本文選題：超聲支氣管鏡引導針吸活檢術　切入點：縱隔淋巴結腫大　出處：《廣西醫(yī)科大學》2015年碩士論文

【摘要】：目的評價超聲支氣管鏡引導針吸活檢術(endobronchial ultrasound guided transbronchial needle aspiration, EBUS — TBNA)對不明原因縱隔淋巴結腫大性疾病的診斷價值和安全性。方法回顧性分析2013年5月至2014年6月期間在廣西醫(yī)科大學附屬腫瘤醫(yī)院行EBUS-TBNA檢查的30例縱隔淋巴結腫大病人,穿刺物送病理學檢查。以病理學結果為金標準,研究EBUS-TBNA在縱隔淋巴結腫大性疾病中的診斷價值；對比EBUS-TBNA和CT這兩種方法在診斷縱隔惡性病變中的差異。結果30例病人中男20例,女10例,年齡28-82歲,中位年齡55歲,臨床最終確診病例28例,未能明確診斷2例,其中惡性病變27例,良性病變1例。經(jīng)EBUS-TBNA診斷24例,其中原發(fā)性肺癌19例,轉(zhuǎn)移性肺癌1例,縱隔惡性腫瘤3例,肺部炎癥1例,4例為假陰性,EBUS-TBNA診斷疾病的敏感度及陰性預測值分別為85.7%、33.6%;EBUS-TBNA診斷惡性疾病的敏感度和陰性預測值分別為85.1%和20%,與CT診斷惡性疾病(敏感度81.4、陰性預測值16.7%)相比較,兩者進行X2檢驗,P0.05,顯示兩者之間無統(tǒng)計學差異。而EBUS-TBNA在診斷原發(fā)性肺癌中敏感度為95%,特異度為100%,陽性預測值為100%,陰性預測值為88.9%。3例來源和病理類型不明的惡性腫瘤中,結合免疫組織化學結果最后確診2例為原發(fā)性肺腺癌,1例為轉(zhuǎn)移性肺癌。所有行EBUS-TBNA檢查的患者均未出現(xiàn)嚴重的并發(fā)癥。結論EBUS-TBNA作為一種微創(chuàng)、安全的檢查方法,它在診斷不明原因縱隔淋巴結腫大性疾病方面有著較高的診斷價值,對于惡性疾病來說,EBUS-TBNA檢查略優(yōu)于CT檢查。而對于診斷原發(fā)性肺癌,EBUS-TBNA有著很高的診斷價值,結合免疫組織化學檢查有助于明確惡性病變的來源及病理類型。
[Abstract]:Objective to evaluate the diagnostic value and safety of endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA) for unknown mediastinal lymphadenopathy. Thirty patients with mediastinal lymphadenopathy underwent EBUS-TBNA examination in the Cancer Hospital affiliated to Guangxi Medical University. The diagnostic value of EBUS-TBNA in mediastinal lymphadenopathy was studied, and the difference between EBUS-TBNA and CT in the diagnosis of mediastinal malignant lesions was compared. There were 10 female patients, aged 28-82 years, with a median age of 55 years. 28 cases were diagnosed by clinical final diagnosis, 2 cases were not clearly diagnosed, including 27 cases of malignant lesions and 1 case of benign lesions. 24 cases were diagnosed by EBUS-TBNA, including 19 cases of primary lung cancer and 1 case of metastatic lung cancer. 3 cases of mediastinal malignant tumor, The sensitivity and negative predictive value of EBUS-TBNA for diagnosis of malignant diseases were 85.75.73.6and 85.1% and 20.1%, respectively, compared with those for CT diagnosis of malignant diseases (sensitivity 81.4, negative predictive value 16.7B). The X2 test showed that there was no statistical difference between the two. However, the sensitivity, specificity, positive predictive value, negative predictive value and negative predictive value of EBUS-TBNA in the diagnosis of primary lung cancer were 95, 100, 100 and 88.9.3, respectively. Combined with immunohistochemical results, 2 cases of primary lung adenocarcinoma and 1 case of metastatic lung cancer were confirmed. There were no serious complications in all patients undergoing EBUS-TBNA examination. Conclusion EBUS-TBNA is a minimally invasive and safe method. It has a high diagnostic value in diagnosing mediastinal lymphadenopathy with unknown causes, and is slightly superior to CT in the diagnosis of malignant diseases, but it has a high diagnostic value in the diagnosis of primary lung cancer. Combined with immunohistochemical examination, it is helpful to identify the origin and pathological type of malignant lesions.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R734

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本文編號：1682485