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。

Application value of transbronchial needle aspiration in the diagnosis with pulmonary disease and mediastinal lymphadenopathy

Objective To evaluate the role and safety of transbronchial needle aspiration （TBNA） in the diagnosis of patients with and mediastinal hilar lymphadenopathy. Methods Patients with mediastinal and enlarged hilar lym- phoadenopathy proven by CT scan were eligible for TBNA as reported.The positive rate and complication were ob- served. Results Eighty-four patients were examined, including 57 lung cancers, 13 sareoidosis of 84 patients, 3 pul- monary tuberculosis, 1 malignant lymphoma and 10 cases without definite diagnosis. Total 136 lymph nodes were punctured, positive rate of TBNA was 82.14%（69/84）. The positive rate of TBNA plus bronchial mucosal biopsies or bronchoalveolar lavage （88.1%） was higher than TBNA alone（82.1%）, but with no significant difference （P〉O.05）. The positive rate of TBNA was correlated with lymph node size （P〈0.05）. Bleeding in the puncture site was one of the com- mon complications of TBNA. The others were small amount of bleeding, with no other complications. Conclution TBNA plays a remarkable role in diagnosis of patients with mediastinal and hilar lymphadenopathy, and in diagnosis and staging of lung cancer. It is also helpful in diagnosis of benign lung disease with high safety, easy operation and low cost, which is worthy of clinical application.