| 摘要: |
| 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，EBUS-TBNA的阳性率差异有统计学意义（P<0.000 1）；其中最大径≤1 cm组的EBUS-TBNA阳性率低于最大径>2 cm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>2 cm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。 |
| 关键词: 超声检查 针吸活组织检查 敏感性 影响因素 |
| DOI：10.16781/j.0258-879x.2016.08.0931 |
| 投稿时间：2016-02-15修订日期：2016-04-08 |
| 基金项目:无 |
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| Factors influencing sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration |
| CHEN Chang-ming,CHEN Si,HUANG Hai-dong,LI Qiang* |
(Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To explore the factors that are closely related to the sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) by analyzing the procedure-related factors, hoping to improve the operation of EBUS-TBNA. Methods A retrospective analysis was performed on all the 393 cases that had received EBUS-TBNA from Jan, 2015 to Dec, 2015 in Changhai Hospital, Second Military Medical University. Positive rates under different conditions such as working experiences of bronchoscopy operators, the types of patients, the types of anesthesia, the positions and sizes of biopsied lymph node, the numbers of biopsied lymph node groups, and the puncture times of each single lymph node were investigated. Logistic regression models and χ2-test were used to identify factors associated with the sensitivity of EBUS-TBNA. Results Our findings showed that the positive rates of EBUS-TBNA were not related to the different working periods as a bronchoscopy operators, types of patients (outpatient or hospitalization), types of anesthesia (local anesthesia or additional intravenous sedation to a local anesthetic), different positions of biopsied lymph node, the puncture times of each single lymph node or the numbers of different groups of lymph node chosen for biopsy. The maximum diameters of punctured lymph nodes under ultrasound interface were found related to the diagnosis rate of EBUS-TBNA (P<0.000 1). Among them, the positive rate of lymph node biopsy was significantly lower in those with the maximum diameter ≤1.0 cm than those with the maximum diameter>2.0 cm (P<0.000 1). The result showed that the positive rate of EBUS-TBNA was positively correlated with the size of biopsied lymph node, with a regression coefficient of 1.027(P<0.001). Conclusion Respiratory physicians can achieve satisfactory performance in EBUS-TBNA operation after formal training and extensive practice. In order to increase the positive rate and to improve the sensitivity of EBUS-TBNA, maximum diameter>2.0 cm lymph nodes should be chosen when possible. The numbers of biopsied lymph node groups, the puncture times of each single lymph node, the positions of biopsied lymph node, the type of anesthesia or the types of patients are not related to the positive rate of EBUS-TBNA. |
| Key words: ultrasonography needle biopsy sensitivity influencing factors |
