作者：张业，刘颖，颜晶晶，马姣，刘政

单位：

065000河北省廊坊市，河北中石油中心医院呼吸与危重症医学科

Units：

Department of Respiratory and Critical Care Medicine, Hebei Petro China Central Hospital, Langfang 065000, China

关键词：

纵隔肿块；纵隔淋巴结肿大；经气管镜超声引导针吸活检术；一致性；诊断

Keywords：

Mediastinal mass; Mediastinal lymph node enlargement; Endobronchial ultrasound-guided transbronchial needleaspiration; Consistency; Diagnosis

CLC：

R 655

DOI：

10.12114/j.issn.1008-5971.2022.00.022

Funds：

廊坊市科技支撑计划项目（2018013079）

摘要：

　背景　不明原因肺门及纵隔肿块、纵隔淋巴结肿大是胸外科常见的一种疾病，尽管纵隔镜或胸腔镜 检查是临床诊断纵隔病变良恶性的“金标准”，但因对机体损伤较大、检查费用高昂、可重复性差等导致其临床应 用受限，故寻找一种安全、有效的诊断方法一直是临床医师面对的难题。目的　探讨经气管镜超声引导针吸活检术 （EBUS-TBNA）在定性诊断不明原因肺门及纵隔肿块、纵隔淋巴结肿大中的应用价值。方法　本研究为前瞻性研 究。选取2018年12月至2020年12月河北中石油中心医院收治的行EBUS-TBNA的108例不明原因肺门及纵隔肿块、纵 隔淋巴结肿大患者为研究对象。以纵隔镜或胸腔镜检查结果作为“金标准”。统计患者EBUS-TBNA病理诊断结果并 分析其诊断效能，观察患者术后并发症发生情况。结果　108例患者穿刺成功率为100%，其中恶性病变72例，良性 病变36例。EBUS-TBNA定性诊断不明原因肺门及纵隔肿块、纵隔淋巴结肿大的灵敏度为90.41%（66/73），特异度为 82.86%（29/35），正确率为87.96%（95/108）；Kappa检验结果显示，EBUS-TBNA与“金标准”定性诊断不明原因肺 门及纵隔肿块、纵隔淋巴结肿大的一致性较高（Kappa值为0.727，P＜0.001）。患者行EBUS-TBNA后发生咯血2例， 发热4例，均未经特殊处理自行缓解。结论　EBUS-TBNA的穿刺成功率较高，其定性诊断不明原因肺门及纵隔肿块、 纵隔淋巴结肿大的灵敏度、特异度及正确率均较高，且与“金标准”具有较高的一致性，提示EBUS-TBNA或可替代 纵隔镜或胸腔镜检查而成为临床定性诊断不明原因肺门及纵隔肿块、纵隔淋巴结肿大的首选方案。

Abstract：

Background Unexplained hilar and mediastinal masses and mediastinal lymphadenopathy are common diseases in Department of Thoracic Surgery. Although mediastinoscopy or thoracoscopy is the "gold standard" for clinical diagnosis of benign and malignant mediastinal lesions, its clinical application is limited due to its great damage, high examination cost and poor repeatability. Therefore, it is always a difficult problem for clinicians to explore a safe, effective diagnosis method for unexplained hilar and mediastinal masses and mediastinal lymphadenopathy. Objective To evaluate the application value of endobronchial ultrasound-guided transbronchial needleaspiration (EBUS-TBNA) in the qualitative diagnosis of unexplained hilar and mediastinal mass and mediastinal lymph node enlargement. Methods This study is a prospective study. A total of 108 patients with unexplained hilar and mediastinal mass and mediastinal lymph node enlargement underwent EBUS-TBNA were selected in Hebei Petro China Central Hospital from December 2018 to December 2020. Took diagnostic results of mediastinoscopy or thoracoscopy as "gold standard", the pathological diagnostic results of EBUS-TBNA were counted, its diagnostic efficacy was analyzed, and the incidence of postoperative complications were observed. Results Of 108 patients, puncture success rate was 100%, there were 72 cases of malignant lesions, 36 cases of benign lesions. EBUS-TBNA had a sensitivity of 90.41% (66/73) , specificity of 82.86% (29/35) , and accuracy of 87.96% (95/108) in the diagnosis of unexplained hilar and mediastinal mass and mediastinal lymph node enlargement, and the results of Kappa test showed that EBUS-TBNA was consistent with "gold standard" in qualitative diagnosis of unexplained hilar and mediastinal masses and mediastinal lymphadenopathy (Kappa=0.727, P < 0.001) . Two patients occurred haemoptysis after EBUS-TBNA, 4 cases occurred fever, and they were relieved without special treatment. Conclusion EBUS-TBNA has higher puncture success rate and higher sensitivity, specificity and accuracy in the qualitative diagnosis of unexplained hilar and mediastinal mass and mediastinal lymph node enlargement, and it has high consistency with the "gold standard" , suggesting that EBUS-TBNA may replace mediastinoscopy or thoracoscopy and become the first choice for clinical qualitative diagnosis of unexplained hilar and mediastinal masses and mediastinal lymphadenopathy.

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