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目的通过对经支气管内超声引导针吸活检术(EBUS-TBNA)操作过程中的相关因素进行统计分析,探寻与其敏感性相关的影响因素,以促进临床进一步提高EBUS-TBNA的操作质量。方法回顾性收集2015年1月至12月于第二军医大学长海医院行EBUS-TBNA淋巴结活检的393例患者的资料,采用χ2检验、logistic回归多因素分析统计方法比较支气管镜操作者的经验、患者属性、手术麻醉方式、穿刺淋巴结的站点、穿刺淋巴结的大小、淋巴结穿刺组数及单个淋巴结穿刺针数不同时EBUS-TBNA阳性率的差异,分析影响EBUS-TBNA敏感性的相关因素。结果操作支气管镜不同年限的操作者之间、门诊与住院患者之间、局麻与无痛静脉麻醉患者之间、穿刺不同站点的淋巴结之间、单个淋巴结不同的穿刺针数之间以及穿刺不同组数淋巴结的患者之间EBUS-TBNA的阳性率差异均无统计学意义。超声界面下不同最大径的淋巴结之间,EBUSTBNA的阳性率差异有统计学意义(P<0.000 1);其中最大径≤1cm组的EBUS-TBNA阳性率低于最大径>2cm组的EBUS-TBNA阳性率(P<0.000 1)。淋巴结大小与EBUS-TBNA的阳性率呈正相关(回归系数为1.027,P<0.001)。结论所有呼吸科医生经过培训掌握操作要领后,均可实施EBUS-TBNA操作,而并非只有专职的介入肺脏病医生才能获得满意的结果。临床工作中,穿刺>2cm的淋巴结有助于提高EBUS-TBNA的敏感性。淋巴结穿刺的组数、单个淋巴结的穿刺针数、穿刺淋巴结的站点、麻醉方式以及患者是在门诊还是住院操作与EBUS-TBNA的阳性率均无明显相关性。
OBJECTIVE: To investigate the factors related to the sensitivity of EBUS-TBNA during the operation of EBUS-TBNA in order to further improve the quality of EBUS-TBNA. Methods The data of 393 patients with EBUS-TBNA lymph node biopsy from Changhai Hospital of the Second Military Medical University from January to December 2015 were retrospectively collected. Chi-square test and logistic regression multivariate statistical analysis were used to compare bronchoscopic operation experience, The differences of the positive rates of EBUS-TBNA between the patients, the characteristics of the patients, the methods of operation anesthesia, the sites of punctual lymph nodes, the size of puncturing lymph nodes, the number of puncturing lymph nodes and the number of puncturing of single lymph node were analyzed to analyze the related factors influencing the sensitivity of EBUS-TBNA. Results There was no difference in the number of puncture needle between different operation time of bronchoscope, outpatient and inpatient, local anesthesia and painless intravenous anesthesia, puncture of different sites of lymph nodes, single lymph node, There was no significant difference in the positive rates of EBUS-TBNA between groups of lymph nodes. The positive rate of EBUSBNA was significantly different between lymph nodes with different diameters under the ultrasound interface (P <0.0001). The positive rate of EBUS-TBNA with the largest diameter≤1cm was lower than that of EBUS-TBNA with the diameter> 2cm Positive rate (P <0.000 1). The size of lymph nodes was positively correlated with the positive rate of EBUS-TBNA (regression coefficient was 1.027, P <0.001). CONCLUSIONS All respiratory specialists have EBUS-TBNA training after they have learned the essentials of operation, and not only satisfactory full-time interventional physicians can obtain satisfactory results. Clinical work, puncture> 2cm lymph nodes help to improve EBUS-TBNA sensitivity. The number of lymph node punctures, the number of puncturing single lymph nodes, the site of puncturing lymph nodes, the mode of anesthesia, and the patient’s outpatient or inpatient operation had no significant correlation with the positive rate of EBUS-TBNA.