经支气管针吸活检术21例失败原因分析

Analysis of failure in 21 patients with transbronchial needle aspiration

目的总结本科开展经支气管穿刺针吸活检技术以来穿刺失败的病例21例,并分析其原因。方法回顾性分析2010年3月～2011年7月间在无锡市第四人民医院气管镜室进行TBNA操作的所有未获得有效组织细胞学证据的病例21例进行分析。结果 21例TBNA失败病例中,2例(2/21,9.5%)因咳嗽剧烈无法完成穿刺;1例(1/21,4.8%)因穿刺误入血管,出血较多无法完成穿刺;4例(4/21,19%)气管环间多次穿刺无法透过气管壁而失败;10例(10/21,47.6%)穿刺物中无细胞组分,仅有红细胞、软骨或支气管上皮细胞;1例(1/21,4.8%)穿刺中纵隔气肿,未完成穿刺;1例(1/21,4.8%)因细胞涂片未及时酒精固定,细胞溶解而无法诊断;2例(2/21,9.5%)因肿块位于肺周围,呼吸活动大而无法完成穿刺。结论 TB-NA是一项需要反复操作训练,经历多次失败后才能掌握的技术。

Objective To summarize the failure in 21 patients with transbronchial needle as- piration in our department and analyze the causes. Methods The failures in 21 patients with trans- bronchial needle aspiration which did not obtain effective cytological or histological sampling in our hospital from March 2010 to July 2010 were retrospectively reviewed. Results In 21 failure cases, 2 cases（2/21, 9.5% ） did not complete because of severe cough, one （ 1/21, 4.8% ） because of puncturing blood vessel and hemorrhage, 4 （4/21, 19%） because of failing to puncture the bronchial wall, 10 （10/21, 47.6% ） had no cells in the samples and only had red cells, cartilage, or bronchial epithelial cells, one （1/21, 4.8%） caused mediastinal emphesema, one case（i/21, 4. 8% ） caused cytolysis because cell tissue was not put into the fixing solution in time, and 2 （2/21, 9.5 % ） because of breath motion. Conclusion TBNA is a difficult - to - master technique which re- quires constant practice.