教学-EBUS-TBNA(教学PPT)

,支气管内超声引导下针吸术(EBUS-TBNA)在临床中的作用,广州医学院第一附属医院广州呼吸疾病研究所,1,超声支气管镜及主机,2,外径:6.9mm扫描范围：50度器械管道：2.0mm光学：向前倾斜35度,3,EBUS-TBNA的临床应用,肺癌淋巴结分期术前分期术后评估化疗重新分期邻接气管或大气道的肺癌诊断纵隔病变的诊断和治疗,4,5,淋巴结,肺门、纵隔诊断方法影像学：CT、PET-CT病理：根据影像学提示穿刺CT监测（非实时）穿刺超声引导下穿刺（气道、食道）纵隔镜、VATS,6,Non-InvasiveStagingmediastinalLN,CTSensitivity51%(95%CI,47to54%)Specificity85%(95%CI,84to88%)PETSpecificity85%(95%CI,82to88%)Sensitivity74%(95%CI,69to79%)Witheithertest,“abnormalfindingsmustbeconfirmedbytissuebiopsytoensureaccuratestaging”Chest.2007Sep;132(3Suppl):178S-201S.,7,LNassessablebyCP-EBUS,LNassessable1，2,4,7,10,11,12,LNnotassessable3，5,6,8,9,8,EUS-EBUS:CompleteMedicalMediastinoscopy,9,FirstreportofEBUS-TBNAperformedunderlocalanesthesiaAssessmentofMediastinalandhilarlymphnodes70caseswithsensitivity95.7%,specificity100%,diagnosticaccuracy97.1%Nocomplications,10,EBUS-TBNAwassuccessfullyperformedin102patients(meanage67.8years)from147mediastinaland53hilarlymphnodes.ThesensitivitiesofCT,PET,andEBUS-TBNAforthecorrectdiagnosisofmediastinalandhilarlymphnodestagingwere76.9%,80.0%,and92.3%,respectively.Specificitieswere55.3%,70.1%,and100%.Thediagnosticaccuracieswere60.8%,72.5%,and98.0%.,11,如何实施EBUS-TBNA?,STEPBYSTEP,12,1.选择合适的途径进镜,给予适当的镇静与镇痛药物，大部分患者可选择经鼻腔进镜，可提高患者的耐受性及操作时的稳定度，避免插管损伤。,13,支气管内超声可见一不均匀低回声区，常可见清晰边界。,超声引导下穿刺针刺入粘膜，需尽量避开气管软骨。,2.结合CT定位，选择穿刺部位,14,3.超声监视下针吸活检,通过能量显示鉴别血管，穿刺时实时监视，掌握好深度，可尽可能获取标本，并避免损失周围组织。,15,4.标本的处理,组织块穿刺针内芯推出，滤纸上涂片冲洗液,16,17,18,EBUS-TBNA操作前培训,纵隔、肺门的