本文選題：支氣管鏡檢查 + 超聲檢查�。� 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討超聲內(nèi)鏡引導(dǎo)下經(jīng)支氣管針吸活檢術(shù)(EBUS-TBNA)在縱膈及肺門占位性病變中的應(yīng)用、診斷價值及安全性。方法:回顧性分析重慶醫(yī)科大學(xué)附屬二院呼吸科2014年10月至2016年9月,胸部CT檢查示縱膈、肺門淋巴結(jié)腫大和(或)胸腔內(nèi)腫物并行EBUS-TBNA檢查的246例患者臨床資料,對所有行EBUSTBNA檢查患者的細(xì)胞學(xué)和(或)病理學(xué)檢查結(jié)果、診斷陽性率及并發(fā)癥發(fā)生情況進行統(tǒng)計分析。結(jié)果:246例患者EBUS-TBNA后標(biāo)本病理結(jié)果:診斷為惡性腫瘤130例,良性疾病72例,可疑惡性腫瘤26例,診斷未明者18例。惡性腫瘤中小細(xì)胞肺癌共45例,非小細(xì)胞肺癌共39例,無法確切分型者42例,轉(zhuǎn)移性神經(jīng)內(nèi)分泌癌1例,B型淋巴瘤2例,原發(fā)性縱膈肉瘤1例。良性疾病中非特異性炎癥者22例,縱膈囊腫2例,肺膿腫1例,肺囊腫伴放線菌感染1例,塵肺8例,縱膈淋巴結(jié)結(jié)核27例,結(jié)節(jié)病11例。EBUS-TBNA對縱膈、肺門占位性病變的總體診斷率為92.7%,其中對惡性腫瘤的診斷率為94.0%,對縱膈淋巴結(jié)結(jié)核的診斷率為84.4%,對結(jié)節(jié)病的診斷率為73.3%。有6例患者重復(fù)行二次EBUS-TBNA檢查后病理診斷結(jié)果:1例肺癌,2例結(jié)節(jié)病,3例縱膈淋巴結(jié)結(jié)核。246例患者EBUS-TBNA術(shù)中不良反應(yīng)包括,13例患者術(shù)中出現(xiàn)低氧血癥,5例患者術(shù)中出現(xiàn)心律失常,19例患者出現(xiàn)術(shù)中少量出血。術(shù)后并發(fā)癥主要表現(xiàn)為咳嗽及痰中帶血,未見嚴(yán)重并發(fā)癥發(fā)生。結(jié)論:EBUS-TBNA具有良好的安全性和可重復(fù)性,用于診斷縱膈、肺門占位性病變是安全、有效的,尤其對于惡性疾病檢出率高,對于縱膈、肺門淋巴結(jié)腫大的結(jié)節(jié)病及結(jié)核病亦有重要的診斷價值。在實際應(yīng)用中,對行首次檢查結(jié)果不理想者,可通過重復(fù)檢查提高診斷率。EBUS-TBNA對縱膈、肺門少見疾病亦是一種重要的輔助檢查手段。
[Abstract]:Objective: to evaluate the diagnostic value and safety of endoscopic transbronchial needle aspiration (EBUS-TBNA) in mediastinal and hilar space occupying lesions. Methods: from October 2014 to September 2016, the clinical data of 246 patients with mediastinal, hilar lymphadenopathy and / or intrathoracic mass were analyzed retrospectively. The results of cytology and / or pathology, positive rate of diagnosis and incidence of complications in all patients with EBUSTBNA were analyzed statistically. Results the pathological results of EBUS-TBNA in 246 patients were as follows: 130 cases of malignant tumor, 72 cases of benign disease, 26 cases of suspected malignant tumor and 18 cases of unknown diagnosis. There were 45 cases of small cell lung cancer, 39 cases of non-small cell lung cancer, 42 cases of which could not be classified accurately, 1 case of metastatic neuroendocrine carcinoma, 2 cases of type B lymphoma and 1 case of primary mediastinal sarcoma. There were 22 cases of nonspecific inflammation, 2 cases of mediastinal cyst, 1 case of pulmonary abscess, 1 case of pulmonary cyst with actinomycosis, 8 cases of pneumoconiosis, 27 cases of tuberculosis of mediastinal lymph node, 11 cases of sarcoidosis. The overall diagnostic rate of hilar occupying lesions was 92.70.The diagnostic rate of malignant tumor was 94.0, the diagnosis rate of mediastinal lymph node tuberculosis was 84.4, and the diagnostic rate of sarcoidosis was 73.3%. Results of pathological diagnosis after repeated secondary EBUS-TBNA examination in 6 cases of lung cancer: 1 case of lung cancer 2 cases of sarcoidosis 3 cases of mediastinal lymph node tuberculosis. 246 cases of adverse reactions during EBUS-TBNA including 13 cases of intraoperative hypoxemia and 5 cases of intraoperative excision A small amount of bleeding occurred in 19 patients with arrhythmia. Postoperative complications were mainly cough and blood in sputum, without serious complications. ConclusionTwo EBUS-TBNA has good safety and reproducibility. It is safe and effective to diagnose mediastinal and hilar occupying lesions, especially for malignant diseases and mediastinum. Pulmonary hilar lymph node enlargement sarcoidosis and tuberculosis also have important diagnostic value. In practical application, the diagnosis rate can be improved by repeated examination. EBUS-TBNA is also an important auxiliary examination method for mediastinal and hilar rare diseases.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734

【參考文獻】

相關(guān)期刊論文 前10條

1 李璽;榮福;;非小細(xì)胞肺癌經(jīng)支氣管針吸活檢標(biāo)本microRNA-126和microRNA-205的表達(dá)及意義[J];廣東醫(yī)學(xué);2016年22期

2 柴艷;陳丹峰;佟凌霞;嚴(yán)時;呂明;李慧;;支氣管內(nèi)超聲引導(dǎo)針吸活檢術(shù)在肺癌診斷中的臨床研究[J];臨床肺科雜志;2016年11期

3 劉瑩;劉素玲;賈文青;王圓圓;王靜;;支氣管內(nèi)超聲引導(dǎo)針吸活檢術(shù)對縱隔淋巴結(jié)性質(zhì)的預(yù)測價值[J];中華醫(yī)學(xué)雜志;2016年38期

4 陳曄;張澤明;趙學(xué)琴;;經(jīng)支氣管針吸活檢與超聲內(nèi)鏡引導(dǎo)下經(jīng)支氣管針吸活檢對支氣管肺癌患者腫大淋巴結(jié)性質(zhì)的診斷價值比較研究[J];中國全科醫(yī)學(xué);2016年18期

5 曾輝;黃建安;;超聲引導(dǎo)下經(jīng)支氣管鏡針吸活檢對Ⅰ、Ⅱ期結(jié)節(jié)病的診斷價值[J];中華醫(yī)學(xué)雜志;2016年22期

6 羅為展;鐘長鎬;陳小波;陳愉;唐純麗;李時悅;;支氣管鏡超聲彈性成像在肺門縱隔淋巴結(jié)良惡性的診斷價值[J];國際呼吸雜志;2016年11期

7 李慧;曹敏;徐慶慶;黃妹;李蕤;苗立云;肖永龍;孟凡青;蔡后榮;代靜泓;;超聲支氣管鏡引導(dǎo)下針吸活檢術(shù)與常規(guī)支氣管鏡活檢術(shù)對結(jié)節(jié)病診斷價值的比較[J];中華醫(yī)學(xué)超聲雜志(電子版);2016年02期

8 熊升華;劉念;韓青兵;姜勇;蘇學(xué)英;;支氣管超聲內(nèi)鏡引導(dǎo)下針吸活檢結(jié)合液基細(xì)胞學(xué)檢查對肺及縱隔淋巴結(jié)病變的診斷價值[J];中華病理學(xué)雜志;2015年09期

9 李輯倫;趙輝;隋錫朝;周足力;王俊;;支氣管內(nèi)超聲引導(dǎo)針吸活檢術(shù)在Ⅰ、Ⅱ期胸部結(jié)節(jié)病診斷中的應(yīng)用價值[J];中國微創(chuàng)外科雜志;2015年04期

10 解楨;趙輝;周足力;隋錫朝;王俊;;支氣管內(nèi)超聲引導(dǎo)針吸活檢術(shù)在縱隔病變診斷及鑒別診斷中的應(yīng)用價值[J];中國微創(chuàng)外科雜志;2013年04期

，

本文編號：1828559