本文選題：支氣管鏡 + TBNA　； 參考：《河南大學(xué)》2014年碩士論文

【摘要】：研究背景:傳統(tǒng)的支氣管鏡檢查在氣管支氣管的病變中發(fā)揮著重要的作用，由于傳統(tǒng)氣管鏡檢查范圍的局限性，對(duì)單純縱隔淋巴結(jié)腫大或縱隔淋巴結(jié)腫大合并肺內(nèi)占位經(jīng)傳統(tǒng)支氣管鏡檢查手段管腔內(nèi)未見(jiàn)明確病變患者的明確診斷中存在很大困難，無(wú)創(chuàng)檢查如增強(qiáng)CT或PET-CT可以提供傾向性診斷，不能提供病理學(xué)診斷依據(jù)，對(duì)最終治療決策的幫助很有限，而且由于縱隔鏡、胸腔鏡及開(kāi)胸肺活檢創(chuàng)傷大、費(fèi)用高，在臨床使用中受到很大的限制。經(jīng)支氣管針吸活檢術(shù)(transbronchial needle aspiration,TBNA)就是應(yīng)用特制的穿刺針，經(jīng)纖維支氣管鏡活檢通道進(jìn)入氣管內(nèi)，然后穿透支氣管壁對(duì)腔外病變組織部分，比如腫塊、淋巴結(jié)、炎癥等進(jìn)行穿刺抽吸獲得細(xì)胞學(xué)或組織學(xué)標(biāo)本的技術(shù)，這項(xiàng)檢查技術(shù)極大的減少了患者的痛苦，并降低了手術(shù)風(fēng)險(xiǎn)，在診斷縱隔及支氣管腔外病變方面是一種非常簡(jiǎn)單有效的方法。 研究目的:探討支氣管鏡針吸活檢術(shù)（TBNA）與傳統(tǒng)支氣管鏡檢查方法相比在縱隔及支氣管腔外病變組織中的診斷價(jià)值。 研究方法:本文選擇自2010年09月到2013年10月期間，由于胸部CT掃描發(fā)現(xiàn)縱隔淋巴結(jié)增大和/或肺內(nèi)腫塊、結(jié)節(jié)，或因阻塞性肺炎等導(dǎo)致的肺不張，然后就診于河南大學(xué)淮河醫(yī)院呼吸內(nèi)科，在常規(guī)支氣管檢查管腔內(nèi)未見(jiàn)明顯新生物或僅見(jiàn)外壓性狹窄、局部粘膜充血水腫的患者，患者共87名。對(duì)其進(jìn)行TBNA檢查,TBNA檢查后,每名患者均于病變部位行刷檢、活檢、灌洗，然后將患者進(jìn)行TBNA檢查、刷檢及活檢、灌洗的陽(yáng)性率進(jìn)行系統(tǒng)的統(tǒng)計(jì)學(xué)分析,從而研究分析經(jīng)支氣管針吸活檢技術(shù)在縱隔病變及支氣管腔外病變中的診斷意義。87例病例中男性患者57例,女性患者30例,年齡19-80歲，根據(jù)胸部320增強(qiáng)CT,按照WANG氏TBNA穿刺法確定穿刺部位。使用的電子支氣管鏡為OLYMPUS BF一1T60， MW-319型WANG氏TBNA組織學(xué)穿刺針。 檢查前患者要簽署氣管鏡檢查知情同意書(shū)，，局部麻醉后,將電子支氣管鏡經(jīng)鼻腔插入氣管內(nèi)，按氣管、支氣管樹(shù)順序檢查氣管管腔，觀(guān)察管腔內(nèi)有無(wú)明顯新生物，將氣管鏡插入檢查位置確定穿刺部位,將WANG氏針經(jīng)支氣管鏡活檢孔（FOB）送入，直視下盡可能垂直于支氣管壁方向刺入病變，確定刺入病變組織后，在維持負(fù)壓的情況下抽取標(biāo)本。抽吸完畢后，用30ml注射器將穿刺吸取物用力推出，涂于干凈的載玻片上，然后風(fēng)干、固定，如果取到組織塊，則將組織塊放入10%的福爾馬林中送病理科檢查并對(duì)取材充分的標(biāo)本進(jìn)行免疫組化。TBNA抽吸結(jié)束后，每名患者均于病變部位行常規(guī)刷檢、活檢、灌洗檢查。 結(jié)果：1.常規(guī)支氣管鏡檢查結(jié)果：管腔無(wú)狹窄及粘膜未見(jiàn)明顯異常的有25例，管腔呈不同程度的狹窄有39例，患者局部粘膜可見(jiàn)充血水腫的有23例。2.不同取材方法診斷結(jié)果：2.1TBNA穿刺結(jié)果：87例患者，TBNA共對(duì)160個(gè)病變部位進(jìn)行穿刺，結(jié)果有76名患者取得了陽(yáng)性診斷，76例陽(yáng)性診斷中惡性腫瘤有69例（79.3%），良性病變共有7例（9.2%）。2.2活檢結(jié)果：87例患者中，10例獲得陽(yáng)性診斷結(jié)果，其中小細(xì)胞肺癌3例，腺癌5例，鱗癌1例，結(jié)核病1例，余77例均為正常支氣管粘膜組織。2.3刷檢結(jié)果：87例患者中，13例獲得陽(yáng)性診斷結(jié)果，其中小細(xì)胞肺癌5例，腺癌3例，鱗癌2例，非特異性炎癥2例，肺結(jié)核1例。2.4灌洗結(jié)果：87例患者中，8例獲得陽(yáng)性診斷結(jié)果，其中腺癌5例，小細(xì)胞肺癌2例，鱗癌1例。3.不同取材方法在不同病變類(lèi)型中的診斷結(jié)果：3.1在縱隔淋巴結(jié)腫大合并粘膜水腫病變中：TBNA獲得陽(yáng)性診斷21例，活檢獲得陽(yáng)性診斷6例，刷檢獲得陽(yáng)性診斷7例，灌洗獲得陽(yáng)性診斷3例，其中有5例TBNA為其唯一診斷陽(yáng)性檢查方法。3.2在縱隔淋巴結(jié)腫大合并管腔狹窄病變中：TBNA獲得陽(yáng)性診斷33例，活檢獲得陽(yáng)性診斷3例，刷檢獲得陽(yáng)性診斷5例，灌洗獲得陽(yáng)性診斷4例，其中有21例TBNA為其唯一診斷陽(yáng)性檢查方法。3.3在單純縱隔淋巴結(jié)腫大病變中：TBNA獲得陽(yáng)性診斷22例，活檢獲得陽(yáng)性診斷1例，刷檢獲得陽(yáng)性診斷1例，灌洗獲得陽(yáng)性診斷1例，其中有,21例TBNA為其唯一診斷陽(yáng)性檢查方法。4. TBNA細(xì)胞學(xué)與組織學(xué)對(duì)肺癌的診斷：經(jīng)組織活檢和術(shù)后病理證實(shí)的肺癌患者共78例，TBNA細(xì)胞學(xué)獲得了明確肺癌診斷的患者有66例。5.TBNA免疫組化結(jié)果：CD56、P63、TTF-1、Syn4種抗體在不同肺癌類(lèi)型中的陽(yáng)性率明顯不同。6.并發(fā)癥：5例患者出現(xiàn)少量出血，未行特殊處理，3例患者出現(xiàn)穿刺部位大量出血，給予腎上腺素稀釋液支氣管腔內(nèi)注入后出血停止，未見(jiàn)感染、縱隔氣腫等并發(fā)癥發(fā)生。7.結(jié)論及意義：TBNA是一項(xiàng)操作簡(jiǎn)單的內(nèi)鏡檢查技術(shù)，對(duì)肺部疾病檢出率高，并發(fā)癥較少，尤其是在診斷縱隔及支氣管腔外病變中有著舉足輕重的作用，顯著提高了診斷陽(yáng)性率，可常規(guī)應(yīng)用于支氣管鏡檢查中。
[Abstract]:Background: traditional bronchoscopy plays an important role in the tracheobronchial lesions. Due to the limitations of the scope of traditional bronchoscopy, the diagnosis of patients with simple mediastinal lymph node enlargement or mediastinal lymph node enlargement and intrapulmonary occupying is not clearly diagnosed by conventional bronchoscopy. Noninvasive tests, such as enhanced CT or PET-CT, can provide a tendency diagnosis, fail to provide the basis for pathological diagnosis, and have limited help for final treatment decisions, and because of the large trauma, high cost and high cost in the clinical use of mediastinoscopy, thoracoscopy and thoracotomy (transbron). Chial needle aspiration, TBNA) is the technique of applying a special puncture needle through a bronchoscopic biopsy channel into the trachea and then penetrating the wall of the bronchus to obtain cytological or histologic markers, such as lumps, lymph nodes, and inflammation, which greatly reduces the patient's technique. Pain and reduced operative risk are a very simple and effective way to diagnose mediastinum and extra bronchial lesions.
Objective: To evaluate the diagnostic value of bronchoscopy needle aspiration (TBNA) in mediastinum and extra bronchial lesions compared with conventional bronchoscopy.
Study methods: from 09 months of 2010 to October 2013, we found the enlargement of the mediastinal lymph nodes and / or the enlargement of the mediastinal lymph nodes and / or the pulmonary masses, nodules, or obstructive pneumonia caused by pulmonary atelectasis from 09 months of 2010 to October 2013. A total of 87 patients with pressure stenosis and local mucosal congestion and edema were examined by TBNA. After TBNA examination, each patient was examined, biopsy, and lavage at the lesion site, then the patient was examined by TBNA, brush examination and biopsy, and the positive rate of lavage was analyzed systematically, so as to study and analyze the bronchial needle aspiration biopsy technique. In the diagnostic significance of mediastinal lesions and Extrabronchial lesions, 57 cases were male patients, 30 cases of female patients, age 19-80 years old. The puncture site was determined according to the 320 enhancement of CT in the chest. The electronic bronchoscope was OLYMPUS BF 1T60, MW-319 type WANG TBNA tissue puncture needle was used in.87 cases.
Before the examination, the patient should sign the informed consent of the trachea. After the local anesthesia, the electronic bronchoscope was inserted into the trachea through the nasal cavity. The trachea was checked by the trachea and the bronchus tree in order to observe the tracheal lumen. The trachea was inserted into the location to determine the puncture site, and the WANG's needle was sent through the bronchoscope biopsy hole (FOB). When the lesion was inserted into the bronchial wall as far as possible, the specimen was selected after the lesion was inserted into the lesion. After the suction was maintained, a 30ml syringe was used to force the puncture to be pushed out, smeared on the clean slides, and then dry, fixed, if the fruit was taken to the tissue block, and then put the tissue into 10% formalin. After the pathological examination was sent to the pathological section and the samples were immunized for.TBNA aspiration, each patient was examined by routine brush examination, biopsy, and lavage.
Results: 1. the results of routine bronchoscopy showed that there were 25 cases with no stenosis and no obvious abnormalities in the mucosa, 39 cases were narrowed in different degrees, and 23 cases of.2. were found in the partial mucous membrane of the patients. The results of 2.1TBNA puncture: 87 cases, TBNA were punctured in 160 lesions. There were 76 patients with positive diagnosis, 69 cases (79.3%) in 76 cases of positive diagnosis and 7 cases of benign lesions (9.2%).2.2 biopsy results: among 87 patients, 10 cases received positive diagnosis, including 3 cases of small cell lung cancer, 5 cases of adenocarcinoma, 1 cases of squamous cell carcinoma, 1 cases of tuberculosis, and the remaining 77 cases were the results of normal bronchial mucosa tissue.2.3 brush examination results. Of the 87 cases, 13 cases were diagnosed as positive, including 5 cases of small cell lung cancer, 3 cases of adenocarcinoma, 2 cases of squamous cell carcinoma, 2 cases of nonspecific inflammation and 1 cases of.2.4 lavage in pulmonary tuberculosis: 8 cases were found in 87 cases, 5 cases of adenocarcinoma, 2 cases of small cell lung cancer, and 5 cases of squamous cell carcinoma in different types of diagnosis of.3.. Fruit: 3.1 in mediastinal lymph node enlargement and mucous membrane edema: TBNA positive diagnosis 21 cases, biopsy positive diagnosis 6 cases, brush examination positive diagnosis 7 cases, lavage positive diagnosis 3 cases, of which 5 cases TBNA is the only diagnostic positive method.3.2 in mediastinal lymphadenopathy combined with lumen stenosis: TBNA obtained Positive diagnosis of 33 cases, positive diagnosis of 3 cases, 5 cases of positive diagnosis by brush examination and 4 cases of positive diagnosis, 21 cases of TBNA are the only positive diagnosis of.3.3 in simple mediastinal lymph node enlargement: 22 cases of positive diagnosis of TBNA, 1 cases with positive diagnosis of biopsy, 1 cases of positive diagnosis by brush examination, lavage. 1 cases of positive diagnosis were obtained, of which 21 cases of TBNA were the only diagnosis of.4. TBNA cytology and histology for the diagnosis of lung cancer: 78 cases of lung cancer confirmed by biopsy and postoperative pathology, and 66 cases of.5.TBNA immunization with CD56, P63, TTF-1, Syn4 kinds of anti lung cancer patients. The positive rate of the body in different types of lung cancer was distinctly different from.6. complications: 5 cases had a small amount of bleeding, no special treatment, 3 cases had massive hemorrhage in the puncture site, the bleeding stopped after the injection of adrenaline diluent, no infection, and the complications of mediastinal emphysema, such as.7. conclusion and significance: TBNA was an exercise. Simple endoscopic examination has a significant effect on the detection of pulmonary diseases and less complications, especially in the diagnosis of mediastinal and Extrabronchial lesions, which significantly improves the positive rate of diagnosis and can be routinely applied to bronchoscopy.
【學(xué)位授予單位】：河南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R562

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