气管内超声引导下针吸活检（EBUS-TBNA）对肺门、纵隔及肺内病变的诊断价值

发布时间：2018-05-22 13:46

本文选题：EBUS-TBNA + 纵隔病变　；参考：《蚌埠医学院》2015年硕士论文

【摘要】：目的评价EBUS-TBNA在肺门、纵隔及肺内病变中的诊断价值。方法回顾性分析2012年5月至2014年3月,119例伴肺门、纵隔和(或)毗邻气管、支气管的肺内肿块,行常规电子支气管镜检查未能明确诊断的患者实施了经气管内超声引导下针吸活检术(EBUS-TBNA),应用快速细胞学、微生物学及组织病理学协助诊断。EBUS-TBNA未能获得明确诊断者,进一步选择侵袭性操作或至少6个月的临床随访。记录最终诊断结果及术中超声特点,使用SPSS软件对相关结果进行统计学分析。结果本组研究中共对234个肺门、纵隔淋巴结及26个毗邻气管、支气管的肿块实施了TBNA。其中经EBUS-TBNA诊断肺腺癌33例,肺鳞癌7例,唾腺源性肿瘤1例,肺小细胞癌16例,肺差分化癌1例,食管癌纵隔淋巴结转移1例,结肠癌纵隔淋巴结转移1例,结核性淋巴结炎31例,炎症8例,结节病7例,纵隔囊肿3例。10例未获得明确诊断者,后期5例行纵隔镜检查,3例诊断为结节病,1例诊断为淋巴结结核,1例诊断为非特异性炎症。1例开胸探查后确诊为肺巨大淋巴组织增生症(Castleman病)。4例进行半年临床随访观察,2例抗结核治疗后好转,2例观察无明显变化。本组研究中,EBUS-TBNA对纵隔、肺门及肺内肿块的诊断率为91.6%,对良、恶性病变均具有较高的诊断价值。本组共15例不良反应,2例术中出现一过性低氧血症,6例术后痰血,4例术后咽喉部疼痛,2例术后低热,1例纵隔淋巴结结核穿刺点气道播散。结论EBUS-TBNA是一项微创的操作方法,用于诊断肺门、纵隔病变和毗邻气道的肺内肿块是有效、安全的,对良、恶性病变均有较高的诊断率。
[Abstract]:Objective to evaluate the diagnostic value of EBUS-TBNA in hilar, mediastinal and intrapulmonary lesions. Methods from May 2012 to March 2014, 119 patients with hilar, mediastinal and / or adjacent tracheal and bronchial masses were retrospectively analyzed. The patients who failed to make a definite diagnosis by routine electronic bronchoscopy performed EBUS-TNAA under the guidance of ultrasound in the trachea. The diagnosis was assisted by rapid cytology, microbiology and histopathology, and no definite diagnosis was obtained by EBUS-TBNA. Further selection of invasive procedures or clinical follow-up for at least 6 months. The results of final diagnosis and intraoperative ultrasound were recorded and analyzed statistically with SPSS software. Results TBNA was performed on 234 hilar, mediastinal lymph nodes and 26 adjacent tracheobronchial masses. 33 cases of lung adenocarcinoma, 7 cases of squamous cell carcinoma, 1 case of salivary gland tumor, 16 cases of small cell carcinoma of lung, 1 case of poorly differentiated lung cancer, 1 case of mediastinal lymph node metastasis of esophageal carcinoma and 1 case of mediastinal lymph node metastasis of colon cancer were diagnosed by EBUS-TBNA. 31 cases of tuberculous lymphadenitis, 8 cases of inflammation, 7 cases of sarcoidosis, 3 cases of mediastinal cyst. Mediastinoscopy was performed in 3 cases with sarcoidosis, 1 case with lymph node tuberculosis, 1 case with nonspecific inflammation, 1 case with pulmonary giant lymphoid tissue hyperplasia, 4 cases with pulmonary giant lymphoid tissue hyperplasia, and 4 cases with pulmonary giant lymphoid tissue hyperplasia. Two cases of antituberculous treatment were observed, and 2 cases had no obvious change after antituberculous treatment. The diagnostic rate of EBUS-TBNA for mediastinal, hilar and intrapulmonary masses was 91.6. EBUS-TBNA had high diagnostic value for benign and malignant lesions. There were 15 cases of adverse reactions and 2 cases of transient hypoxemia during operation. 6 cases had phlegm and 4 cases had postoperative pharynx and larynx pain 2 cases had low fever and 1 case had mediastinal lymph node tuberculosis. Conclusion EBUS-TBNA is a minimally invasive method for the diagnosis of hilar, mediastinal and adjacent airway masses, and has a high diagnostic rate for benign and malignant lesions.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R734

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