教学-EBUS-TBNA.pptVIP

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 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 Non-Invasive Staging mediastinal LN CT Sensitivity 51% (95% CI, 47 to 54%)? Specificity 85% (95% CI, 84 to 88%)? PET Specificity 85% (95% CI, 82 to 88%) Sensitivity 74% (95% CI, 69 to 79%) With either test, “abnormal findings must be confirmed by tissue biopsy to ensure accurate staging” Chest. 2007 Sep;132(3 Suppl):178S-201S. LN assessable by CP-EBUS EUS-EBUS: Complete Medical Mediastinoscopy 如何实施EBUS-TBNA? STEP BY STEP 1.选择合适的途径进镜 2.结合CT定位，选择穿刺部位 3.超声监视下针吸活检 4.标本的处理 组织块 穿刺针内芯推出，滤纸上 涂片 冲洗液 EBUS-TBNA操作前培训 纵隔、肺门的解剖 有关的文献、专著、录像 专门训练，观摩、进修 静脉麻醉、局麻 方法、技巧，助手 标本处理、穿刺次数、现场病理片检查 超声医师、超声知识 EUS and EBUS are complementary and overlapping in the coverage of mediastinal lymph node stations. * * 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 超声支气管镜 及主机 Scanning Range： 50 degrees Instrument Channel： 2.0mm Direction of View： 30 degrees forward oblique Outer Diameter: 6.9mm 外径: 6.9mm 扫描范围： 50 度 器械管道： 2.0mm 光学：向前倾斜35度 AJR:174, March 2000 LN assessable 1，2, 4, 7, 10, 11, 12 LN not assessable 3，5, 6, 8, 9 AJR:174, March 2000 Annema JT and Rabe KF:State of the art lecture: EUS and EBUS in pulmonary medicine. Endoscopy 2006; 38:?118-122 First report of EBUS-TBNA performed under local anesthesia Assessment of Mediastinal and hilar lymph nodes 70 cases with sensitivity 95.7%, specificity 100%, diagnostic accuracy 97.1% No complications EBUS-TBNA was successfully performed in 102 patients (mean age 67.8 years) from 147 mediastinal and 53 hilar lymph nodes. The sensitivities of CT, PET, and EBUS-TBNA for the correct diagnosis of mediastinal and hilar lymph node staging were 76.9 %, 80.0 %, and 92.3 %, respectively. Specificities were 55.3 %, 70.1 %, and 100 %. The diagnostic accuracies we