经支气管镜超声引导针吸活检术在常规经支气管镜针吸活检术检查阴性的纵隔疾病中的应用价值

Diagnostic value of endobronchial ultrasound-guided tansbronchial needle aspiration in conventional tansbronchial needle aspiration negative paratracheal mediastinal lesions

目的 探讨经支气管镜超声引导针吸活检术（EBUS-TBNA）在常规经支气管镜针吸活检术（C-TBNA）检查阴性的纵隔疾病中的应用价值.方法 选取2009年4月至2013年6月就诊于山东大学附属省立医院呼吸内科、经胸部CT检查显示纵隔淋巴结肿大而常规支气管镜检查未发现病变的患者403例,其中淋巴结周围存在血管分布者共76例,行EBUS-TBNA检查（A组）;余327例淋巴结周围未存在血管分布者行TBNA检查（B组）,C-TBNA检查结果回报后未明确诊断者共62例,其中54例选择行EBUS-TBNA检查（C组）.对各组患者的病理学检查结果、诊断阳性率进行统计分析.结果 A组确诊71例（93.4％）,其中恶性肿瘤57例、良性病变14例.B组确诊265例（81.0％）,其中恶性肿瘤232例、良性病变33例.C组确诊49例（90.7％）,其中恶性肿瘤42例、良性病变7例;A、B组诊断阳性率差异有统计学意义（x^2=6.639,P=0.010）.结论 对C-TBNA检查结果阴性的患者行EBUS-TBNA检查是必要的,并且可以获得满意的诊断结果.

Objective To investigate the diagnostic value of endobronchial ultrasound-guided tansbronchial needle aspiration （EBUS-TBNA） in patients with mediastinal lesions and previously conventional TBNA-negative results.Methods A total of 403 patients with mediastinal lesions on chest CT but negative results of routine bronchoscopy were enrolled at Shandong Provincial Hospital Affiliated to Shandong University from April 2009 to June 2013.Seventy-six cases with enlarged lesions surrounded with peripheral vascularity were allocated to group A and underwent EBUS-TBNA examination.The other 327 cases without peripheral vascularity were allocated to group B and underwent TBNA.Fifty-four of the 62 patients with previous TBNA （group B） negative results consequently underwent EBUS-TBNA were allocated to group C.The association between pathologic examinations and positive rate were analyzed.Results Seventy-one cases in group A （93.4%） had a final diagnosis,of which 57 were diagnosed as malignant lesions and 14 as benign lesions.Two hundred and sixty-five cases in group B （81.0%） had a final diagnosis,of which 232 were malignant lesions and 33 benign lesions.Forty-nine cases （90.7%） in group C had a final diagnosis,of which 42 were malignant lesions and 7 benign lesions.The difference between group A and B was significant （x^2 =6.639,P =0.010）.Conclusions In conventional TBNA examination negative cases,a following EBUS-TBNA examination is necessary and has a satisfactory diagnostic efficacy.