CAJ | 학술논문

目的探讨与常规经支气管针吸活检术(C-TBNA)相关的纵隔内间隙(纵隔内淋巴结位点)的形态、位置及其与气管支气管腔内生理和解剖标志之间的关系.方法采用前瞻性研究,对2010年1月至2011年12月广东顺德市第一人民医院接受支气管镜检查的连续1 000例患者进行薄层胸部CT分析,了解与C-TBNA相关的纵隔间隙形态、定位并确定与这些纵隔间隙密切相关的管腔内生理及解剖标志,确定穿刺点;全身麻醉下,采用EBUS-TBNA对52例患者的81组淋巴结按选择的穿刺点进行穿刺,再以超声显示验证穿刺点选择的准确性.结果与C-TBNA操作相关的4R、4L、7等纵隔淋巴结组所处的纵隔间隙为气管前间隙、主动脉-左肺动脉窗间隙、隆突上间隙及隆突下间隙等4个间隙,与这些间隙相对应的管腔内生理和解剖标志为主动脉对管腔的压迹和主动脉搏动点对气管前间隙进行定位,气管第一软骨环12点位置的倒三角为隆突上间隙、左气管支气管转角9 ～ 10点为主动脉-左肺动脉窗、隆突尖至右中叶支气管开口连线的8～9点为隆突下间隙;52例81组淋巴结的EBUS-TBNA验证,仅3组淋巴结有所偏差,无纵隔出血、纵隔气肿等并发症发生.结论纵隔间隙及其中的淋巴结与管腔内的一些生理和解剖标志相对固定,利用这些标志可对纵隔淋巴结进行较准确的定位,有助于改善医生对纵隔淋巴结解剖位置及对C-TBNA定位的理解和掌握.
목적 탐토여상규경지기관침흡활검술(C-TBNA)상관적종격내간극(종격내림파결위점)적형태、위치급기여기관지기관강내생리화해부표지지간적관계.방법 채용전첨성연구,대2010년1월지2011년12월엄동순덕시제일인민의원접수지기관경검사적련속1 000례환자진행박층흉부CT분석,료해여C-TBNA상관적종격간극형태、정위병학정여저사종격간극밀절상관적관강내생리급해부표지,학정천자점;전신마취하,채용EBUS-TBNA대52례환자적81조림파결안선택적천자점진행천자,재이초성현시험증천자점선택적준학성.결과 여C-TBNA조작상관적4R、4L、7등종격림파결조소처적종격간극위기관전간극、주동맥-좌폐동맥창간극、륭돌상간극급륭돌하간극등4개간극,여저사간극상대응적관강내생리화해부표지위주동맥대관강적압적화주동맥박동점대기관전간극진행정위,기관제일연골배12점위치적도삼각위륭돌상간극、좌기관지기관전각9 ～ 10점위주동맥-좌폐동맥창、륭돌첨지우중협지기관개구련선적8～9점위륭돌하간극;52례81조림파결적EBUS-TBNA험증,부3조림파결유소편차,무종격출혈、종격기종등병발증발생.결론 종격간극급기중적림파결여관강내적일사생리화해부표지상대고정,이용저사표지가대종격림파결진행교준학적정위,유조우개선의생대종격림파결해부위치급대C-TBNA정위적리해화장악.
Objective To explore the shape and the location of mediastinal spaces (mediastinal lymph node locations) associated with conventional transbronchial needle aspiration technique (C-TBNA),and to determine the relationship between the mediastinal spaces and physiological and anatomical marks in trachea-bronchial lumen for choosing the puncture points of C-TBNA.Methods The chest HRCT images of 1 000 consecutive patients preparing for bronchoscopic examination were analyzed to determine the shape and the location of the mediastinal gap,and which physiological and anatomic markers in the airway were suitable for locating the mediastinal spaces and lymph nodes.Eighty-one groups of lymph nodes from 52 patients were punctured by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to verify the locating of puncture points by these markers for the mediastinal lymph nodes under general anesthesia.The needle was punctured into the wall of the airway first,and then the ultrasound was used to confirm if the needle was in the lymph nodes.Results Pretracheal space,aortic-left pulmonary window space,superiorcarinal space and subcarinal space showed close relationship with C-TBNA biopsy for mediastinal lymph nodes.The pretracheal space could be located by the physiological and anatomic marks of aortic impression and aortic pulse points.The superior-carinal space was like a triangle and locating in 12 o' clock of the first ring of trachea.The 9-10 o' clock of the first ring of the trachea was the aortic-left pulmonary window.The 8-9 o' clock of the right main bronchus and middle bronchus was for subcarinal space.Eighty-one groups of lymph nodes from 52 patients were punctured by EBUS-TBNA according to the physiological and anatomic markers,and it showed that only 3 groups were missed by C-TBNA.No mediastinal bleeding and pneumomediastinum occurred.Conclusion Mediastinal spaces (mediastianl lymph nodes) and physiological and anatomical marks within the airway had a relatively fixed relationship.These marks could be used for locating the mediastinal lymph nodes when C-TBNA was performed.