气管镜下二氧化碳冷冻活组织检查及消融治疗非小细胞肺癌所致阻塞性肺不张的疗效

目的观察气管镜下二氧化碳冷冻活组织检查(活检)的优势及二氧化碳冷冻消融治疗非小细胞肺癌(NSCLC)所致阻塞性肺不张的有效性和安全性。方法选择2017年6月-2019年6月石家庄市第一医院肿瘤科收治的非小细胞肺癌所致阻塞性肺不张患者77例作为研究对象,比较气管镜下普通活检组(n=35)与二氧化碳冷冻活检(冷冻活检组,n=42)检测NSCLC的成功率、安全性,观察气管镜下二氧化碳冷冻消融治疗的疗效,比较治疗前后气促评分、体质评分、KPS自由评分的差异。结果普通活检组病理诊断阳性率77.14%(27/35),冷冻活检组病理诊断阳性率97.62%(41/42),2组病理诊断阳性率比较差异有统计学意义(χ~2=7.755,P=0.005)。二氧化碳冷冻消融38例,患者气道内肿瘤清除及肺复张治疗有效率均为94.74%(36/38);其中应用喉罩下二氧化碳冷冻消融32例,耐受性良好,无明显不适主诉;硬质气管镜下二氧化碳冷冻消融6例,术后仅有轻微咽喉疼痛不适。二氧化碳冷冻消融治疗前后气促评分、体质评分和KPS自由评分比较差异均有统计学意义(P<0.05)。结论气管镜下二氧化碳冷冻活检成功率高,操作简单、安全;气管镜下二氧化碳冷冻消融能够使肿瘤快速、有效清除,对所致阻塞性肺不张能有效地复张。     

两术合用以提高肺癌诊断价值

目的:为进一步提高标本的阳性率,提高对肺癌的阳性诊断率。方法:对102例临床和放射学检查后需做纤维支气管镜的患者,留取针吸液及刷片两种标本共同进行细胞学诊断。结果:通过细胞学明确诊断为肺癌59例,总阳性率58%,针吸阳性率39.2%,刷片阳性率44.1%。结论:纤维支气管刷片与细针吸取合同并用增加了查出肺癌的阳性诊断率。     

经支气管针吸活检对支气管狭窄型肺癌的诊断价值

目的　探讨经支气管针吸活检 (TBNA)对支气管狭窄型肺癌的诊断价值。方法　纤维支气管镜检查中先用Olympus-N1 2C或Mill-RoseMW - 12 2型穿刺针对狭窄部位穿刺 ,然后钳夹活检和 或刷检 ,部分病例开胸手术和临床治疗观察 ,共确诊 117例肺癌 ,对其资料整理分析。结果　对肺癌的诊断率TBNA为 76 %,刷检为 6 0 %,两者间差别有非常显著性意义 (P <0 0 0 5 )。结论　TBNA加刷检佐以可行的钳夹活检及纤维支气管镜查痰是诊断支气管狭窄型肺癌的好方法。     

经支气管针吸术在肺癌诊断中应用的临床分析

目的：分析经支气管针吸术在支气管腔外病变或伴有纵隔淋巴结肿大的肺癌诊断中的价值。方法回顾性总结分析60例对支气管腔外病变或纵隔淋巴结肿大的拟诊肺癌患者行TBNA检查的临床资料。结果60例患者中TBNA检查确诊肺癌的有41例,阳性率68．33％（41/60）,常规活检、刷检的阳性率分别为13．33％（8/60）、8．33％（5/60）。TBNA诊断阳性率分别高于常规活检、刷检,差异有统计学意义（P＜0．05）。结论对于支气管腔外病变或纵隔淋巴结肿大的肺癌患者,TBNA是一种安全和有效的诊断方法,具有重要的临床应用价值。     

经支气管镜肺活检45例分析

目的探讨经支气管镜肺活检（TBLB）的操作体会和对弥散性肺部疾病的诊断价值。方法45例弥散性肺疾病患者行TBLB,对临床资料及病理诊断结果进行回顾分析。结果45例弥散性肺疾病中有42例成功取得肺组织标本,24例明确诊断,确诊率达57．1％．患者耐受性良好,术后发生气胸2例（4．8％）。结论支气管镜肺活检对弥散性肺疾病的诊断是一种可靠、安全、简便、经济的方法,熟练的操作技术和默契的医护配合是提高成功率的关键。     

气道内超声定位下经支气管针吸术对肺癌的诊断价值

目的:探讨气道内超声定位下经支气管针吸术(TBNA)在肺癌诊断中的应用价值。方法:对33例支气管镜检查呈外压性隆起,和/或有纵隔或肺门淋巴结转移的可疑肺癌患者行气道内超声检查,在超声定位下行TB-NA。术前常规支气管镜均未能确诊,且不能通过经皮肺穿刺获取病变组织。结果:33例患者中,1例支气管镜示外压性隆起,超声显示为血管,未行穿刺,32例行TBNA,诊断肺癌敏感性、特异性和准确性分别为96.3%、100%和96.9%,其中诊断肺癌26例(81.3%)、淋巴结结核3例(9.4%)、结节病1例(3.1%)、2例未能明确诊断(1例外科手术后病检证实为结核)。全部患者未出现任何与穿刺相关严重并发症。结论:气道内超声是一项安全、有效的新型内镜检查辅助工具,它能帮助定位支气管腔外病灶和纵隔、肺门淋巴结,引导TBNA,为肺癌诊断和分期提供了一种新的方法,具有微创、准确、安全的特点。     

支气管镜对周围型肺癌的诊断价值

目的比较不同检查方法对周围型肺癌的诊断价值及安全性。方法对40例周围型肺癌的患者同时行支气管镜下盲目毛刷（BB）、经支气管镜肺活检（TBLB）及经支气管镜支气管肺泡灌洗（BAL）,获取标本后行细胞学或组织学检查。结果BB的阳性率为25．0％（10／40）,TBLB的阳性率为45．0％（18／40）,BAL的阳性率为42．5％（17／40）,BB＋TBLB的阳性率为65．0％（26／40）,三者联合的阳性率为80．0％（32／40）。结论联合多种方法能提高周围型肺癌的诊断率,严重并发症少见。     

气管镜针吸活检联合刷检在诊断纵隔、肺部肿瘤中的作用

目的 探讨经气管镜行纵隔淋巴结及肺部肿瘤针吸活检联合刷检的诊断作用.方法 对经CT检查的67例纵隔淋巴结肿大和(或)叶、段支气管腔外占位的患者通过经气管镜行针吸活检和刷检并与传统的常规钳取活检对照.结果 针吸阳性诊断率为74.63%,针吸联合刷检阳性诊断率82.09%;常规钳取阳性诊断率17.91%.单纯针吸和针吸联合刷检诊断率均高于常规活检(P＜0.01).结论 经气管镜针吸活检术是一种简便、安全、阳性率高的检查技术.     

液基细胞学在经支气管镜针吸细胞学诊断肺癌中的价值

目的探讨液基细胞学技术（thin prep cytology test,TCT）在中央型肺癌针吸细胞学诊断中的价值。方法分析127例中央型肺癌患者的经支气管针吸活检（transbronchial needle aspiration,TBNA）标本,随机将患者分为常规涂片（conventional smear,CS）组及CS联合TCT组,其中CS组62例,CS＋TCT组65例。比较两组方法的敏感性及特异性。结果 CS组的敏感性为75.9%,特异性为100.0%;CS＋TCT组的敏感性为96.2%,特异性为100.0%。与CS组相比,CS＋TCT组的敏感性明显高于CS组（P=0.000046〈0.01）。结论联合使用CS＋TCT能提高中央型肺癌针吸细胞学的敏感性,TBNA的TCT检测法可推广应用于临床。     

隐源性机化性肺炎1例并文献复习

目的提高对隐源性机化性肺炎的认识.方法 分析我院2009年5月收治的1例隐源性机化性肺炎(COP)的临床、影像和病理资料及治疗方法,并复习相关文献.结果 COP临床表现、影像学均缺乏特异性,病理有相对特异性改变,COP经支气管肺活检(TBLB)可明确诊断.结论 TBLB可获得满意的肺组织标本,可作为获取标本的首选方式....     

经支气管镜针吸活检术在肺部及纵隔疾病诊断中的价值

目的探讨经支气管镜针吸活检术（TBNA）对纵隔及肺门肿大淋巴结的诊断价值,评估其安全性。方法选择胸部CT检查发现纵隔、肺门淋巴结肿大、估计气管镜检查不能发现气道内新生物的患者,采用TBNA技术进行检查,观察其诊断的阳性率及并发症。结果 84例患者中57例诊断为肺癌,13例诊断为结节病,3例诊断为肺结核,1例诊断为恶性淋巴瘤,10例最终无明确诊断。84例患者共穿刺136组淋巴结,其中TBNA阳性结果69例（82.14%）。TBNA联合黏膜活检及肺泡灌洗等方法的阳性率（88.1%）高于单行TBNA（82.1%）,但差异无统计学意义（P=0.252）。TBNA阳性率与淋巴结大小相关（P〈0.05）。有1例患者穿刺中出现大出血,其余均为少量出血,无其他并发症。结论 TBNA对纵隔、肺门淋巴结肿大的诊断具有重要的应用价值,对肺癌的诊断和分期有很大的帮助,对肺部良性病变的诊断亦有一定价值,其安全性高,操作简单,费用低,值得临床推广应用。     

导向鞘引导超声支气管镜肺活检术在外周肺结节诊断中的临床应用

目的 探讨导向鞘引导的超声支气管镜检查技术在诊断外周肺结节中的临床应用及安全性。方法 回顾性分析2018年1月至2019年9月在空军军医大学唐都医院呼吸与危重症医学科气管镜室接受导向鞘引导超声支气管镜肺活检术(endobronchial ultrasonography with a guide sheath transbronchial lung biopsy,EBUS-GS-TBLB)检查的患者67例,研究EBUS-GS-TBLB对外周肺结节病理活检诊断阳性率及其影响因素。结果 EBUS-GS-TBLB对外周肺结节的总诊断率为70.15%,其中病灶支气管征阳性患者的诊断率为80.49%,明显高于支气管征阴性患者,差异有统计学意义(χ²=5.393,P＜0.05);病灶大小、位置、与胸膜的距离及病灶类型对EBUS-GS-TBLB病理活检诊断率的影响均无显著统计学差异。结论 与常规支气管镜检查相比,EBUS-GS-TBLB在提高活检诊断阳性率、降低活检风险方面具有明显优势,值得在临床推广应用,且EBUS-GS-TBLB活检阳性率在支气管征阳性患者中表现出显著优势,从而有利于从优选择肺外周结节病理活检方法,以达到提高肺癌早期诊断率的目的。     

Endobronchial ultrasound-guided transbronchial needle aspiration of undiagnosed mediastinal lymphadenopathy

Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） can sample the enlarged mediastinal lymph nodes which are unreachable by conventional bronchoscopy.It is a relatively simple and safe method to see beyond the bronchial tree.We describe and discuss its initial application and our experience.Methods From July 2009 to December 2009, 52 patients with undiagnosed enlarged mediastinal lymph nodes were accessed with EBUS-TBNA in the People＇s Liberation Army General Hospital.Conventional bronchoscopy was performed before EBUS-TBNA, and patients with endobronchial lesions were excluded from this study.Smears fixed in 95% alcohol and histological specimens fixed in formalin were sent to Department of Pathology.Results EBUS-TBNA was diagnostic in 33 （63%） patients, with diagnosis of lung cancer in 23 patients （14 patients of small cell lung cancer, eight patients with adenocarcinoma, and one patient of squamous carcinoma）.Four patients, who had negative EBUS-TBNA results, were later diagnosed with malignancy at thoracotomy.One patient with negative EBUS-TBNA results died of cancer cachexia.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of neoplastic disease were 85%, 100%, 100%, and 50% respectively.Among the 16sarcoidosis patients, who were diagnosed by a combination of the clinical and radiological information as well as pathological results obtained by EBUS-TBNA, nine of them had granulomas and benign lymphoid cells detected by EBUS-TBNA.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of sarcoidosis were 56%, 100%, 100%, and 13%, respectively.Five patients with no definite diagnosis from EBUS-TNBA examination are under close follow-up.Conclusions EBUS-TBNA can provide a safe and effective method to sample mediastinal leisions suspected of malignancy.It also adds pathological information needed to make the diagnosis of sarcoidosis.     

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

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.     

纤维支气管镜肺活检及刷检对肺癌诊断的价值

目的探讨纤维支气管镜肺活检及刷检对肺癌诊断的价值。方法对153例经病理组织学及细胞学确诊为肺癌的纤维支气管镜检查结果进行统计分析,了解纤维支气管镜肺活检和刷检两种不同病理检查方法对肺癌诊断的阳性率。结果肺活检、刷检阳性率分别为81%和72.5%,两者联合检查的阳性率为89.5%,联合检查阳性率明显高于单一检查（P〈0.05）。结论联合应用纤维支气管镜活检及刷检细胞学检查可以提高肺癌的检出率和诊断的准确性。     

CT引导下经皮肺穿刺活检术在周围型肺癌诊断中的临床价值

目的 探讨评价CT引导下经皮肺穿刺活检术在周围型肺癌诊断中的临床价值.方法 对38例疑似周围型肺癌患者行CT引导下经皮肺穿刺活检,对照组32例行经支气管镜肺活检,对两组穿刺活检确诊率和并发症发生率进行比较.结果 CT引导下经皮肺穿刺活检及经支气管镜肺活检的确诊率分别为89.47%及46.88%,两者比较差异有统计学意义（P〈0.05）,CT引导下经皮肺穿刺活检及经支气管镜肺活检的并发症的发生率分别为18.42%及15.62%,差异无统计学意义（P〉0.05）.结论 CT引导下经皮肺穿刺活检术对周围型肺癌诊断准确率高,并发症少.     

Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lesions

Background  Mediastinal lesions are often difficult to diagnose in clinical practice because of the unique anatomical position of the mediastinum, which makes performance of biopsy difficult. The value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer and mediastinal lymph node staging has been widely accepted. However, few studies have been conducted on the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of mediastinal lesions. The current study was conducted to investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of isolated mediastinal lesions without lung abnormalities.

Methods  We retrospectively analyzed the data of patients with isolated mediastinal lesions without lung abnormalities for whom endobronchial ultrasound-guided transbronchial needle aspiration examination was performed at the Department of Thoracic Surgery of Peking University People’s Hospital, between September 2009 and December 2010. For patients who could not be diagnosed with endobronchial ultrasound-guided transbronchial needle aspiration, surgical biopsy or more than 6 months of clinical and imaging follow-up was carried out. 

Results  Endobronchial ultrasound-guided transbronchial needle aspiration was performed for 60 patients with isolated mediastinal lesions. Correct diagnosis was made in 48 cases. Nineteen cases were malignant, and 29 were benign. The rate of correct diagnosis was 80%. The sensitivity, specificity, and accuracy of endobronchial ultrasound-guided transbronchial needle aspiration in distinguishing benign from malignant mediastinal lesions were 95%, 100%, and 98%, respectively. The examination was tolerable for all patients. No associated complications were observed. 

Conclusion  Endobronchial ultrasound-guided transbronchial needle aspiration is a safe and effective method of diagnosing mediastinal lesions.

     

不同麻醉通气方式对经支气管冷冻肺活检患者影响的前瞻性随机对照研究

目的 探讨全身静脉麻醉气管插管接常频通气和插入硬质支气管镜接高频通气下对经支气管冷冻肺活检(TBCB)患者的影响.方法 采用前瞻性随机对照研究,对2018年8月至2019年2月在广州医科大学附属第一医院行TBCB的间质性肺疾病(ILD)患者进行研究,根据麻醉插管通气方式的不同随机分成气管插管接常频通气(TI-CV)组和...     

经支气管镜肺活检在特发性间质性肺炎中的诊断价值

目的评价经支气管镜肺活检（TBLB）病理在特发性间质性肺炎（IIP）诊断及预后评价中的作用。方法回顾性分析2005年1月至2009年4月在北京大学第一医院住院治疗的29例IIP患者的相关临床资料,联合病理科医师对相应的TBLB标本病理进行重新判读和分析并做出病理诊断,重新阅读患者的胸部HRCT,并对患者进行随访。分析影响TBLB诊断价值的因素,观察TBLB病理表现与预后的关系。结果在29例IIP患者中,男21例,女8例;年龄43～79岁,平均（63±10）岁。获取具有诊断价值TBLB标本16例,肺组织块2～7块,平均（4.2±1.8）块;不具有诊断价值13例,肺组织块0～5块,平均（2.1±1.6）块,与有诊断价值标本的肺组织块数量差异有统计学意义（P〈0.005）。具有诊断价值标本中,TBLB表现为非特异性间质性肺炎（NSIP）9例、寻常性间质性肺炎（UIP）6例、机化性肺炎（OP）1例。29例患者中,HRCT表现为UIP样改变14例,获取具有诊断价值TBLB标本5例（35.7%）;HRCT表现为non-UIP样改变15例,获取具有诊断价值TBLB标本11例（73.3%）。16例随访结果显示,TBLB表现为UIP 6例,死亡5例,加重1例;NSIP 9例,缓解8例,死亡1例;OP 1例,症状缓解。TBLB表现为non-UIP组生存时间明显长于UIP组（P〈0.005）。结论TBLB的诊断价值与获取肺组织块数量及HRCT表现密切相关。肺组织块数量≥3块时,TBLB具有较高的诊断价值。与HRCT表现UIP者相比,表现为non-UIP者更易获得有诊断价值的TBLB标本。TBLB表现为non-UIP改变者预后好于UIP。TBLB有助于IIP的诊断及预后评价。     

Transbronchial lung biopsy in the compromised host

Thirty-eight immunocompromised patients underwent transbronchial lung biopsy via the fiberoptic bronchoscope as part of a diagnostic evaluation for fever and roentgenographic evidence of a new pulmonary infiltrate. Diagnostic information was obtained from lung biopsy in 29 patients (76%), with infection accounting for ten cases and a nonspecific interstitial pneumonitis in 13 patients. Concomitant bronchial brushings were diagnostic in only three patients (all with infections). Diffuse roentgenographic infiltrates were expecially amenable to bronchoscopic lung biopsy diagnosis (84%), while in localized infiltrates, there was only a 43% diagnostic yield. Although thrombocytopenia and hypoxemia were common in these patients, morbidty was low (four patients had pneumothoraces with no noteworthy bleeding) and there were no deaths resulting from this procedure. Prebiopsy platelet transfusions were used in five patients with severe thrombocytopenia (platelet cound, less than 50,000/cu mm). The diagnostic efficiency and low morbidity associated with transbronchial lung biopsy indicate that this procedure can safely play a role in the evaluation of pneumonia in the compromised host.