纵隔囊性病变行EBUS-TBNA并发症3例报道及文献复习

EBUS-TBNA related complications for cystic lesions of the mediastinum： three case report and literature review

目的探讨超声引导下经支气管针吸活检术（EBUS-TBNA）在纵隔囊性病变诊治中的风险及获益。方法回顾分析3例纵隔囊性病变患者行EBUS-TBNA穿刺后出现并发症的临床资料并进行相关文献复习，以检索词complications AND（endobronchial ultrasound OR endoscopic ultrasound OR endosonography 0R transbronchial ultrasound OR fine-needle OR fine-needle aspiration），检索PubMed、Medline、EBSCO等数据库，检索时间为2003年1月至2016年7月。结果一例21岁男性患者，在行超声引导下经支气管针吸活检支气管囊肿后出现囊肿感染。一例48岁男性患者，行超声引导下经支气管针吸活检纵隔囊肿后出现囊肿复发。一例49岁女性患者行EBUS-TBNA后，局部出现黄白色液体外渗，后诊断为肺结核。对文献进行检索，经筛选剔除，共纳入49篇文献。其中与纵隔囊性病变穿刺并发症相关文献6篇，共有10例纵隔囊性病变穿刺后出现并发症。结论EBUS-TBNA是一项安全的检查方法，目前用于多种疾病的诊断及治疗，并发症发生率相对较低，但是在穿刺坏死区域、囊性病变及结核性淋巴结肿大等区域时，需要警惕相关严重的感染性并发症的发生。若无创的检查方法能够协助诊断，应尽量避免对上述区域进行穿刺活检。如必须行EBUS-TBNA检查，建议预防性应用抗生素，并减少穿刺次数，缩短手术时间等，以减少并发症的发生。

Objective To discuss risks and benefits in diagnosis and treatment of mediastinal cystic lesions by endobronchial ultrasound-guided transbronehial needle aspiration （EBUS-TBNA）.Methods A retrospective analysis of three patients with EBUS-TBNA related complications and review related literature. A literature research was performed with complications AND （endobronchial ultrasound OR endoscopic ultrasound OR endosonography OR transbronchial ultrasound OR fine needle OR fine-needle aspiration） as the English key words in PubMed, Medline and EBSCO database. The time interval was from January 2003 to July 2016. Results One case presented with cyst infection 2 days after EBUS- TBNA. One case presented with cyst recurrence 1 days after EBUS-TBNA. In the other case, amount of purulent secretion effused from the orifice of punture location after EBUS-TBNA. The diagnosis of this case was Tuberculosis. Literature review found 49 articles. Among them, there were 6 articles related to mediastinal cystic lesions, including a total of 10 cases that presented with complications after aspirate mediastinal cystic lesions under endobronchial ultrasound-guided. Conclusions EBUS-TBNA is a safe and effective technology, which is used in the diagnosis process of various diseases with little complications. However, for special diseases, such as lesions with necrosis, mediastinal cysts and Tuberculous lymphadenitis, complications such as serious infections should be considered and prevented. EBUS-TBNA should not be performed on these patients if other noninvasive diagnosis methods could be used. If necessary, it is recommended to give prophylactic antibiotic treatment, reduce the number of puncture and shorten the operation time, thus reduce the incidence of complications.