超声支气管镜引导下的经支气管镜针吸活检术在纵隔及肺部病变诊疗中的应用价值

The application value of endobronchial ultrasound-guided transbronchial needle aspiration in diagnosis and treatment of mediastinal and pulmonary diseases

目的探讨超声支气管镜引导下的经支气管镜针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)对纵隔及纵隔旁肺部病变的诊疗意义。方法收集2014年7月-2015年2月南京军区南京总医院呼吸与危重症医学科收治并接受EBUS-TBNA诊查的52例临床资料,结合患者最后诊断对EBUS-TBNA针吸活检阳性结果进行统计学分析。结果 52例中通过EBUS-TBNA取得可检测标本82份,病理确诊45例,其中恶性病变33例,良性病变12例。未确诊7例中,肺硬化性血管瘤1例、肺癌4例、结核2例。敏感性为85.2%,特异性100%,准确性85.4%,阳性预测值100%,阴性预测值7.7%,所有患者无严重并发症。结论 EBUS-TBNA是对纵隔及纵隔旁肺部病变诊断的安全和微创的检查方法,而且在某些疾病诊断过程中还可进行治疗。

Objective To investigate the application value of endobronchial ultrasound guided transbronchial needle aspira- tion （EBUS-TBNA） in the diagnosis and treatment of mediastinal and pulmonary diseases. Methods The clinical data of total 52 pa- tients who hospitalized in the department of respiratory and critical care medicine in Nanjing general hospital of Nanjing military com- mand during July 2014 to February 2015 and also taken the examination of EBUS-TBNA were obtained. The positive results of EBUS- TBNA biopsy were statistically analyzed with the final diagnosis. Results Total 82 specimens from all 52 patients were obtained via EBUS-TBNA biopsy. Among these, 45 cases were diagnosed by pathology, including 33 cases of malignant lesions and 12 cases of be- nign lesions. There were 7 patients with false-negative results, including 1 cases of pulmonary sclerosing hemangioma, 4 cases of lung cancer, 2 cases of tuberculosis. The sensitivity of EBUS-TBNA in this study was 85.2%, specificity of 100%, accuracy of 85.4%, positive predictive value of 100% , and negative predictive value of 7.7%. All patients had no serious complications. Conclusion EBUS-TBNA examination is a safe and minimally invasive method for the diagnosis of mediastinal and pulmonary diseases, which can also be used as a further therapy approach during the diagnostic process of some diseases.