CAJ | 학술논문

目的探讨经支气管针吸活检术(TBNA)对儿童纵隔及肺门淋巴结大疾病的临床诊断价值及安全性,提高儿科医师对TBNA的认识.方法回顾性分析2013年12月至2014年8月温州医科大学附属第二医院、育英儿童医院儿童呼吸科因不明原因纵隔及肺门淋巴结大收治并成功实施TBNA的3例患儿的临床资料,年龄3～8岁,观察儿童TBNA有效性及安全性;强调熟练掌握纵隔及肺门淋巴结定位解剖学的重要性和TBNA操作技巧;并复习国内外相关文献.结果 3例患儿均有显著纵隔及肺门淋巴结大,行常规儿童支气管镜检查+纵隔淋巴结、肺门淋巴结TBNA,标本涂片送检病理细胞学和抗酸杆菌、细菌及真菌检查和培养等检查协助病因诊断.手术过程顺利,术中和术后无并发症.3例患儿分别确诊为肺炎支原体肺炎、肺结核及EB病毒相关支气管淋巴增生症,协助排除了淋巴瘤.以“经支气管针吸活检术”、“儿童”或“儿科”为检索词,国内万方数据库和中国期刊全文数据库检索到2篇文献,均为本文作者报道.PubMed外文数据库检索到关于儿童TBNA文献8篇,其中5篇均为超声引导下的TBNA,而TBNA仅为3篇(其中1篇为本文作者报道).结论 TBNA是一种微创、有效、低风险的操作,在儿童纵隔或肺门淋巴结大疾病病因诊断中安全且有良好效果,值得进一步探索.
목적 탐토경지기관침흡활검술(TBNA)대인동종격급폐문림파결대질병적림상진단개치급안전성,제고인과의사대TBNA적인식.방법 회고성분석2013년12월지2014년8월온주의과대학부속제이의원、육영인동의원인동호흡과인불명원인종격급폐문림파결대수치병성공실시TBNA적3례환인적림상자료,년령3～8세,관찰인동TBNA유효성급안전성;강조숙련장악종격급폐문림파결정위해부학적중요성화TBNA조작기교;병복습국내외상관문헌.결과 3례환인균유현저종격급폐문림파결대,행상규인동지기관경검사+종격림파결、폐문림파결TBNA,표본도편송검병리세포학화항산간균、세균급진균검사화배양등검사협조병인진단.수술과정순리,술중화술후무병발증.3례환인분별학진위폐염지원체폐염、폐결핵급EB병독상관지기관림파증생증,협조배제료림파류.이“경지기관침흡활검술”、“인동”혹“인과”위검색사,국내만방수거고화중국기간전문수거고검색도2편문헌,균위본문작자보도.PubMed외문수거고검색도관우인동TBNA문헌8편,기중5편균위초성인도하적TBNA,이TBNA부위3편(기중1편위본문작자보도).결론 TBNA시일충미창、유효、저풍험적조작,재인동종격혹폐문림파결대질병병인진단중안전차유량호효과,치득진일보탐색.
Objective To explore the clinical diagnostic value and safety of the transbronchial needle aspiration (TBNA) in children's mediastinal and hilar lymphadenopathy,and deepen the understanding of pediatricians about the clinical application of TBNA.Methods A retrospective analysis of 3 clinical cases of children,aged 3 years to 8 years,who were treated and successfully implemented TBNA in the Department of Pediatric Pulmonology for unknown reasons of mediastinum and hilar lymphadenopathy from December 2013 to August 2014 in the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University;observing the efficiency and safety of the transbronchial needle aspiration biopsy in children;emphasizing the importance of mediastimal and hilar lymph node mapping and operational skills;and reviewing domestic and foreign literature.Results Three children were diagnosed with mediastinal and hilar lymphadenopathy by TBNA for mediastinal and hilar lymph node.The cytopathology and acid-fast bacilli,bacterial and fungal inspection of specimen smear,culture and other tests contributed to the diagnosis of the causes.Surgery went smoothly,and there were no intraoperative and postoperative complications.Three children were diagnosed with mycoplasma pneumoniae pneumonia,tuberculosis and EB virus-associated lymphoproliferative disease,which helped to exclude lymphoma.Using "transbronchial needle aspiration","children" or "pediatric" as the key words,2 papers were found in domestic Medical Network database and Chinese Journal Full-text database,both reported by the author of this paper.Eight reports of children TBNA were found in Foreign PubMed database,in which 5 papers were about ultrasound-guided transbronchial needle aspiration,only 3 cases were held by TBNA (one of which was reported by the author of this paper).Conclusions TBNA is a minimally invasive,effective,low-risk operation.It is safe with good results in the etiological diagnosis of children's mediastinal or hilar lymphadenopathy,worth further exploration and promotion.