CAJ | 학술논문

目的分析优化支气管内超声引导下针吸活检(EBUS-TBNA)适应证,探索提高确诊率的方法.方法近4年完成的669例EBUS-TBNA病例中,未能确诊者53例,占7.92％.统计其术前、术后的各类临床资料,从病种、病灶部位和大小及穿刺手术的术者经验3个方面分析未确诊病例的临床特点.结果按病种分析,未确诊率较高的是淋巴瘤(77.78％)、结核(23.08％)和结节病(9.09％).病灶位置分析,上气管旁病灶(R2组)未确诊率最高,为15.38％;其次为双肺门病灶,右侧15.00％,左侧11.54％.淋巴结大小与确诊率无显著相关性.穿刺经验方面,前10例是学习曲线的爬坡期,10例以后曲线趋于平直.结论应当根据病种特点、病灶位置及术者经验恰当选择EBUS-TBNA适应证,与纵隔镜配合提高诊断率.
목적 분석우화지기관내초성인도하침흡활검(EBUS-TBNA)괄응증,탐색제고학진솔적방법.방법 근4년완성적669례EBUS-TBNA병례중,미능학진자53례,점7.92％.통계기술전、술후적각류림상자료,종병충、병조부위화대소급천자수술적술자경험3개방면분석미학진병례적림상특점.결과 안병충분석,미학진솔교고적시림파류(77.78％)、결핵(23.08％)화결절병(9.09％).병조위치분석,상기관방병조(R2조)미학진솔최고,위15.38％;기차위쌍폐문병조,우측15.00％,좌측11.54％.림파결대소여학진솔무현저상관성.천자경험방면,전10례시학습곡선적파파기,10례이후곡선추우평직.결론 응당근거병충특점、병조위치급술자경험흡당선택EBUS-TBNA괄응증,여종격경배합제고진단솔.
Objective Analyze the clinical feature of patients failed for diagnosis through endobronchial ultrasound transbronchial needle aspiration(EBUS-TBNA).Optimize the indication and increase diagnosis rate of EBUS-TBNA.Methods A total of 669 patients failed for diagnosis of EBUS-TBNA were included.Fifty-three of them(7.92％) were not exactly diagnosed.Perioperation clinical data and clinical feature were collected and evaluated based on specific disease,lesion location,size and operator' s experience.Results The undiagnosis rate was higher in lymphoma (77.78％),tuberculosis (23.08％) and sarcoidosis(9.09％) when analyzed from specific diseases.If the lesion location was taken into consideration,15.38％ upper paratracheal lymph nodes(R2) could not be diagnosed exactly by EBUS-TBNA,and the bilateral hilar lymph nodes(15.00％ for right,11.54 for left) were followed.Size of the lesion was not associated with the diagnosis rate.The operator's experience could also affect the results.The undiagnosis rate was highest in the first 10 cases among all operators.After at least 10 EBUS-TBNA processes,the undiagonsis rate stayed near 7.50％,which was close to the average.Conclusion It is necessary to select suitable indications for EBUS-TBNA based on the disease,lesion location and operatior experience,and cooperate with mediastinoscopy to rise diagnosis rate.