电视纵隔镜与支气管内超声引导针吸活检术诊断纵隔肿物价值
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摘要
目的比较电视纵隔镜(VAM)与支气管内超声引导针吸活检术(EBUS-TBNA)对纵隔肿物的诊断价值。方法选择我院胸外科胸部CT检查拟诊纵隔肿物(肿物短径大于1. 0cm),需要进一步明确诊断的126例住院患者分别行VAM、EBUS-TBNA。VAM组:75例; EBUS-TBNA组:51例。根据术后石蜡切片病理结果及随访,分别计算两种方法的准确性、灵敏度、特异度。结果 VAM诊断纵隔肿物的准确性94. 67%,灵敏度94. 12%,特异度100%; EBUS-TBNA诊断纵隔肿物的准确性88. 24%,灵敏度87. 50%,特异度100%。结论在纵隔肿物诊断方面,VAM和EBUS-TBNA均是有效的方法。从创伤、并发症、伦理等因素综合考虑,建议首先EBUS-TBNA。对于纵隔良性病变及淋巴瘤VAM可能具有更高的诊断价值;对于合并有肺门或邻近气管、支气管肺内肿物的患者,EBUS-TBNA在疾病诊断方面具有更明显的优势。
Objective To compare the diagnostic value of TV mediastinum( VAM) and endobronchial ultrasound guided needle aspiration( EBUS-TBNA) for mediastinal mass. Methods 126 cases of hospitalized patients with short diameter of the tumor greater than 1. 0 cm from the department of thoracic surgery were given VAM and EBUS-TBNA to make further clear diagnosis when they were initially diagnosed as mediastinal mass through CT examination. There were 75 cases in the VAM group and 51 cases in the Ebus-tbna group. The accuracy,sensitivity,specificity of the two methods were calculated according to the pathological results and follow-up. Results The accuracy of VAM in the diagnosis of mediastinal mass was 94. 67%,its sensitivity was 94. 12% and its specificity was 100%.The accuracy of EBUS-TBNA was 88. 24%,its sensitivity was 87. 50%,and specificity was 100%. Conclusion Both VAM and EBUS-TBNA are effective methods in the diagnosis of mediastinal mass. EBUS-TBNA is recommended for the combination of trauma,complications and ethics. VAM may have higher diagnostic value for mediastinal benign lesions and lymphoma. EBUS-TBNA has more obvious advantages in the diagnosis of disease in patients with lung or adjacent trachea and bronchus mass.
Objective To compare the diagnostic value of TV mediastinum( VAM) and endobronchial ultrasound guided needle aspiration( EBUS-TBNA) for mediastinal mass. Methods 126 cases of hospitalized patients with short diameter of the tumor greater than 1. 0 cm from the department of thoracic surgery were given VAM and EBUS-TBNA to make further clear diagnosis when they were initially diagnosed as mediastinal mass through CT examination. There were 75 cases in the VAM group and 51 cases in the Ebus-tbna group. The accuracy,sensitivity,specificity of the two methods were calculated according to the pathological results and follow-up. Results The accuracy of VAM in the diagnosis of mediastinal mass was 94. 67%,its sensitivity was 94. 12% and its specificity was 100%.The accuracy of EBUS-TBNA was 88. 24%,its sensitivity was 87. 50%,and specificity was 100%. Conclusion Both VAM and EBUS-TBNA are effective methods in the diagnosis of mediastinal mass. EBUS-TBNA is recommended for the combination of trauma,complications and ethics. VAM may have higher diagnostic value for mediastinal benign lesions and lymphoma. EBUS-TBNA has more obvious advantages in the diagnosis of disease in patients with lung or adjacent trachea and bronchus mass.
引文
[1]简俊岭,徐先全,王起奎,等.电视纵隔镜检查术在纵隔疾病诊断中的应用[J].安徽医学,2015,36(12):1501-1503.
[2]朱峰,徐宁,马冬春.纵隔肿大淋巴结的诊断及研究进展[J].中华胸心血管外科杂志,2017,33(1):60-62.
[3]高峰,张泽峰,冯明祥.纵隔镜对单纯纵隔淋巴结肿大的诊断价值[J].中国肿瘤临床,2012,39(8):455-457.
[4]邵丰,许栋生,杨如松,等.电视纵隔镜在纵隔疾病诊断及肺癌分期中的应用[J].中国微创外科杂志,2010,10(6):490-491.
[5]朱峰,徐宁,汤磊,等. 120例不明原因纵隔淋巴结肿大的纵隔镜临床应用[J].中华胸心血管外科杂志,2015,31(7):432-433.
[6] DETTERBECK F C,JANTZ M A,WALLACE M,et al. Invasive mediastinal staging of lung cancer:ACCP evidence-based clinical practice guidelines(2nd edition)[J]. Chest,2007,132(S3):S202-S220.
[7]罗广裕,徐国良,李茵,等.实时超声支气管镜引导下经支气管针吸活检术对肺癌的诊断作用[J].中国肿瘤临床,2011,38(21):1338-1341.
[8]赵辉,王俊,李剑锋,等.支气管内超声引导针吸活检术(EBUSTBNA)临床应用的初步体会[J].中国微创外科杂志,2010,10(2):110-113.
[9]徐宁,汤磊.电视纵隔镜技术在纵隔病变临床诊断中的应用及体会[J].临床肺科杂志,2016,21(1):78-80.
[10]陈强,武焱旻,蒋峰,等.支气管镜引导下经支气管针吸活检术与纵隔镜在肺癌及纵隔肿物诊断中的比较[J].中华实验外科杂志,2017,34(9):1443-1445.
[11]张良,毛锋,蔡明辉,等.纵隔镜与EBUS-TBNA对肺癌诊断和分期价值的比较研究[J].中国肺癌杂志,2013,16(6):289-293.
[12] HASSAN T,MCLAUGHLIN A M,O’CONNELL F,et al. EBUSTBNA performs well in the diagnosis of isolated thoracic tuberculous lymphadenopathy[J]. Am J Respir Crit Care Med,2011,183(1):136-137.
[13] ZHU F,GE J J. A retrospective study about 140 mediastinal lymphadenectasis patients receiving video-assisted mediastinoscopy[J].Int J Clin Exp Med,2016,9(7):12839-12845.
[14]胡鸿,陈海泉,陈颖,等.经气管镜超声引导针吸活检术诊断纵隔病变的价值[J].中华肿瘤杂志,2011,33(10):787-790.
[15] ZHU F,MA D C,XU N,et al. Diagnostic value of video-assisted mediastinoscopy and endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lymphadenectasis without pulmonary abnormalities[J]. Med Sci Monit,2017,23:3064-3070.
[2]朱峰,徐宁,马冬春.纵隔肿大淋巴结的诊断及研究进展[J].中华胸心血管外科杂志,2017,33(1):60-62.
[3]高峰,张泽峰,冯明祥.纵隔镜对单纯纵隔淋巴结肿大的诊断价值[J].中国肿瘤临床,2012,39(8):455-457.
[4]邵丰,许栋生,杨如松,等.电视纵隔镜在纵隔疾病诊断及肺癌分期中的应用[J].中国微创外科杂志,2010,10(6):490-491.
[5]朱峰,徐宁,汤磊,等. 120例不明原因纵隔淋巴结肿大的纵隔镜临床应用[J].中华胸心血管外科杂志,2015,31(7):432-433.
[6] DETTERBECK F C,JANTZ M A,WALLACE M,et al. Invasive mediastinal staging of lung cancer:ACCP evidence-based clinical practice guidelines(2nd edition)[J]. Chest,2007,132(S3):S202-S220.
[7]罗广裕,徐国良,李茵,等.实时超声支气管镜引导下经支气管针吸活检术对肺癌的诊断作用[J].中国肿瘤临床,2011,38(21):1338-1341.
[8]赵辉,王俊,李剑锋,等.支气管内超声引导针吸活检术(EBUSTBNA)临床应用的初步体会[J].中国微创外科杂志,2010,10(2):110-113.
[9]徐宁,汤磊.电视纵隔镜技术在纵隔病变临床诊断中的应用及体会[J].临床肺科杂志,2016,21(1):78-80.
[10]陈强,武焱旻,蒋峰,等.支气管镜引导下经支气管针吸活检术与纵隔镜在肺癌及纵隔肿物诊断中的比较[J].中华实验外科杂志,2017,34(9):1443-1445.
[11]张良,毛锋,蔡明辉,等.纵隔镜与EBUS-TBNA对肺癌诊断和分期价值的比较研究[J].中国肺癌杂志,2013,16(6):289-293.
[12] HASSAN T,MCLAUGHLIN A M,O’CONNELL F,et al. EBUSTBNA performs well in the diagnosis of isolated thoracic tuberculous lymphadenopathy[J]. Am J Respir Crit Care Med,2011,183(1):136-137.
[13] ZHU F,GE J J. A retrospective study about 140 mediastinal lymphadenectasis patients receiving video-assisted mediastinoscopy[J].Int J Clin Exp Med,2016,9(7):12839-12845.
[14]胡鸿,陈海泉,陈颖,等.经气管镜超声引导针吸活检术诊断纵隔病变的价值[J].中华肿瘤杂志,2011,33(10):787-790.
[15] ZHU F,MA D C,XU N,et al. Diagnostic value of video-assisted mediastinoscopy and endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lymphadenectasis without pulmonary abnormalities[J]. Med Sci Monit,2017,23:3064-3070.