超声支气管镜引导下经支气管针吸活检术在纵隔肺门占位性病变中的临床应用

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal and hilar lesions

目的探讨超声支气管镜引导下经支气管针吸活检术(EBUS-TBNA)在肺门及纵隔占位性病变中的应用、诊断价值及安全性。方法收集重庆医科大学附属第二医院呼吸科2014年10月至2016年9月,胸部CT检查显示纵隔、肺门淋巴结肿大和(或)胸腔内肿物并行EBUS-TBNA检查的246例患者临床资料,对所有行EBUS-TBNA检查患者的细胞学或病理学检查结果、诊断阳性率及并发症发生情况进行回顾性分析。结果 246例患者EBUS-TBNA后标本病理结果:诊断为恶性肿瘤130例,良性疾病72例,可疑恶性肿瘤26例,诊断未明者18例。恶性肿瘤中小细胞肺癌共45例,非小细胞肺癌共39例,无法确切分型者42例,转移性神经内分泌癌1例,B型淋巴瘤2例,原发性纵隔肉瘤1例。良性疾病中非特异性炎症者22例,纵隔囊肿2例,肺脓肿1例,肺囊肿伴放线菌感染1例,尘肺8例,纵隔淋巴结结核27例,结节病11例。结论 EBUS-TBNA对不明原因的肺门、纵隔淋巴结肿大或肺门、纵隔旁占位病变的诊断具有重要价值,对肺门、纵隔少见疾病的诊断亦是一种重要的辅助检查手段。

Objective To investigate the application, diagnostic value and safety of endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） in hilar and mediastinal lesions.Methods A total of 246 patients with thoracic computed tomography （CT） examinations showed mediastinal, hilar lymphadenopathy and/or pleural masses ,which were examined for EBUS-TBNA in the department of respiratory medicine,Second Affiliated Hospital of Chongqing Medical University from October 2014 to September 2016. The results of cytology or pathology, the positive rate of diagnosis and the incidence of complications were analyzed.Results In the 246 patients ,there were 130 cases of malignant tumors,72 cases of benigh diseases and 26 cases of suspicious cancer, but 18 cases＇ pathological diagnosis couldn＇t be definite. In malignant tumors cases ,45 cases were small cell lung cancer and 39 non-small cell lung cancer ,42 cases of non-specific type,1 case of metastatic neuroendocrine carcinoma, 2 cases of type B lymphoma and 1 case of primary mediastinal sarcoma. In benign disease, there were 22 cases of non-specific inflammation, 2 cases of mediastatic cyst, 1 case of pulmonary abscess, 1 case of pulmonary cyst with actinomycete infection,8 cases of pneumocouiosis ,27 cases of mediastinal lymph node tuberculosis, and l l cases of sarcoidosis. Conclusions EBUS-TBNA is of great value in the diagnosis of unexplained hilar, mediastinal lymph node enlargement or hilar and mediastinal epiphyseal lesions, especially for the diagnosis of sarcoidosis. It is also an important auxiliary examination to diagnosis of the rare hilar and mediastinal dieases.