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目的通过对经支气管针吸活检术(TBNA)并发出血的回顾性临床分析,探讨出血的防治策略。方法对临沂市人民医院收治的178例纵隔和(或)肺门淋巴结肿大患者开展TBNA,共穿刺248个部位淋巴结:气管前腔静脉后淋巴结组(4R)穿刺数100个,左气管旁主动脉-肺动脉窗淋巴结组(4L)穿刺数10个,隆突前淋巴结组(7)穿刺数13个,隆突下淋巴结组(7)穿刺数90个,隆突远端淋巴结组(7)穿刺数12个,右肺门淋巴结组(11R)穿刺数12个,左下肺门淋巴结组(11L)穿刺数11个。以WANG氏TBNA定位及穿刺法实施操作,统计及分析穿刺后并发出血的部位及发生率。结果隆突下淋巴结组(7)穿刺出血率最高(20%),气管前腔静脉后淋巴结组(4R)穿刺出血率最低(2%)。穿刺部位间出血率的差异均有统计学意义(χ2=17.035,P=0.009)。结论气管前腔静脉后和隆突下淋巴结是TBNA最常穿刺的淋巴结,隆突下淋巴结组(7)行TBNA时出血发生率高。行TBNA前采用肺部CT增强扫描或内镜超声可显示肿大淋巴结区域内血供情况,避免穿刺后并发大出血。
Objective To explore the strategy of prevention and treatment of bleeding through retrospective clinical analysis of concurrent transbronchial needle aspiration (TBNA) with bleeding. Methods One hundred and eighty-eight patients with mediastinal and / or hilar lymphadenopathy admitted to Linyi People’s Hospital were enrolled in this study. A total of 248 lymph nodes were punctured. The number of puncture of the posterior vena cava in the posterior vena cava (4R) was 100, There were 10 punctures in the group of arterial-pulmonary artery window lymph nodes (4L), 13 punctures in the group of anterior lymph nodes (7), 90 punctures in the group of subcapsular lymph nodes (7), and distal lymph node group (7) 12 in number, 12 in right hilar lymph node group (11R) and 11 in lower left hilar node group (11L). The operation of WANG TBNA positioning and puncture was performed, and the location and incidence of bleeding after puncture were statistically analyzed. Results The rate of puncture and hemorrhage was the highest (20%) in submandibular lymph node group (7) and the lowest (2%) in puncture and anterior tracheal vena cava group (4R). Differences in bleeding rates between the puncture sites were statistically significant (χ2 = 17.035, P = 0.009). CONCLUSIONS: Tracheal anterior vena cava and subglottic lymph nodes are the most frequently punctuated lymph nodes in TBNA. The incidence of hemorrhage in TBNA with subacromial lymph nodes (7) is high. Before the line of TBNA pulmonary CT enhanced scanning or endoscopic ultrasonography can show the situation within the enlarged lymph node blood supply, to avoid bleeding after puncture complicated by.