CAJ | 학술논문

目的探讨支气管内超声引导透支气管壁针吸活检术(EBUS-TBNA)在结节病诊断中的应用价值.方法对22例临床疑诊结节病患者行支气管镜及超声支气管镜检查,先后进行支气管黏膜活检(EBB)、透支气管壁肺活检(TBLB)及EBUS-TBNA.将EBB、TBLB和EBUS-TBNA活检物行石蜡包埋,并分别进行HE染色、抗酸染色.比较EBB、TBLB和EBUS-TBNA在结节病诊断中的差异,评价EBUS-TBNA的诊断效能,分析结节病患者介入呼吸病学诊断策略.结果 22例疑诊结节病的患者中20例确诊为结节病,1例为小细胞肺癌,1例为淋巴瘤.其中经EBB、TBLB和EBUS-TBNA确诊的患者数分别为6例、9例和16例,诊断率分别为30.0％,45.0％和80.0％,EBUS-TBNA诊断率明显高于前两者(P =0.005).EBB与EBUS-TBNA联合诊断率可达85.0％,TBLB与EBUS-TBNA联合诊断率可达90.0％,三者联合诊断率可达95.0％.EBUS-TBNA诊断率受淋巴结部位和淋巴结大小影响,隆突下组和气管旁组淋巴结EBUS-TBNA的诊断率高于肺门旁组淋巴结的诊断率(x2=4.29,P ＜0.05),淋巴结直径≥2 cm的EBUS-TBNA诊断率高(x2=4.067,P＜0.05).EBUS-TBNA并发症少,绝大多数患者仅穿刺点有少许出血.结论 EBUS-TBNA有助于结节病的确诊,同时TBLB和EBB对EBUS-TBNA在结节病的诊断上具有互补价值.
목적 탐토지기관내초성인도투지기관벽침흡활검술(EBUS-TBNA)재결절병진단중적응용개치.방법 대22례림상의진결절병환자행지기관경급초성지기관경검사,선후진행지기관점막활검(EBB)、투지기관벽폐활검(TBLB)급EBUS-TBNA.장EBB、TBLB화EBUS-TBNA활검물행석사포매,병분별진행HE염색、항산염색.비교EBB、TBLB화EBUS-TBNA재결절병진단중적차이,평개EBUS-TBNA적진단효능,분석결절병환자개입호흡병학진단책략.결과 22례의진결절병적환자중20례학진위결절병,1례위소세포폐암,1례위림파류.기중경EBB、TBLB화EBUS-TBNA학진적환자수분별위6례、9례화16례,진단솔분별위30.0％,45.0％화80.0％,EBUS-TBNA진단솔명현고우전량자(P =0.005).EBB여EBUS-TBNA연합진단솔가체85.0％,TBLB여EBUS-TBNA연합진단솔가체90.0％,삼자연합진단솔가체95.0％.EBUS-TBNA진단솔수림파결부위화림파결대소영향,륭돌하조화기관방조림파결EBUS-TBNA적진단솔고우폐문방조림파결적진단솔(x2=4.29,P ＜0.05),림파결직경≥2 cm적EBUS-TBNA진단솔고(x2=4.067,P＜0.05).EBUS-TBNA병발증소,절대다수환자부천자점유소허출혈.결론 EBUS-TBNA유조우결절병적학진,동시TBLB화EBB대EBUS-TBNA재결절병적진단상구유호보개치.
Objective To investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of sarcoidosis.Methods Twenty-two cases of clinically suspected sarcoidosis underwent bronchoscopy and ultrasound bronchoscopy examination,including endobronchial biopsy (EBB),transbronchial lung biopsy (TBLB),and EBUS-TBNA.The biopsy samples of EBB,TBLB,and EBUS-TBNA were paraffin-embedded for hematoxylin eosin (HE) staining and acid-fast staining,respectively.Differences in the diagnosis of sarcoidosis were compared among EBB,TBLB,and EBUS-TBNA.The diagnostic performance of EBUS-TBNA was evaluated.Interventional pulmonology diagnostic strategy of sarcoidosis was analyzed.Results Among all the 22 patients with suspected sarcoidosis,20 cases were diagnosed as sarcoidosis,1 case was small cell lung cancer,and 1 case was lymphoma.The number of patients who were diagnosed by EBB,TBLB,and EBUS-TBNA was 6 cases,9 cases,and 16 cases,respectively;and their diagnostic yield was 30.0％,45.0％,and 80.0％,respectively.The diagnostic yield of EBUS-TBNA was significantly better than the other two (P =0.005).Combined EBB and EBUS-TBNA,the diagnostic yield was 85.0％.Combined TBLB and EBUS-TBNA,the diagnostic yield was 90.0％.Combined those three,the diagnostic yield was 95.0％.EBUS-TBNA diagnostic yield was affected by the location and size of lymph nodes.The diagnostic yield of subcarinal lymph nodes and paratracheal lymph nodes by EBUS-TBNA was significantly better than that of Hilar lymph nodes (x2 =4.29,P ＜0.05),EBUS-TBNA showed better diagnostic yield for the lymph nodes whose diameter was greater than 2cm (x2 =4.067,P ＜ 0.05).EBUS-TBNA had fewer complications.Most patients only had a little bleeding in puncture site.Conclusions EBUS-TBNA contributed to diagnose sarcoidosis,while TBLB and EBB had a complementary value in the diagnosis of sarcoidosis by EBUS-TBNA.