摘要
目的分析优化支气管内超声引导下针吸活检（EBUS—TBNA）适应证，探索提高确诊率的方法。方法近4年完成的669例EBUS—TBNA病例中，未能确诊者53例，占7．92％。统计其术前、术后的各类临床资料，从病种、病灶部位和大小及穿刺手术的术者经验3个方面分析未确诊病例的临床特点。结果按病种分析，未确诊率较高的是淋巴瘤（77．78％）、结核（23．08％）和结节病（9．09％）。病灶位置分析，上气管旁病灶（R2组）未确诊率最高，为15．38％；其次为双肺门病灶，右侧15．00％，左侧11．54％。淋巴结大小与确诊率无显著相关性。穿刺经验方面，前10例是学习曲线的爬坡期，10例以后曲线趋于平直。结论应当根据病种特点、病灶位置及术者经验恰当选择EBUS-TBNA适应证，与纵隔镜配合提高诊断率。
Objective Analyze the clinical feature of patients failed for diagnosis through endobronchial ultrasound transbronchial needle aspiration（EBUS-TBNA） . Optimize the indication and increase diagnosis rate of EBUS-TBNA. Methods A total of 669 patients failed for diagnosis of EBUS-TBNA were included. Fifty-three of them（7.92% ） were not exactly diagnosed. Perioperation clinical data and clinical feature were collected and evaluated based on specific disease, lesion loca- tion, size and operator＇s experience. Results The undiagnosis rate was higher in lymphoma （77.78%）, tuberculosis （23.08 % ）and sareoidosis （9.09 % ） when analyzed from specific diseases. If the lesion location was taken into consideration, 15.38% upper paratraeheal lymph nodes（R2） could not be diagnosed exactly by EBUS-TBNA, and the bilateral hilar lymph nodes （15.00% for right, I 1.54 for left） were followed. Size of the lesion was not associated with the diagnosis rate. The oper- ator＇s experience could also affect the results. The undiagnosis rate was highest in the first 10 cases among all operators. After at least 10 EBUS-TBNA processes, the undiagonsis rate stayed near 7.50%, which was close to the average. Conclusion It is necessary to select suitable indications for EBUS-TBNA based on the disease, lesion location and operatior experience, and cooperate with mediastinoscopy to rise diagnosis rate.
出处
《中华胸心血管外科杂志》
CSCD
2015年第9期516-518,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
支气管内超声引导针吸活检
诊断
学习曲线
Endobronchial ultrasound transbronchial needle aspiration Diagnosis Learning curve
