经支气管针吸活检术在伴有纵隔淋巴结肿大的肺及纵隔病变中的诊断价值研究

摘要

Objective To explore the diagnostic value of transbronchial needle aspiration ( TBNA ) for pulmonary or mediastinal lesions.Methods Fifty - six patients with enlarged mediastinal lymph nodes underwent routine fiberoptic bronchoscope examinations, which revealed no ohvious lumps inside the cavity nor pressure from outside the bronchial cavity.Transbronchial needle aspiration was carried out in these patients, with subsequent brush cytology performed at the TBNA site.Additional biopsy were carried out when thickened local mucosa, congestion or edema were seen.Positive rates of diagnosis of TBNA and bronchoscopy brush cytology combined with mucosa biopsy were compared to evaluate the validity and safety of TBNA,with its possible influencing factors analyzed.Results Of the 56 cases with mediastinal lymphonode enlargement, 34 were diagnosed by TBNA, with the diagnostic rate ( 60.7％ ) higher than that of hronchoscopy hrush cytology comhined with mucosa hiopsy ( 16.1％ )( P ＜0.01 ).The influencing factors included size and site of the examined lymph nodes.Lymph nodes larger than 2 cm in diameter delivered higher positive rates of TBNA diagnosis ( P ＜ 0.01 ).Mediastinal lymph nodes in group seven delivered higher positive rates than those in the other groups ( 76.9％ vs.46.7％ ) ( P ＜ 0.05 ).Complications of TBNA were rare,mostly slight bleeding of the puncture site.Conclusion TBNA is a safe and effective method in the diagnosis of lesions outside the bronchial cavity or enlargement of mediastinal lymph nodes and lymph nodes within the hilum of the lungs , especially when the bronchi are unobstructed.%目的 探讨经支气管针吸活检术(transbronchial needle aspiration,TBNA)在肺及纵隔病变诊断中的临床价值.方法 对56例常规纤维支气管镜检查支气管,管腔内未见肿物及明显外压但伴有纵隔淋巴结肿大的患者进行纵隔淋巴结针吸活检,直接涂片后送检.TBNA完成后,再以毛刷在穿刺点处刷检,如果可见局部黏膜增厚或充血水肿需另行活检.比较TBNA与黏膜活检联合刷检的诊断率,评价TBNA的有效性及安全性,分析其影响因素.结果 56例纵隔淋巴结肿大的患者经TBNA确诊34例,诊断率为60.7%,高于支气管黏膜活检联合刷检的16.1%的诊断率,差异有统计学意义(P＜0.01).TBNA诊断率受淋巴结大小影响,直径大于2 cm的淋巴结的TBNA诊断率高,差异有统计学意义(P＜0.01).另外TBNA诊断率还受淋巴结部位影响,7组淋巴结的TBNA阳性率为76.9%,高于非7组淋巴结46.7%的阳性率,差异有统计学意义(P＜0.05).TBNA并发症少,绝大多数患者仅穿刺点有少许出血.结论 TBNA是一项有效、安全的检查手段,对支气管管腔外病变或肺门、纵隔淋巴结肿大的确诊具有重要意义,尤其在纤维支气管镜检查支气管管腔通畅的情况下.