【作者】 廖慧；

【导师】 王导新；

【作者基本信息】 重庆医科大学 ， 临床医学（专业学位）， 2017， 硕士

【摘要】 目的:探讨超声内镜引导下经支气管针吸活检术(EBUS-TBNA)在纵膈及肺门占位性病变中的应用、诊断价值及安全性。方法:回顾性分析重庆医科大学附属二院呼吸科2014年10月至2016年9月,胸部CT检查示纵膈、肺门淋巴结肿大和(或)胸腔内肿物并行EBUS-TBNA检查的246例患者临床资料,对所有行EBUSTBNA检查患者的细胞学和(或)病理学检查结果、诊断阳性率及并发症发生情况进行统计分析。结果:246例患者EBUS-TBNA后标本病理结果:诊断为恶性肿瘤130例,良性疾病72例,可疑恶性肿瘤26例,诊断未明者18例。恶性肿瘤中小细胞肺癌共45例,非小细胞肺癌共39例,无法确切分型者42例,转移性神经内分泌癌1例,B型淋巴瘤2例,原发性纵膈肉瘤1例。良性疾病中非特异性炎症者22例,纵膈囊肿2例,肺脓肿1例,肺囊肿伴放线菌感染1例,尘肺8例,纵膈淋巴结结核27例,结节病11例。EBUS-TBNA对纵膈、肺门占位性病变的总体诊断率为92.7%,其中对恶性肿瘤的诊断率为94.0%,对纵膈淋巴结结核的诊断率为84.4%,对结节病的诊断率为73.3%。有6例患者重复行二次EBUS-TBNA检查后病理诊断结果:1例肺癌,2例结节病,3例纵膈淋巴结结核。246例患者EBUS-TBNA术中不良反应包括,13例患者术中出现低氧血症,5例患者术中出现心律失常,19例患者出现术中少量出血。术后并发症主要表现为咳嗽及痰中带血,未见严重并发症发生。结论:EBUS-TBNA具有良好的安全性和可重复性,用于诊断纵膈、肺门占位性病变是安全、有效的,尤其对于恶性疾病检出率高,对于纵膈、肺门淋巴结肿大的结节病及结核病亦有重要的诊断价值。在实际应用中,对行首次检查结果不理想者,可通过重复检查提高诊断率。EBUS-TBNA对纵膈、肺门少见疾病亦是一种重要的辅助检查手段。更多还原

【Abstract】 Objective: To investigate the application,diagnostic value and safety of endobronchial ultrasound-guided transdronchial needle aspiration(EBUS-TBNA)in hilar and mediastinal lesions.Methods: A total of 246 patients with thoracic CT examinations showed mediastinal,hilar lymphadenopathy and / or pleural masses,which were examined for EBUS-TBNA in the department of respiratory medicine,Second Affiliated Hospital,Chongqing Medical University from October 2014 to September 2016.The results of cytology or pathology,the positive rate of diagnosis and the incidence of complications were analyzed in all patients who underwent EBUS-TBNA examination.Results: Of the 246 patients,130 cases were malignant tumors,72 benign diseases,26 suspicious cance and 18 cases’ pathological diagnosis cannot be definited.In malignant tumors cases,45 cases were small cell lung cancer and 39 non-small cell lung cancer,42 cases of nonspecific type,1 case of metastatic neuroendocrine carcinoma,2 cases of type B lymphoma and 1 case of primary mediastinal sarcoma.22 cases of non-specific inflammation in benign disease,2 cases of mediastatic cyst,1 case of pulmonary abscess,1 case of pulmonary cyst with actinomycete infection,8 cases of pneumoconiosis,27 cases of mediastinal lymph node tuberculosis,11 cases of sarcoidosis.EBUS-TBNA for the diagnosis rate of mediastinal and hilar lesions is 92.7%,for the diagnosis rate of malignant tumor was 94.0%,for the diagnosis rate of mediastinal lymph node tuberculosis was 84.4%,for the diagnosis rate of sarcoidosis Was 73.3%.6 patients with repeated EBUS-TBNA examination was diagnosed as: 1 case of lung cancer,2 cases of sarcoidosis,3 cases of mediastinal lymph node tuberculosis.Adverse reactions in EBUS-TBNA of 246 patients included hypoxemia in 13 patients,arrhythmia in 5 patients,and 19 cases of intraoperative bleeding.Postoperative complications were mainly manifested as cough and sputum bloody,no serious complications occurred.Conclusion: EBUS-TBNA has good safety and repeatability,for the diagnosis of mediastinal,hilar lesions are safe and effective,especially for the detection rate of malignant disease,for sarcoidosis and tuberculosis of mediastinal,hilar lymph nodes also have important diagnostic value.In practical application,if the first inspection result is not ideal,through repeated EBUS-TBNA inspection increase diagnosis rate.EBUS-TBNA is also an important means of auxiliary examination for the rare mediastinal,hilar disease.更多还原