经气管镜超声引导针吸活检与支气管镜针吸活检技术在纵隔及肺门占位性疾病诊断中的应用和比较
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摘要
目的评价经气管镜超声引导针吸活检(EBUS-TBNA)与常规经支气管镜针吸活检(C-TBNA)在纵隔及肺门占位性疾病诊断中的价值。方法收集2010年-2016年新医大一附院纵隔、肺门占位性疾病患者301例,其中行C-TBNA检查者183例,行EBUS-TBNA检查者118例,比较两种方法穿刺阳性率及并发症情况,探究EBUS-TBNA技术的价值及优势所在。结果 (1)EBUS-TBNA患者的中央区组淋巴结(2R、4L、4R、7)活检阳性率高于周围区组淋巴结(10R、10L、11R、11L)(P<0.05),EBUS-TBNA于2R、4R、7组淋巴结活检阳性率高于C-TBNA组,差异具有统计学意义(P<0.05);(2)EBUS-TBNA于4R和7组淋巴结穿刺的一针阳性率明显高于C-TBNA组(P<0.05),三针累计阳性率基本接近该穿刺部位总体阳性率(P>0.05),可获得较满意穿刺效果;(3)EBUS-TBNA组诊断技术的准确度及敏感度优于C-TBNA组(P<0.05),尤其对纵隔、肺门良性疾病的检出率高于C-TBNA组(P<0.05);(4)两组患者并发症的发生率无明显差异(P>0.05)。结论 EBUS-TBNA对不明原因纵隔、肺门占位或气管、支气管腔外病变的诊断具有重要价值,是一种安全、有效的操作技术。
Objective To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA) and conventional-transbronchial needle aspiration(C-TBNA) in mediastinal and lung hilar lesions. Method 301 cases of lung hilar and mediastinal lesions were selected from 2010 to 2016. Among them, 183 cases underwent TBNA, and the other 118 cases received EBUS-TBNA technology. During the research, the associations of diagnostic positive rate and complications were analyzed in order to explore the advantage and the value of EBUS-TBNA. Results The positive rates of EBUS-TBNA in central groups(2R, 4L, 4R, 7) were higher than in the peripheral groups(10R, 10 L, 11 R, 11L)(P < 0.05). When studying the lymph node group 2R, 4R and 7R, the positive rate of EBUS-TBNA is much more significant than conventional TBNA(P < 0.05); When biopsying at the lymph node group R4 and group 7, one needle positive rate of EBUS-TBNA were much more superior than TBNA(P < 0.05), the three needles cumulative positive rate of EBUS-TBNA almost reach the total positive rate(P > 0.05), an approving effect of puncture can be acquired; The accuracy and sensitivity of EBUS-TBNA in the diagnosis of lung hilar and mediastinal lesions were much better than conventional TBNA(P < 0.05), especially the diagnostic positive rate of EBUS-TBNA in benign diseases was higher(P < 0.05); The complications rates in both two technologies were not significantly different(P > 0.05), there were no severe complications during the operations in all cases. Conclusion EBUS-TBNA is useful in diagnosis of mediastinal and hilar lesions of unknown reason, and significant in diagnosis of bronchial and extrabronchial diseases. It is an efficiency and safe operation while further application studies are needed.
Objective To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA) and conventional-transbronchial needle aspiration(C-TBNA) in mediastinal and lung hilar lesions. Method 301 cases of lung hilar and mediastinal lesions were selected from 2010 to 2016. Among them, 183 cases underwent TBNA, and the other 118 cases received EBUS-TBNA technology. During the research, the associations of diagnostic positive rate and complications were analyzed in order to explore the advantage and the value of EBUS-TBNA. Results The positive rates of EBUS-TBNA in central groups(2R, 4L, 4R, 7) were higher than in the peripheral groups(10R, 10 L, 11 R, 11L)(P < 0.05). When studying the lymph node group 2R, 4R and 7R, the positive rate of EBUS-TBNA is much more significant than conventional TBNA(P < 0.05); When biopsying at the lymph node group R4 and group 7, one needle positive rate of EBUS-TBNA were much more superior than TBNA(P < 0.05), the three needles cumulative positive rate of EBUS-TBNA almost reach the total positive rate(P > 0.05), an approving effect of puncture can be acquired; The accuracy and sensitivity of EBUS-TBNA in the diagnosis of lung hilar and mediastinal lesions were much better than conventional TBNA(P < 0.05), especially the diagnostic positive rate of EBUS-TBNA in benign diseases was higher(P < 0.05); The complications rates in both two technologies were not significantly different(P > 0.05), there were no severe complications during the operations in all cases. Conclusion EBUS-TBNA is useful in diagnosis of mediastinal and hilar lesions of unknown reason, and significant in diagnosis of bronchial and extrabronchial diseases. It is an efficiency and safe operation while further application studies are needed.
引文
[1]李时悦,陈小波,何颖,等.气管内超声实时引导经支气管针吸术对肺癌纵隔肺门淋巴结的诊断价值[J].中华医学杂志,2009,89(24):1672-1675.[1]LI S Y,CHEN X B,HE Y,et al.Real time endobronchial ultrasound-guided transbronchial needle aspiration:preliminary study on mediastinal and hilar lymph notes of lung cancer[J].Chinese Medical Journal,2009,89(24):1672-1675.Chinese
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[7]赵辉,王俊.支气管内超声引导下针吸活检术(EBUS-TBNA)在肺癌分期中的应用价值[J].中华胸心血管外科杂志,2010,26(2):137-139.[7]ZHAO H,WANG J.Endobronchial ultrasound-guided transbronchial needle aspiration for the evaluation of lung cancer stage[J].Chin JThorac Cardiovasc Surg,2010,26(2):137-139.Chinese
[8]SUN J,TENG J,YANG H,et al.Endobronchial ultrasoundguided transbronchialneedle aspiration in diagnosing intrathoracic tuberculosis[J].Ann Thorac Surg,2013,96(6):2021-2027.
[9]RINTOUL R C,TOURNOY K G,EL DALY H,et al.EBUS-TBNAfor theclarification of PET positive intra-thoracie lymph nodesaninternational multi-centre experience[J].J Thorac Oncol,2009,4(1):44-48.
[10]GOUSSARD P,GIE R P,KLING S,et al.The diagnostic value and safety of transbronchial needle aspiration biopsy in children with mediastinal Lymphadenopathy[J].Pediatr Pulm,2010,45(12):1173-1179.
[11]OKACHI S,IMAI N,IMAIZUMI K,et al.Endobronchial ultrasound transbronchial needle aspiration in older people[J].Geriatr Gerontol Int,2013,13(4):986-992.
[2]DHOORIA S,AGARWAL R,AGGARWAL A N,et al.Differentiating tuberculosis from sarcoidosis by sonographic characteristics of lymph nodes onendobronchial ultrasonography:Astudy of 165 patients[J].J Thorac Cardiovasc Surg,2014,148(2):662-667.
[3]WANG K P,EDWARD F,HAPONIC T,et al.Transbrochial needle aspiration of peripheral pulmonary nodules[J].Chest,1984,86(6):819-823.
[4]李强.介入肺脏病学的临床应用现状与展望[J].中华结核和呼吸杂志,2008,31(1):3-5.[4]LI Q.The status of clinical application and prospect of interventional lung epidemiology[J].Chin J Tuberc Respir Dis,2008,31(1):3-5.Chinese
[5]HERTH F,BECKET H D,ERNST A.Conventional VSendobronchialultrasound-guided needle aspiration:a randomizedtrial[J].Chest,2004,125(1):322-325.
[6]ARSLAN Z,ILGAZLI A,BAKIR M,et al.Conventional vsendobronchial ultrasound-guided transbronchial needle aspirationin the diagnosis of mediastinal lymphadeuopathies[J].Tuber Toraks,2011,59(2):153-157.
[7]赵辉,王俊.支气管内超声引导下针吸活检术(EBUS-TBNA)在肺癌分期中的应用价值[J].中华胸心血管外科杂志,2010,26(2):137-139.[7]ZHAO H,WANG J.Endobronchial ultrasound-guided transbronchial needle aspiration for the evaluation of lung cancer stage[J].Chin JThorac Cardiovasc Surg,2010,26(2):137-139.Chinese
[8]SUN J,TENG J,YANG H,et al.Endobronchial ultrasoundguided transbronchialneedle aspiration in diagnosing intrathoracic tuberculosis[J].Ann Thorac Surg,2013,96(6):2021-2027.
[9]RINTOUL R C,TOURNOY K G,EL DALY H,et al.EBUS-TBNAfor theclarification of PET positive intra-thoracie lymph nodesaninternational multi-centre experience[J].J Thorac Oncol,2009,4(1):44-48.
[10]GOUSSARD P,GIE R P,KLING S,et al.The diagnostic value and safety of transbronchial needle aspiration biopsy in children with mediastinal Lymphadenopathy[J].Pediatr Pulm,2010,45(12):1173-1179.
[11]OKACHI S,IMAI N,IMAIZUMI K,et al.Endobronchial ultrasound transbronchial needle aspiration in older people[J].Geriatr Gerontol Int,2013,13(4):986-992.