传统与径向气道内超声探头引导经支气管针吸活检诊断纵隔肺门淋巴结的比较

摘要

Objective To compare the value of conventional vs. radial probe endobronchial ultrasound guided transbronchial needle aspiration in the diagnosis of mediastinal and hilar lymphadenopathies.Methods From January lst, 2009 to June 30th, 2011, 60 patients with 65 enlarged mediastinal and hilar lymph node were ramdomized into conventional TBNA group ( n=30 ) or RPEBUS-TBNA group ( n=32 ), and then subdividede into group one ( subcarinal lymph node ) and group two ( non-subcarinal lymph node ). Compare the differences of positive yield and side effects between the two groups. Results The overall diagnostic yield of conventional TBNA was 36.4％ ( 12/33 ), and RPEBUS-TBNA was 71.9％ ( 23/32 ), P=0.004. In group one ( subcarinal lymph node ), the yield of conventional TBNA was 72.7％ ( 8/11 ),while RPEBUS-TBNA had a yield of 76.9( 10/13 ),but there was no statistically significant differences (P= 0.813 ). In group two ( non-subcarinal lymph node ), the diagnostic yield of conventional TBNA and RPEBUS-TBNA were 33.3％ ( 4/14 ) and 76.5％ ( 13/17 ) respectively,P=0.007. Complications included minimal hemorrhage, cough, transient hypoxemia, all were selflimited. Conclusion RPEBUS-TBNA can improve the diagnostic efficiency than conventional TBNA,especially in the non-subcarinal lymph node station. This technique is minimal invasive, cost-effective,safe and feasible.%目的 比较传统经支气管针吸活检(Conventional transbronchial needle aspiration，Conventional TBNA)与径向气道内超声探头引导经支气管针吸活检(Radial probe endobronchial ultrasound guided transbronchial needle aspiration，RPEBUS-TBNA)断纵隔肺门淋巴结的价值。方法 2009年1月1日-2011年6月30日，60例患者共65枚纵隔肺门淋巴结肿大的患者随机分人传统TBNA( n=30)或RPEBUS-TBNA组(n=32)，再按淋巴结是否位于隆突下分为两组，一组为隆突下淋巴结，二组为非隆突下淋巴结。分别于CT阅片后进行传统TBNA及径向气道内超声探头扫描后进行TBNA。观察比较两组在阳性率、不良反应等方面的差别。结果 总阳性率传统TBNA为36.4％( 12/33)，RPEBUS-TBNA为71.9％( 23/32)，P=0.004。一组（隆突下淋巴结），传统TBNA阳性率为72.7％ (8/11),RPEBUS-TBNA组为76.9( 10/13)，但两者差异没有统计学意义（P= 0.813）。在二组（非隆突下淋巴结），传统TBNA阳性率为33.3％( 4/14)，RPEBUS-TBNA组为76.5％( 13/17)，P=0.007。并发症包括少量出血、咳嗽、一过性低氧血症，均为自限性。结论 RPEBUS-TBNA可以较传统TBNA提高诊断效率，尤其在非隆突下淋巴结，而且微创、性价比高、安全可行。