本文選題：EBUS-TBNA + 縱隔病變　； 參考：《蚌埠醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的評價EBUS-TBNA在肺門、縱隔及肺內(nèi)病變中的診斷價值。方法回顧性分析2012年5月至2014年3月,119例伴肺門、縱隔和(或)毗鄰氣管、支氣管的肺內(nèi)腫塊,行常規(guī)電子支氣管鏡檢查未能明確診斷的患者實施了經(jīng)氣管內(nèi)超聲引導(dǎo)下針吸活檢術(shù)(EBUS-TBNA),應(yīng)用快速細胞學(xué)、微生物學(xué)及組織病理學(xué)協(xié)助診斷。EBUS-TBNA未能獲得明確診斷者,進一步選擇侵襲性操作或至少6個月的臨床隨訪。記錄最終診斷結(jié)果及術(shù)中超聲特點,使用SPSS軟件對相關(guān)結(jié)果進行統(tǒng)計學(xué)分析。結(jié)果本組研究中共對234個肺門、縱隔淋巴結(jié)及26個毗鄰氣管、支氣管的腫塊實施了TBNA。其中經(jīng)EBUS-TBNA診斷肺腺癌33例,肺鱗癌7例,唾腺源性腫瘤1例,肺小細胞癌16例,肺差分化癌1例,食管癌縱隔淋巴結(jié)轉(zhuǎn)移1例,結(jié)腸癌縱隔淋巴結(jié)轉(zhuǎn)移1例,結(jié)核性淋巴結(jié)炎31例,炎癥8例,結(jié)節(jié)病7例,縱隔囊腫3例。10例未獲得明確診斷者,后期5例行縱隔鏡檢查,3例診斷為結(jié)節(jié)病,1例診斷為淋巴結(jié)結(jié)核,1例診斷為非特異性炎癥。1例開胸探查后確診為肺巨大淋巴組織增生癥(Castleman病)。4例進行半年臨床隨訪觀察,2例抗結(jié)核治療后好轉(zhuǎn),2例觀察無明顯變化。本組研究中,EBUS-TBNA對縱隔、肺門及肺內(nèi)腫塊的診斷率為91.6%,對良、惡性病變均具有較高的診斷價值。本組共15例不良反應(yīng),2例術(shù)中出現(xiàn)一過性低氧血癥,6例術(shù)后痰血,4例術(shù)后咽喉部疼痛,2例術(shù)后低熱,1例縱隔淋巴結(jié)結(jié)核穿刺點氣道播散。結(jié)論EBUS-TBNA是一項微創(chuàng)的操作方法,用于診斷肺門、縱隔病變和毗鄰氣道的肺內(nèi)腫塊是有效、安全的,對良、惡性病變均有較高的診斷率。
[Abstract]:Objective to evaluate the diagnostic value of EBUS-TBNA in hilar, mediastinal and intrapulmonary lesions. Methods from May 2012 to March 2014, 119 patients with hilar, mediastinal and / or adjacent tracheal and bronchial masses were retrospectively analyzed. The patients who failed to make a definite diagnosis by routine electronic bronchoscopy performed EBUS-TNAA under the guidance of ultrasound in the trachea. The diagnosis was assisted by rapid cytology, microbiology and histopathology, and no definite diagnosis was obtained by EBUS-TBNA. Further selection of invasive procedures or clinical follow-up for at least 6 months. The results of final diagnosis and intraoperative ultrasound were recorded and analyzed statistically with SPSS software. Results TBNA was performed on 234 hilar, mediastinal lymph nodes and 26 adjacent tracheobronchial masses. 33 cases of lung adenocarcinoma, 7 cases of squamous cell carcinoma, 1 case of salivary gland tumor, 16 cases of small cell carcinoma of lung, 1 case of poorly differentiated lung cancer, 1 case of mediastinal lymph node metastasis of esophageal carcinoma and 1 case of mediastinal lymph node metastasis of colon cancer were diagnosed by EBUS-TBNA. 31 cases of tuberculous lymphadenitis, 8 cases of inflammation, 7 cases of sarcoidosis, 3 cases of mediastinal cyst. Mediastinoscopy was performed in 3 cases with sarcoidosis, 1 case with lymph node tuberculosis, 1 case with nonspecific inflammation, 1 case with pulmonary giant lymphoid tissue hyperplasia, 4 cases with pulmonary giant lymphoid tissue hyperplasia, and 4 cases with pulmonary giant lymphoid tissue hyperplasia. Two cases of antituberculous treatment were observed, and 2 cases had no obvious change after antituberculous treatment. The diagnostic rate of EBUS-TBNA for mediastinal, hilar and intrapulmonary masses was 91.6. EBUS-TBNA had high diagnostic value for benign and malignant lesions. There were 15 cases of adverse reactions and 2 cases of transient hypoxemia during operation. 6 cases had phlegm and 4 cases had postoperative pharynx and larynx pain 2 cases had low fever and 1 case had mediastinal lymph node tuberculosis. Conclusion EBUS-TBNA is a minimally invasive method for the diagnosis of hilar, mediastinal and adjacent airway masses, and has a high diagnostic rate for benign and malignant lesions.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R734

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