CAJ | 학술논문

目的探讨气管内超声引导下针吸活检术(EBUS-TBNA)对肺门纵隔肿物的诊断价值.方法对837例胸部CT或正电子发射体层摄影术(PET)-CT提示肺门纵隔淋巴结肿大和(或)位于气管或支气管周围肿块的患者进行EBUS-TBNA检查.获取病理组织标本,同期进行有创检查或随访,得到最终结果,验证EBUS-TBNA的准确性.结果共穿刺淋巴结1631例次,平均1.95次/例,穿刺成功率100％,其中4R组与7组淋巴结分别占穿刺总数的43％和34％,肺癌诊断率为94.11％；其中鳞癌89例,占19.22％；腺癌150例,占32.40％；小细胞癌109例,占23.54％；非小细胞癌-组织学类型不明确型44例,占9.50％；腺鳞癌35例,占7.56％；其他类型36例,占7.78％.结核病诊断率为85.50％；结节病诊断率为55.88％；经统计分析,得出EBUS-TBNA总体敏感度为94.02％,特异度为100％,阳性预测值100％,阴性预测值61.91％,准确率94.56％.除穿刺部位少许出血外,无其他并发症,未见气胸、纵隔气肿、大血管损伤等严重并发症.结论 EBUS-TBNA作为一种微创,便利,低风险的操作,对于纵隔和肺门淋巴结以及肿块的穿刺诊断有着较高的实用价值.
목적 탐토기관내초성인도하침흡활검술(EBUS-TBNA)대폐문종격종물적진단개치.방법 대837례흉부CT혹정전자발사체층섭영술(PET)-CT제시폐문종격림파결종대화(혹)위우기관혹지기관주위종괴적환자진행EBUS-TBNA검사.획취병리조직표본,동기진행유창검사혹수방,득도최종결과,험증EBUS-TBNA적준학성.결과 공천자림파결1631례차,평균1.95차/례,천자성공솔100％,기중4R조여7조림파결분별점천자총수적43％화34％,폐암진단솔위94.11％；기중린암89례,점19.22％；선암150례,점32.40％；소세포암109례,점23.54％；비소세포암-조직학류형불명학형44례,점9.50％；선린암35례,점7.56％；기타류형36례,점7.78％.결핵병진단솔위85.50％；결절병진단솔위55.88％；경통계분석,득출EBUS-TBNA총체민감도위94.02％,특이도위100％,양성예측치100％,음성예측치61.91％,준학솔94.56％.제천자부위소허출혈외,무기타병발증,미견기흉、종격기종、대혈관손상등엄중병발증.결론 EBUS-TBNA작위일충미창,편리,저풍험적조작,대우종격화폐문림파결이급종괴적천자진단유착교고적실용개치.
Objective To explore the diagnostic values of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with hilar and mediastinal tumors.Methods A total of 837 patients with chest CT or PET/CT confirmed mediastinal/hilar lymphadenopathy and or tumors in (or around) the trachea or bronchi,were evaluated by EBUS-TBNA examination.Pathological study or follow-up visit was carried out in the same period to make a final diagnosis,and therefore to verify the accuracy of EBUS-TBNA.Result The study punctured 1631 lymph nodes totally,with an average of 1.95 times per case.The 4R group and the 7th group of lymph nodes accounted for 43％ and 34％,respectively.The success rate of TBNA was 100％.The diagnosis rates of lung cancer was 94.11％,of which squamous cell carcinoma accounted for 19.22％ (89 cases),adenocarcinoma 32.40％ (150 cases),small cell carcinoma 23.54％ (109 cases),non-small cell carcinoma of unknown histological type 9.50％ (44 cases),adenosquamous carcinoma 7.56％ (35 cases),and other types 7.78％ (36 cases).The diagnosis rate of tuberculosis was 85.50％,and that of sarcoidosis was 55.88％.The overall sensitivity of EBUS-TBNA was 94.02％,specificity 100％,positive predictive value 100％,negative predictive value 61.91％,and the accuracy was 94.56％.Besides mild bleeding in the puncture site,no other complications occurred,and there were no severe complications such as pneumothorax,pneumomediastinum,or major vascular injury.Conclusion EBUS-TBNA is of high value as a minimnally invasive,convenient,and low-risk procedure for the diagnosis of mediastinal and hilar lymphadenopathy and tumors.