全身麻醉下行EBUS-TBNA诊断纵隔病变的临床经验

Clinical experience of EBUS-TBNA in diagnosis of mediastinal diseases under general anesthesia

目的探讨在全身麻醉下进行超声支气管镜引导下经支气管透壁针吸活检(EBUS-TBNA)的安全性及手术、麻醉方式。方法 2016年1月至2016年12月在第四军医大学唐都医院呼吸内镜中心接受EBUS-TBNA的患者71例,术前通过胸部CT或MRI提示为纵隔病变;20例患者接受常规丁卡因局部麻醉,51例静脉麻醉联合喉罩全身麻醉,回顾性分析其临床资料。结果 71例接受EBUS-TBNA在局部麻醉和全身麻醉下均可安全进行;局部麻醉组患者术中出现频繁体动、咳嗽、呻吟情况,其中2例中断检查,1例未取得标本;而全身麻醉组患者在安静状态下进行穿刺,咳嗽和支气管出血更少,可获得满意的组织标本,并未增加操作风险。结论全身麻醉下进行EBUS-TBNA更安全、可靠、舒适,值得临床推广应用。

Objective To explore the safety and feasibility of endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） under the general anesthesia, summing up the clinical experience. Methods To collected 71 cases underwent EBUS-TBNA between January 2016 to December 2016 in Respiratory endoscopy center of Tangdu Hospital the Fourth Military Medical University. All patients reoperative chest CT or MRI tips for mediastinal lesions. 20 patients received conventional local dicaine inhibition anesthesia, and 51 patients intravenous anesthesia combined with laryngeal mask anesthesia. The clinical data were retrospectively reviewed. Results All 71 patients under the conventional local dicaine inhibition anesthesia, frequent occurrence of movement, cough, groan in operation, 2 cases interrupt check, 1 case no specimen. The patients under the general anesthesia have less blood and time of operation, felt more comfortable; the complication was no significantly different. Conclusion EBUS-TBNA biopsy under general anesthesia has better quality, less bad memories, and more acceptability by patients, and it deserves further application in clinic.