【摘要】 目的:探讨气管镜下针吸活检在非腔内生长型肺癌诊断中的应用,并对影响因素进行回归分析方法:对叶、段支气管非腔内生长型肺癌患者124例进行气管镜针吸活检（transhronehial needle aspiration,TBNA）分为2组:A组为表面黏膜正常,B组表面黏膜明显充血、颗粒样粗糙其中A组进行TBNA+刷片;B组采用TBNA+钳检+刷片所获标本进行病理学诊断采用Logistic回归分析进行统计分析结合CT检查提示有纵隔及肺门淋巴结肿大的86例患者进行淋巴结穿刺活检,初步进行术前N分期结果:124例肺癌患者中A组76例、B组48例全部患者的TBNA及刷片诊断阳性率分别为75.80%和30.64%,TBNA明显高于刷片（x²=50.79,P<0.001） A组中,TBNA诊断阳性率明显高于刷片诊断阳性率（78.94%vs.1 8.42%,P<0.001）。B组病例中,TBNA、钳检及刷片诊断阳性率分别为70.83%（34/48）、25.00%（12/48）、50.00%（24/48）,TBNA阳性率最高（P<0.001）86例纵隔及肺门淋巴结肿大的肺癌患者淋巴结穿刺活检,穿刺成功率达73.6%,穿刺阳性率达71.70%初步分期为N₁、N₂、N₃期的病例分别为8例、44例和12例Logistic回归分析显示病变部位、大小、病理类型以及穿刺针数是TBNA的主要影响因素结论:TBNA可提高非腔内生长型肺癌及纵隔或肺门淋巴结的病理学诊断率对肺癌术前明确N分期有明显的帮助,有利于合理选择治疗方式更多还原

【Abstract】 Objective:To discusse the transbronchial needle aspiration(TBNA) application in etio-diagnose cavity lung tumor appearance and N staging.Methods:Out of 124 lung cancer patients who underwent TBNA,86 patients with mediastinal and/or hilar lymph node lesions underwent TBNA for lymph node.All patients were divided into two groups:Group A(normal mucosal changes) and Group B(suspected mucosal changes).Biopsy,TBNA,and brushing were performed.Logistic regression analyses were adjusted for endobronchial visibility,the number of puncture for each position,distance from carina,and tumor size.Results:TBNA had 75.80%positive diagnostic rate,which is better than that for bronchial brushing and clamp biopsies.(P<0.001) In 86 patients with mediastinal and/or hilar lymph node lesions in the CT scan of chest,TBNA for the lymph node has a 73.60%successful rate and the positive rate is 71.70%.The positive rate of TBNA is related to pathological types,the number of puncture for each position,distance from carina,and tumor size.Conclusion:TBNA is quite helpful diagnosing and staging an etio-diagnosis of cavity lung tumor.更多还原