【摘要】 [目的]探讨超声内镜引导下细针穿刺活检(EUS-FNA)对纵膈和腹膜后淋巴结转移癌的诊断价值,并评价EUS-FNA的安全性。[方法]收集经影像学检查发现有纵膈和(或)腹膜后淋巴结肿大怀疑恶性肿瘤转移,并伴或不伴实质或空腔脏器管壁占位的门诊和住院患者119例、共187处病灶行EUS-FNA,其中穿刺肿大淋巴结140个,穿刺实质或空腔脏器管壁占位47处。[结果]119例均接受了EUS-FNA,每部位平均穿刺3次。140个淋巴结和47处实质或空腔脏器病灶均可获得细胞学涂片,136个淋巴结和45处实质或空腔脏器病灶可获得组织学切片。119例中,EUS-FNA诊断阳性率95.0%(113/119),细胞学诊断阳性率92.4%(110/119),组织学诊断阳性率87.4%(104/119)。113例EUS-FNA阳性诊断中,80例为恶性肿瘤,不确定诊断者6例。EUS-FNA诊断恶性肿瘤41例,良性占位4例,2例诊断不明确。术后观察1例胸痛不适,2例轻微腹痛不适,其中1例合并一过性发热,均给予对症处理后好转,余未出现出血、穿孔等并发症。[结论]超声内镜可在一次操作中对多部位病灶进行EUS-FNA,获得病理学诊断;EUS-FNA对纵膈和腹膜后淋巴结转移癌的确诊具有肯定的价值;EUS-FNA可在实时超声监控下进行,安全性高,值得临床重视。更多还原

【Abstract】 [Objective]Endoscopic ultrasound guided fine needle aspiration biopsy(EUS-FNA)was performed for diagnosis of mediastinal and retroperitoneal lymph node metastasis,and the safety of this method were evaluated.[Methods]A total of 119 suspected with mediastinal and retroperitoneal lymph node metastasis accompanied with or without parenchymatous or cavitation organ lesions referred for EUS-FNA were studied retrospectively,including 78 male and 41 female,the age of patients ranged from 16 to 78 years old(mean age[57.13±12.44]years),all patients were received EUS-FNA.[Results]All of the 119 patients were performed fine needle biopsy,total 140 lymph nodes and 47 cases of parenchymatous or cavitation organ lesions were detected by EUS-FNA.The size of lymph nodes were 0.5-4.6 cm(mean size[1.93±1.08]cm),and the size of parenchymatous or cavitation organ lesions were 0.7-5.9 cm(mean size[2.35±1.50]cm),every lesion was punctured 3 times.Cytologic specimens were obtained in 140(100%)lymph nodes and 47(100%)case of parenchymatous or cavitation organ lesions,histological specimens were obtained in 136(97.1%)lymph nodes and 45(95.7%)cases of parenchymatous or cavitation organ lesions.The overall diagnostic positive rate was 95.0%(113/119),the positive rate of cell smears was 92.4%(110/119)and the positive rate of histological blocks was 87.4%(104/119).There were 80 in 113 patients were diagnosed malignant lymph nodes,and 6 cases were uncertain diagnosis.The 41 lesions were diagnosed malignant carcinoma(include 35 cases of primary tumors and 6 cases of metastatic tumors),4 cases were benign tumors,the other 2 cases were not diagnosed clearly.According to post-operative follow up,1 patient got chest pain,2 patients got slight pain,one of them got a transient fever,all those symptoms were relieved by heteropathy,other patients got no significant complications.[Conclusion]EUS-guided FNA has clinical value in the diagnosis of mediastinal and retroperitoneal lymph nodes metastasis,meanwhile EUS-FNA has the advantage of pathological diagnosis of multiple lesion locations.The procedure of EUS-FNA is safe by real-time ultrasonography monitoring.EUS-FNA is well worthy of attention.更多还原