超声内镜引导下经支气管针吸活检术在纵膈肺门占位性病变中的临床应用

发布时间：2018-05-01 08:30

本文选题：支气管镜检查 + 超声检查　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:探讨超声内镜引导下经支气管针吸活检术(EBUS-TBNA)在纵膈及肺门占位性病变中的应用、诊断价值及安全性。方法:回顾性分析重庆医科大学附属二院呼吸科2014年10月至2016年9月,胸部CT检查示纵膈、肺门淋巴结肿大和(或)胸腔内肿物并行EBUS-TBNA检查的246例患者临床资料,对所有行EBUSTBNA检查患者的细胞学和(或)病理学检查结果、诊断阳性率及并发症发生情况进行统计分析。结果:246例患者EBUS-TBNA后标本病理结果:诊断为恶性肿瘤130例,良性疾病72例,可疑恶性肿瘤26例,诊断未明者18例。恶性肿瘤中小细胞肺癌共45例,非小细胞肺癌共39例,无法确切分型者42例,转移性神经内分泌癌1例,B型淋巴瘤2例,原发性纵膈肉瘤1例。良性疾病中非特异性炎症者22例,纵膈囊肿2例,肺脓肿1例,肺囊肿伴放线菌感染1例,尘肺8例,纵膈淋巴结结核27例,结节病11例。EBUS-TBNA对纵膈、肺门占位性病变的总体诊断率为92.7%,其中对恶性肿瘤的诊断率为94.0%,对纵膈淋巴结结核的诊断率为84.4%,对结节病的诊断率为73.3%。有6例患者重复行二次EBUS-TBNA检查后病理诊断结果:1例肺癌,2例结节病,3例纵膈淋巴结结核。246例患者EBUS-TBNA术中不良反应包括,13例患者术中出现低氧血症,5例患者术中出现心律失常,19例患者出现术中少量出血。术后并发症主要表现为咳嗽及痰中带血,未见严重并发症发生。结论:EBUS-TBNA具有良好的安全性和可重复性,用于诊断纵膈、肺门占位性病变是安全、有效的,尤其对于恶性疾病检出率高,对于纵膈、肺门淋巴结肿大的结节病及结核病亦有重要的诊断价值。在实际应用中,对行首次检查结果不理想者,可通过重复检查提高诊断率。EBUS-TBNA对纵膈、肺门少见疾病亦是一种重要的辅助检查手段。
[Abstract]:Objective: to evaluate the diagnostic value and safety of endoscopic transbronchial needle aspiration (EBUS-TBNA) in mediastinal and hilar space occupying lesions. Methods: from October 2014 to September 2016, the clinical data of 246 patients with mediastinal, hilar lymphadenopathy and / or intrathoracic mass were analyzed retrospectively. The results of cytology and / or pathology, positive rate of diagnosis and incidence of complications in all patients with EBUSTBNA were analyzed statistically. Results the pathological results of EBUS-TBNA in 246 patients were as follows: 130 cases of malignant tumor, 72 cases of benign disease, 26 cases of suspected malignant tumor and 18 cases of unknown diagnosis. There were 45 cases of small cell lung cancer, 39 cases of non-small cell lung cancer, 42 cases of which could not be classified accurately, 1 case of metastatic neuroendocrine carcinoma, 2 cases of type B lymphoma and 1 case of primary mediastinal sarcoma. There were 22 cases of nonspecific inflammation, 2 cases of mediastinal cyst, 1 case of pulmonary abscess, 1 case of pulmonary cyst with actinomycosis, 8 cases of pneumoconiosis, 27 cases of tuberculosis of mediastinal lymph node, 11 cases of sarcoidosis. The overall diagnostic rate of hilar occupying lesions was 92.70.The diagnostic rate of malignant tumor was 94.0, the diagnosis rate of mediastinal lymph node tuberculosis was 84.4, and the diagnostic rate of sarcoidosis was 73.3%. Results of pathological diagnosis after repeated secondary EBUS-TBNA examination in 6 cases of lung cancer: 1 case of lung cancer 2 cases of sarcoidosis 3 cases of mediastinal lymph node tuberculosis. 246 cases of adverse reactions during EBUS-TBNA including 13 cases of intraoperative hypoxemia and 5 cases of intraoperative excision A small amount of bleeding occurred in 19 patients with arrhythmia. Postoperative complications were mainly cough and blood in sputum, without serious complications. ConclusionTwo EBUS-TBNA has good safety and reproducibility. It is safe and effective to diagnose mediastinal and hilar occupying lesions, especially for malignant diseases and mediastinum. Pulmonary hilar lymph node enlargement sarcoidosis and tuberculosis also have important diagnostic value. In practical application, the diagnosis rate can be improved by repeated examination. EBUS-TBNA is also an important auxiliary examination method for mediastinal and hilar rare diseases.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734

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