕后，用30ml注射器将穿刺吸取物用力推出，涂于干净的载玻片上，然后风干、固定，如果取到组织块，则将组织块放入10%的福尔马林中送病理科检查并对取材充分的标本进行免疫组化。TBNA抽吸结束后，每名患者均于病变部位行常规刷检、活检、灌洗检查。结果：1.常规支气管镜检查结果：管腔无狭窄及粘膜未见明显异常的有25例，管腔呈不同程度的狭窄有39例，患者局部粘膜可见充血水肿的有23例。2.不同取材方法诊断结果：2.1TBNA穿刺结果：87例患者，TBNA共对160个病变部位进行穿刺，结果有76名患者取得了阳性诊断，76例阳性诊断中恶性肿瘤有69例（79.3%），良性病变共有7例（9.2%）。2.2活检结果：87例患者中，10例获得阳性诊断结果，其中小细胞肺癌3例，腺癌5例，鳞癌1例，结核病1例，余77例均为正常支气管粘膜组织。2.3刷检结果：87例患者中，13例获得阳性诊断结果，其中小细胞肺癌5例，腺癌3例，鳞癌2例，非特异性炎症2例，肺结核1例。2.4灌洗结果：87例患者中，8例获得阳性诊断结果，其中腺癌5例，小细胞肺癌2例，鳞癌1例。3.不同取材方法在不同病变类型中的诊断结果：3.1在纵隔淋巴结肿大合并粘膜水肿病变中：TBNA获得阳性诊断21例，活检获得阳性诊断6例，刷检获得阳性诊断7例，灌洗获得阳性诊断3例，其中有5例TBNA为其唯一诊断阳性检查方法。3.2在纵隔淋巴结肿大合并管腔狭窄病变中：TBNA获得阳性诊断33例，活检获得阳性诊断3例，刷检获得阳性诊断5例，灌洗获得阳性诊断4例，其中有21例TBNA为其唯一诊断阳性检查方法。3.3在单纯纵隔淋巴结肿大病变中：TBNA获得阳性诊断22例，活检获得阳性诊断1例，刷检获得阳性诊断1例，灌洗获得阳性诊断1例，其中有,21例TBNA为其唯一诊断阳性检查方法。4. TBNA细胞学与组织学对肺癌的诊断：经组织活检和术后病理证实的肺癌患者共78例，TBNA细胞学获得了明确肺癌诊断的患者有66例。5.TBNA免疫组化结果：CD56、P63、TTF-1、Syn4种抗体在不同肺癌类型中的阳性率明显不同。6.并发症：5例患者出现少量出血，未行特殊处理，3例患者出现穿刺部位大量出血，给予肾上腺素稀释液支气管腔内注入后出血停止，未见感染、纵隔气肿等并发症发生。7.结论及意义：TBNA是一项操作简单的内镜检查技术，对肺部疾病检出率高，并发症较少，尤其是在诊断纵隔及支气管腔外病变中有着举足轻重的作用，显著提高了诊断阳性率，可常规应用于支气管镜检查中。
[Abstract]:Background: traditional bronchoscopy plays an important role in the tracheobronchial lesions. Due to the limitations of the scope of traditional bronchoscopy, the diagnosis of patients with simple mediastinal lymph node enlargement or mediastinal lymph node enlargement and intrapulmonary occupying is not clearly diagnosed by conventional bronchoscopy. Noninvasive tests, such as enhanced CT or PET-CT, can provide a tendency diagnosis, fail to provide the basis for pathological diagnosis, and have limited help for final treatment decisions, and because of the large trauma, high cost and high cost in the clinical use of mediastinoscopy, thoracoscopy and thoracotomy (transbron). Chial needle aspiration, TBNA) is the technique of applying a special puncture needle through a bronchoscopic biopsy channel into the trachea and then penetrating the wall of the bronchus to obtain cytological or histologic markers, such as lumps, lymph nodes, and inflammation, which greatly reduces the patient's technique. Pain and reduced operative risk are a very simple and effective way to diagnose mediastinum and extra bronchial lesions.
Objective: To evaluate the diagnostic value of bronchoscopy needle aspiration (TBNA) in mediastinum and extra bronchial lesions compared with conventional bronchoscopy.
Study methods: from 09 months of 2010 to October 2013, we found the enlargement of the mediastinal lymph nodes and / or the enlargement of the mediastinal lymph nodes and / or the pulmonary masses, nodules, or obstructive pneumonia caused by pulmonary atelectasis from 09 months of 2010 to October 2013. A total of 87 patients with pressure stenosis and local mucosal congestion and edema were examined by TBNA. After TBNA examination, each patient was examined, biopsy, and lavage at the lesion site, then the patient was examined by TBNA, brush examination and biopsy, and the positive rate of lavage was analyzed systematically, so as to study and analyze the bronchial needle aspiration biopsy technique. In the diagnostic significance of mediastinal lesions and Extrabronchial lesions, 57 cases were male patients, 30 cases of female patients, age 19-80 years old. The puncture site was determined according to the 320 enhancement of CT in the chest. The electronic bronchoscope was OLYMPUS BF 1T60, MW-319 type WANG TBNA tissue puncture needle was used in.87 cases.
Before the examination, the patient should sign the informed consent of the trachea. After the local anesthesia, the electronic bronchoscope was inserted into the trachea through the nasal cavity. The trachea was checked by the trachea and the bronchus tree in order to observe the tracheal lumen. The trachea was inserted into the location to determine the puncture site, and the WANG's needle was sent through the bronchoscope biopsy hole (FOB). When the lesion was inserted into the bronchial wall as far as possible, the specimen was selected after the lesion was inserted into the lesion. After the suction was maintained, a 30ml syringe was used to force the puncture to be pushed out, smeared on the clean slides, and then dry, fixed, if the fruit was taken to the tissue block, and then put the tissue into 10% formalin. After the pathological examination was sent to the pathological section and the samples were immunized for.TBNA aspiration, each patient was examined by routine brush examination, biopsy, and lavage.
Results: 1. the results of routine bronchoscopy showed that there were 25 cases with no stenosis and no obvious abnormalities in the mucosa, 39 cases were narrowed in different degrees, and 23 cases of.2. were found in the partial mucous membrane of the patients. The results of 2.1TBNA puncture: 87 cases, TBNA were punctured in 160 lesions. There were 76 patients with positive diagnosis, 69 cases (79.3%) in 76 cases of positive diagnosis and 7 cases of benign lesions (9.2%).2.2 biopsy results: among 87 patients, 10 cases received positive diagnosis, including 3 cases of small cell lung cancer, 5 cases of adenocarcinoma, 1 cases of squamous cell carcinoma, 1 cases of tuberculosis, and the remaining 77 cases were the results of normal bronchial mucosa tissue.2.3 brush examination results. Of the 87 cases, 13 cases were diagnosed as positive, including 5 cases of small cell lung cancer, 3 cases of adenocarcinoma, 2 cases of squamous cell carcinoma, 2 cases of nonspecific inflammation and 1 cases of.2.4 lavage in pulmonary tuberculosis: 8 cases were found in 87 cases, 5 cases of adenocarcinoma, 2 cases of small cell lung cancer, and 5 cases of squamous cell carcinoma in different types of diagnosis of.3.. Fruit: 3.1 in mediastinal lymph node enlargement and mucous membrane edema: TBNA positive diagnosis 21 cases, biopsy positive diagnosis 6 cases, brush examination positive diagnosis 7 cases, lavage positive diagnosis 3 cases, of which 5 cases TBNA is the only diagnostic positive method.3.2 in mediastinal lymphadenopathy combined with lumen stenosis: TBNA obtained Positive diagnosis of 33 cases, positive diagnosis of 3 cases, 5 cases of positive diagnosis by brush examination and 4 cases of positive diagnosis, 21 cases of TBNA are the only positive diagnosis of.3.3 in simple mediastinal lymph node enlargement: 22 cases of positive diagnosis of TBNA, 1 cases with positive diagnosis of biopsy, 1 cases of positive diagnosis by brush examination, lavage. 1 cases of positive diagnosis were obtained, of which 21 cases of TBNA were the only diagnosis of.4. TBNA cytology and histology for the diagnosis of lung cancer: 78 cases of lung cancer confirmed by biopsy and postoperative pathology, and 66 cases of.5.TBNA immunization with CD56, P63, TTF-1, Syn4 kinds of anti lung cancer patients. The positive rate of the body in different types of lung cancer was distinctly different from.6. complications: 5 cases had a small amount of bleeding, no special treatment, 3 cases had massive hemorrhage in the puncture site, the bleeding stopped after the injection of adrenaline diluent, no infection, and the complications of mediastinal emphysema, such as.7. conclusion and significance: TBNA was an exercise. Simple endoscopic examination has a significant effect on the detection of pulmonary diseases and less complications, especially in the diagnosis of mediastinal and Extrabronchial lesions, which significantly improves the positive rate of diagnosis and can be routinely applied to bronchoscopy.
【学位授予单位】：河南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R562

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