CAJ | 학술논문

目的探讨经支气管镜超声引导针吸活检术(EBUS-TBNA)在纵隔病变诊断中的应用价值.方法选取2010年1月至2012年4月就诊于山东大学附属省立医院呼吸内科,并经胸部CT检查显示纵隔淋巴结肿大而常规支气管镜检查未发现病变的患者264例,淋巴结长轴＞1.5 cm者共222例,其中174例只行经支气管镜针吸活检术(TBNA)检查(A组),48例只行EBUS-TBNA检查(B组).另将42例淋巴结长轴＜1.5 cm的患者作为C组,同时行TBNA(结果计为C1组)和EBUS-TBNA(结果计为C2组)检查.对各组患者的细胞学或病理学检查结果、诊断阳性率及并发症发生情况进行统计分析.结果 A组确诊154例(88.5％),其中恶性肿瘤135例,良性病变19例,损伤血管5例；B组确诊45例(93.8％),其中恶性肿瘤33例,良性病变12例；C1组确诊31例(73.8％),其中恶性肿瘤23例,良性病变8例,损伤血管2例；C2组确诊39例(92.8％),其中恶性肿瘤30例,良性病变9例.A、B两组诊断阳性率差异无统计学意义(x2 =0.621,P=0.431);A组的诊断阳性率明显高于C1组(x2=5.945,P=0.015);B、C2两组诊断阳性率差异无统计学意义(x2=0.065,P=0.320)；C1、C2两组诊断阳性率差异有统计学意义(x2=5.486,P=0.019).结论 EBUS-TBNA对纵隔较小淋巴结的诊断阳性率较高且较安全.
목적 탐토경지기관경초성인도침흡활검술(EBUS-TBNA)재종격병변진단중적응용개치.방법 선취2010년1월지2012년4월취진우산동대학부속성립의원호흡내과,병경흉부CT검사현시종격림파결종대이상규지기관경검사미발현병변적환자264례,림파결장축＞1.5 cm자공222례,기중174례지행경지기관경침흡활검술(TBNA)검사(A조),48례지행EBUS-TBNA검사(B조).령장42례림파결장축＜1.5 cm적환자작위C조,동시행TBNA(결과계위C1조)화EBUS-TBNA(결과계위C2조)검사.대각조환자적세포학혹병이학검사결과、진단양성솔급병발증발생정황진행통계분석.결과 A조학진154례(88.5％),기중악성종류135례,량성병변19례,손상혈관5례；B조학진45례(93.8％),기중악성종류33례,량성병변12례；C1조학진31례(73.8％),기중악성종류23례,량성병변8례,손상혈관2례；C2조학진39례(92.8％),기중악성종류30례,량성병변9례.A、B량조진단양성솔차이무통계학의의(x2 =0.621,P=0.431);A조적진단양성솔명현고우C1조(x2=5.945,P=0.015);B、C2량조진단양성솔차이무통계학의의(x2=0.065,P=0.320)；C1、C2량조진단양성솔차이유통계학의의(x2=5.486,P=0.019).결론 EBUS-TBNA대종격교소림파결적진단양성솔교고차교안전.
Objective To explore the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA) in diagnosing mediastinal lesions.Methods A total of 264 patients with mediastinal lesions on chest CT at Provincial Hospital Affiliated to Shandong University between January 2010 and April 2012 were retrospectively enrolled.Their cytopathological results were difficult to be assessed by conventional bronchoscopy.There were 222 cases whose lymph nodes long axis was ＞ 1.5 cm.Among them,174 cases underwent TBNA alone (group A) and the other 48 cases EBUS-TBNA alone (group B).The remaining 42 cases whose lymph nodes long axis was ＜ 1.5 cm belonged to group C and underwent TBNA (group C1) and EBUS-TBNA (group C2) sequentially as a combined procedure.The associations of pathologic examinations,diagnostic positive rate and complications were analyzed.Results Among 174 cases in group A,154 cases were diagnosed with a positive diagnostic rate of 88.5％.There were 135 malignant lesions while 19 cases were diagnosed with benign diseases and 5 cases had accidental vascular injury.Among 48 cases in group B,45 cases were diagnosed with a positive diagnostic rate of 93.8％.There were 33 malignant lesions while 12 cases were diagnosed with benign diseases.Among 42 paticnts in group C1,31 cases were diagnosed by TBNA with a positive diagnostic rate of 73.8％.There were 23 malignant lesions while 8 cases were diagnosed with benign diseases and 2 cases had accidental vascular injury.Among 42 patients in group C2,39 cases were diagnosed with a positive diagnostic rate of 92.8％.There were 30 malignant lesions while 9 cases had benign diseases.No difference existed in diagnostic positive rate between groups A and B (x2 =0.621,P =0.431) while the diagnostic positive rate in group A was much higher than group C1 (x2 =5.945,P =0.015).The difference between groups B and C2 was insignificant(x2 =0.065,P =0.320)while there was significant difference between groups C1 and C2 (x2 =5.486,P =0.019).Conclusion With a low complication rate,EBUS-TBNA can yield a higher diagnostic positive rate in diagnosing small mediastinal diseases than conventional TBNA.