传统支气管针吸活检术在原发性肺癌诊断中价值

目的探讨传统支气管针吸活检术（C-TBNA）对原发性肺癌患者在肺癌诊断和淋巴结分期中的应用价值。方法回顾性分析2013年1月至2014年12月经C-TBNA病理诊断的原发性肺癌118例患者临床资料，包括淋巴结的穿刺和肺内肿块的穿刺，同时所有患者均行胸部CT检查。结果通过对118例C-TBNA阳性患者的病理分析，其中腺癌45例（38．1％）、鳞癌28例（23．7％）、小细胞癌17例（14．4％）。联合TNBA淋巴结与胸部CT比较，C-TBNA淋巴结穿刺在肺癌诊断及分期中明显优于胸部CT，并减少胸部CT淋巴结的假阴性率。C-TBNA淋巴结的阳性率与穿刺区域无关，118例患者取得淋巴结穿刺标本289份，其中阳性称本194份，分三个区域（上纵隔区，下纵隔区，10-14区），对三个区域进行组间率比较，差异无统计学意义（P〉0．05）。所有患者检查耐受性良好，均无相关并发症。结论C-TBNA作为肺门、纵隔淋巴结及肺内肿块病理评估手段，明显提高肺癌的诊断阳性率，其穿刺阳性率与穿刺区域无关。气管镜在肺癌诊断的应用中安全、有效、可行。

Objective To investigate the application value of the Conventional Transbronchial Needle Aspiration Biopsy （ C-TBNA ） on diagnosis of lung cancer and lymph node staging for primary lung cancer patients. Methods The clinical data of patients with 118 cases of primary lung cancer was analyzed retrospectively and the respiratory department from January 2013 to December 2014 period was analyzed by C-TBNA pathologic diagnosis, including the lymph nodes and lung tumor puncture biopsy. Meanwhile, all patients did chest CT. Results By means of the positive C-TBNA pathologic analysis among the 118 cases of patients, adenocarcinoma were found in 45 cases （ 38.1% ） , squamous cell carcinoma and in 28 cases （ 23.7% ） , small cell carcinoma in 17 patients （ 14.4% ） . Combining the TNBA lymph nodes and the chest CT comparison, C-TBNA lymph node biopsy in the diagnosis and staging of lung cancer was found significantly better than the chest CT. It can reduce the false negative rate of the chest CT lymph nodes. The positive rate of C-TBNA lymph nodes is regardless of the puncture area. 118 patients made 289 parts by lymph node biopsy specimens, including 194 positive samples which are divided into three regions （ the superior mediastinum and lower mediastinal region, 10- 14 region ） . Comparing the three groups＇ region rates no statistical significant difference was found （ P〉0.05 ） . All patients tolerated wellwith no complications. Conclusions As hiius pulmonis and mediastinal lymph nodes and lung tumor pathology assessment tools, C-TBNA can significantly improve the diagnostic yield of lung cancer. In addition, the positive rate is regardless of the puncture area. The application of bronchoscopy of lung cancer diagnosed is safe, effective and feasible.