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目的总结经支气管针吸术(TBNA)在肺癌诊断中的作用。方法分析61例支气管镜TBNA检查患者的临床资料。其中常规胸部CT检查提示有纵隔淋巴结肿大55例,支气管外压性狭窄6例。结果 61例中,确诊肺癌43例,结节病7例,结核3例,感染性淋巴结肿大8例。43例经TBNA获取标本病理确诊为肺癌36例(36/43,83.7%)。36例肺癌患者纵隔淋巴结穿刺62例次,穿刺成功50例次(50/62,80.6%);气管右前、隆突前、右主支气管前淋巴结共穿刺49次(49/62,78%)。其中20例周围型肺癌TBNA诊断阳性率70%(14/20),活检诊断阳性率14.3%(2/14),刷检诊断阳性率25%(5/20),肺泡灌洗诊断阳性率25%(2/8)。TBNA诊断准确率显著高于其他3种诊断方法(P<0.01)。结论对于周围型肺癌伴有纵隔淋巴结肿大及支气管外压性狭窄的患者,TBNA为更好的诊断方法。
Objective To summarize the role of transbronchial needle aspiration (TBNA) in the diagnosis of lung cancer. Methods The clinical data of 61 patients with bronchoscopic TBNA were analyzed. Conventional chest CT examination revealed 55 cases of mediastinal lymph nodes and 6 cases of extrabronchial pressure stenosis. Results Of the 61 patients, 43 were diagnosed with lung cancer, 7 with sarcoidosis, 3 with tuberculosis, and 8 with enlarged lymph nodes. Forty-three patients with TBNA obtained pathologically confirmed lung cancer in 36 patients (36/4283.7%). Sixty-six cases of mediastinal lymph node puncture were performed in 36 patients with lung cancer, and 50 cases (50/62, 80.6%) were successfully punctured; 49 cases (49/62, 78%) of anteroposterior, pre-carina, and right main bronchus lymph nodes were punctured. Among them, the positive rate of TBNA diagnosis in peripheral lung cancer was 70% (14/20), the positive rate of biopsy was 14.3% (2/14), the positive rate of brush test was 25% (5/20), and the diagnostic rate of bronchoalveolar lavage was 25 %(2/8). The diagnostic accuracy of TBNA was significantly higher than the other three diagnostic methods (P<0.01). Conclusion TBNA is a better diagnostic method for patients with peripheral lung cancer associated with mediastinal lymphadenopathy and extrabronchial pressure stenosis.