【作者】 贾婷；

【导师】 姜淑娟；

【作者基本信息】 山东大学 ， 内科学， 2007， 硕士

【摘要】 研究目的：探讨经支气管镜针吸活检术(TBNA)在纵隔及肺部疾病中的诊断价值。研究方法：山东省立医院呼吸内科2005年3月至2006年10月期间，对89例胸部CT检查提示纵隔淋巴结肿大、肺部占位性病变、常规支气管镜检查未见管腔内明显病变患者行经支气管镜针吸活检术，观察其诊断阳性率。其中男59例，女30例，年龄15～78岁。根据胸部薄层强化CT，按照WANG氏定位法确定穿刺部位、角度和深度。采用OLYMPUS BF-240电子支气管镜，WANG氏穿刺针。患者常规术前准备、局部麻醉后，将电子支气管镜经鼻、声门插入气管，按支气管树顺序检查，观察腔内有无可视性病变。确定穿刺部位，将WANG氏针沿气管镜活检通道插入气道，采用推进法结合猛刺法、咳嗽法穿透支气管壁，刺入纵隔淋巴结、腔外病变内，抽取标本。将穿刺物用力推出，涂片、固定，送细胞或病理检查。每一部位至少进行2个点穿刺，以提高阳性率。TBNA完成后，再于支气管相应病变部位反复进行刷检，同样涂于玻片，固定，送检。结果：1．常规支气管镜检查结果：89例患者的气道粘膜均结构完整，未见新生物，未见溃疡及糜烂，未见活动性出血，刷检阳性率12.36％(11／89)。22例单纯纵隔淋巴结肿大患者，13例气管镜检查无气管粘膜及管腔内改变，9例气管呈轻度外压性改变；49例肺部占位性病变合并纵隔淋巴结肿大患者，窥见支气管管腔外病变的间接征像29例，13例病灶区域(穿刺部位)有支气管粘膜充血、水肿，余7例管腔结构无异常：8例单纯支气管管腔外压性狭窄患者管腔闭锁2例，半阻塞性狭窄9例，管腔轻度狭窄7例。2．TBNA检查结果：89例患者均行TBNA检查，共穿刺251次，确诊74例，诊断阳性率83.15％(74／89)。对22例单纯纵隔淋巴结肿大患者行纵隔淋巴结穿刺，确诊18例，诊断阳性率为81.82％；49例肺部占位性病变合并纵隔淋巴结肿大患者TBNA确诊42例(占病例总数的85.71％)；18例支气管管腔外占位患者确诊14例，诊断阳性率77.78％。结论及意义：①TBNA在单纯纵隔病变的诊断及肺癌分期方面有独特优势，敏感性高，并可进行病理分型，可部分代替纵隔镜检查。②对影像学提示支气管管腔狭窄的外压性病变、管腔内基本正常的患者，由于常规气管镜的活检手段如钳检及毛刷等不能较好地获取标本，经支气管镜针吸活检术作为一种独特的检查和诊断方法，在此类病例的诊断中同样发挥了重要的作用，使大部分病例的诊断得以明确。③TBNA相对于对纵隔镜、经皮肺活检和剖胸探查术等手段而言，是一种简单、安全、经济、实用、无严重并发症的检查技术，有较大发展前途，适合广泛推广及普及。更多还原

【Abstract】 Objective: To evaluate the value of transbronchial needle aspiration (TBNA) in the diagnosis of mediastinum and pulmonary diseases.Methods: 89 consecutive patients (59 males and 30 females) referred to the Department of Pulmonary Medicine, Shandong Provincial Hospital, between March 2005 and October 2006 with mediastinal lymphadenectasis, extrabronchial occupying lesions on CT, were included in this study. The age range was 15～78 yrs. We have not included any cases with concomitant endobronchial lesions.TBNA was performed with Wang needle, using electronic bronchoscope (BF-240;Olympus).Following local anesthesia (lidocaine 2%), introduced the electronic bronchoscope transnasally. After a careful examination of the bronchial, provided no endobronchial lesions were identified, the mediastinal lymphaden or extrabronchial lesion was approached first by TBNA and then by brush. Inserted the WANG needle in the retracted position through the work channel of the bronchoscope, reached the lesion by pushing the needle into the corresponding segmental bronchus, then applied suction. Direct smear technique was used for preparation of TBNA specimens. Specifically, needle content was coated on a glass slide and fixed, for cytologic examination. TBNA procedures were repeated at least 2 times every lesion to increase the positive rate. Results:1. The results of routine bronchoscopy:The tunica mucosa bronchiorum were integrated in all the 89 cases, neoplasm, ulcer ,erosion and active hemorrhage were not found;the positive rate of the brush was 12.36%(11/89).Of the 22 patients with simple mediastinal lymphadenectasis, the tunica mucosa bronchiorum and lumens were completely normal in 13 cases;lightly compressed changes of the bronchus were found in 9 cases.During the 49 patients with combined lung disease and mediastinal lymphadenectasis,29 cases showed indirect signs of extrabronchial lesions, 13 cases found bronchial mucosa swollen, hyperemic, 7 cases did not find any abnormal signs.18 cases of extrabronchial dieases, the lumens were locked in 2 cases, half-locked in 9 cases, low-degree stenosis in 7 cases.2. The results of TBNA:74 of 89 cases reached the final diagnosis by TBNA, the diagnostic yield was 83.15% (74/89) .18 of the 22 patients with simple mediastinal lymphadenectasis, reached the final diagnosis, the diagnostic yield was 81.82%; 42 of 49 patients with combined lung disease and mediastinal lymphadenectasis, reached the final diagnosis, the diagnostic yield was 85.71%; 18 cases of extrabronchial dieases, 14 cases got final diagnosis, the diagnostic yield was 77.78%.Conclusions:(1) TBNA has its own unique superiority in the diagnosing of simple mediastinal lymphadenectasis and in the staging of lung cancer, has high sensitivity, can partly take the place of the mediastinoscopy. (2) TBNA could get the final diagnosis of most of extrabronchial lesions whichroutine bronchoscopy( brush smear,biopsy) can not even get the specimen. (3) TBNA is generally more convenient, less risky, and less expensive for diagnosing lung diseases.更多还原