【摘要】 目的:探究超声引导颈部淋巴结穿刺活检(PNCB)在肺结核患者继发颈部淋巴结结核中的诊断价值。方法:纳入80例肺结核合并颈部淋巴结肿大、疑似颈部淋巴结结核的患者作为研究对象，分别采取常规超声检查、超声引导下PNCB检查及手术取样病理学检查对肿大淋巴结进行病理学诊断，评价超声引导下PNCB取材效果，以术后病理学检查结果为“金标准”,分析比较常规超声检查和超声引导下PNCB组织学活检的诊断效能。结果:超声引导下PNCB取材效果满意。颈部淋巴结结核患者的超声表现为一侧或双侧低回声或低回声伴液化。80例经超声引导下PNCB经病理学检查共确诊79例(98.75%),其中淋巴瘤2例(2.50%),转移癌3例(3.75%),淋巴结结核57例(71.25%),淋巴结炎13例(16.25%),反应性增生2例(2.50%),囊肿1例(1.25%),结缔组织病1例(1.25%)。术后病理诊断淋巴结结核为58例(72.50%),非淋巴结结核为22例(27.50%);常规超声检查诊断淋巴结结核为44例(55.00%),非淋巴结结核为36例(45.00%);超声引导下PNCB病理结果为淋巴结结核为57例(71.25%),非淋巴结结核为23例(28.75%)。常规超声检查对于淋巴结结核诊断的敏感度为94.83%,特异度为68.18%,准确度为87.50%,阳性预测值为88.71%,阴性预测值为83.33%;超声引导下PNCB病理检查对于淋巴结结核诊断的敏感度为98.28%,特异度为100.00%,准确度为98.75%,阳性预测值为100.00%,阴性预测值为95.65%。超声引导下PNCB病理检查的准确率显著高于常规超声检查(χ~2=7.907,P=0.005)。结论:超声引导下颈部PNCB检查取材效果好、安全便捷、准确度高，与术后病理学诊断高度一致，具有一定的临床诊断价值。更多还原

【Abstract】 Objective:To analysis the diagnostic value of ultrasound-guided cervical lymph node percutafleous needle core biopsy(PNCB) in patients with cervical lymph node tuberculosis secondary to pulmonary tuberculosis.Methods:Eighty patients with pulmonary tuberculosis complicated with cervical lymph node enlargement and suspected cervical lymph node tuberculosis were included in the study.Conventional ultrasonography, ultrasound-guided PNCB and surgical sampling pathological examination were used for pathological diagnosis of enlarged lymph nodes.The selection effect of ultrasound-guided PNCB was evaluated.Taking the postoperative pathological examination results as the gold standard, the diagnostic efficacy of conventional ultrasonography and ultrasound-guided PNCB was compared.Results:The selection effect of ultrasound-guided PNCB was satisfied.The ultrasonography findings of patients with cervical lymph nodes tuberculosis displayed the character of low echo or low echo with liquidation.A total of 79 cases(98.75%) of 80 were diagnosed by ultrasound-guided PNCB,with 2 cases(2.50%) lymphoma, 3 cases(3.75%) metastatic carcinoma, 57 cases(71.25%) lymph node tuberculosis, 13 cases(16.25%) lymphadenitis, 2 cases(2.50%) reactive hyperplasia, 1 cases(1.25%) cyst, 1 cases(1.25%) connective tissue disease.Postoperative pathological diagnosis showed that lymph node tuberculosis was 58 cases(72.50%),and non-lymph node tuberculosis was 22 cases(27.50%).Conventional ultrasonography showed that lymph node tuberculosis was 44 cases(55.00%),and non-lymph node tuberculosis was 36 cases(45.00%).Ultrasound-guided PNCB showed that lymph node tuberculosis was 57 cases(71.25%),and non-lymph node tuberculosis was 23 cases(28.75%).The sensitivity, specificity, accuracy, positive prediction value and negative prediction value of conventional ultrasonography in the diagnosis of lymph node tuberculosis was 94.83%,68.18%,87.50%,88.71% and 83.33%,while those of ultrasound-guided PNCB was 98.28%,100.00%,98.75%,100.00% and 95.65%.The accuracy of ultrasound-guided PNCB was higher than conventional ultrasonography(c~2=7.907,P=0.005).Conclusion:Ultrasound-guided PNCB had satisfying selection results, and is safe, convenient and high accuracy, which was highly consistent with postoperative pathological diagnosis, and has high clinical diagnostic value.更多还原