超声支气管镜引导下支气管针吸活检对纵隔及肺门病变诊断的应用

Application of endobronchial ultrasound-guided transbronchial needle aspiration on the diagnosis of mediastinal and hilar diseases

目的观察超声支气管内镜引导下支气管针吸活检(EBUS-TBNA)在诊断纵隔及肺门病变中的应用及其安全性。方法对21例经CT证实存在肺内病变伴纵隔和(或)肺门淋巴结肿大、不明原因的纵隔和(或)肺门淋巴结肿大及不明原因纵隔占位患者进行EBUS-TBNA,穿刺物行细胞或组织病理学检查。结果 21例患者均顺利完成EBUS检查,无并发症发生,20例患者穿刺活检阳性。统计穿刺阳性率为95.2%(20/21),诊断阳性率为66.7%(14/21)。肺部病变伴纵隔和(或)肺门淋巴结肿大15例:根据病理结果诊断恶性肿瘤11例,其中鳞癌1例,腺癌1例,小细胞癌1例,不能分类8例;不明原因的纵隔和(或)肺门淋巴结肿大4例:结合临床诊断结节病1例,未能诊断3例;纵隔不明原因的占位2例:根据病理结果诊断支气管囊肿1例,淋巴结核1例。结论 EBUS-TBNA是诊断纵隔及肺门病变一项有效的检查技术,安全性高,可在临床上推广应用。

Objective To evaluate the utility of endohronchial ultrasound-guided transhronchial needle aspiration（EBUS-TBNA） in mediastinal and hilar diseases. Methods A total of 21 patients underwent EBUS-TBNA ,including 15 pulmonary lesions with mediastinal and/or hilar lymph nodes lymphadenopathies ,4 unknown mediastinal and/or hilar lymph nodes lymphadenopathies, and 2 unknown mediastial occupying lesions. All samples were evaluated by cytological and pathological examinations. Results All the 21 patients umterwent EBUS-TBNA successfully, and no complication was observed. Twenty patients had positive resuhs. The aspiration positive rate was 95.2% （20/21） and the diagnosis positive rate was 66.7% （ 14/21 ）. Among the 15 pulmonary lesions with mediastinal and/or hilar lymph nodes lymphadenopathies, 11 malignant tumors were diagnosed, including 1 squamous cell carcinoma, 1 adenocarcinoma, 1 small cell carcinoma, and 1 unclassified. In 4 unknown mediastinal and/or hilar lymph nodes lymphadenopathies, 1 sarcoidosis was diagnosed. For the 2 unknown mediastial occupying lesions, 1 lesion was diagnosed as bronchogenic cyst and 1 lesion was diagnosed as lymphoid tuberculosis. Conclusion EBUS-TBNA is an effective and safe diagnosis technology in mediastinal and hilar diseases ,which could be widely used in clinie.