中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2014年
9期
659-663
,共5页
肺疾病,间质性%活组织检查%有效性%安全性
肺疾病,間質性%活組織檢查%有效性%安全性
폐질병,간질성%활조직검사%유효성%안전성
Lung disease,interstitial%Biopsy%Efficacy%Safety
目的 评价外科肺活检术在弥漫性间质性肺疾病诊断中的安全性和有效性.方法 回顾性分析北京协和医院2006年1月至2012年12月期间收治的弥漫性间质性肺疾病患者的临床资料、影像学资料和病理学资料,经支气管镜相关检查和(或)CT引导下经皮肺穿刺等非创伤性和小创伤性检查,未明确诊断进而接受外科肺活检的179例患者中,男91例,女88例,年龄(16 ～ 76)岁,平均(47±13)岁.结果 179例患者中＜20岁6例(6/179,3.3％),20 ～ 59岁148例(148/179,82.7％),≥60岁25例(25/179,14.0％).自2006年起每年度例数分别为16例(16/179,8.9％)、17例(17/179,9.5％)、19例(19/179,10.6％)、44例(44/179,24.6％)、33例(33/179,18.4％)、31例(31/179,17.3％)和19例(19/179,10.6％).患者平均住院时间为(33±14)d,术后住院天数为(19±10)d,引流管放置时间平均(3.2±1.1)d.胸腔镜肺活检150例,小开胸肺活检例29例,活检部位为:左舌叶54例次、左固有上叶16例次、左下叶基底段56例次、右上叶30例次、右中叶40例次及右下叶基底段56例次.每次活检取得肺组织1～4块不等,其中126例≥2块.肺活检病理确诊103例;结合肺活检病理及临床资料明确诊断32例,44例即使经外科肺活检仍未能明确诊断.确诊的135例病例中,以慢性外源性过敏性肺泡炎(33例)最多见,其次为非特异性间质性肺炎(27例);114例经外科肺活检结果而改变了原有的治疗方案.术后发热16例,其中11例需要使用抗感染治疗;其他术后并发症:伤口延迟愈合6例(＞10 d),需再次留置引流管或抽气的气胸4例次,术后呼吸机脱机困难4例,呼吸衰竭3例,胸腔出血5例,胸腔内感染2例.2例患者因呼吸衰竭于术后30 d内死亡.结论 接受外科肺活检的弥漫性间质病肺疾病患者以青、中年人为主,手术部位以双下肺及左舌叶、右中叶为主;外科肺活检有助于明确这类患者的诊断、指导调整治疗方案;术后并发症以发热、伤口延迟愈合为主要表现,手术相关病死率低;对于诊断不明的弥漫性间质性肺疾病患者建议接受外科肺活检以助于明确诊断、指导治疗.
目的 評價外科肺活檢術在瀰漫性間質性肺疾病診斷中的安全性和有效性.方法 迴顧性分析北京協和醫院2006年1月至2012年12月期間收治的瀰漫性間質性肺疾病患者的臨床資料、影像學資料和病理學資料,經支氣管鏡相關檢查和(或)CT引導下經皮肺穿刺等非創傷性和小創傷性檢查,未明確診斷進而接受外科肺活檢的179例患者中,男91例,女88例,年齡(16 ～ 76)歲,平均(47±13)歲.結果 179例患者中＜20歲6例(6/179,3.3％),20 ～ 59歲148例(148/179,82.7％),≥60歲25例(25/179,14.0％).自2006年起每年度例數分彆為16例(16/179,8.9％)、17例(17/179,9.5％)、19例(19/179,10.6％)、44例(44/179,24.6％)、33例(33/179,18.4％)、31例(31/179,17.3％)和19例(19/179,10.6％).患者平均住院時間為(33±14)d,術後住院天數為(19±10)d,引流管放置時間平均(3.2±1.1)d.胸腔鏡肺活檢150例,小開胸肺活檢例29例,活檢部位為:左舌葉54例次、左固有上葉16例次、左下葉基底段56例次、右上葉30例次、右中葉40例次及右下葉基底段56例次.每次活檢取得肺組織1～4塊不等,其中126例≥2塊.肺活檢病理確診103例;結閤肺活檢病理及臨床資料明確診斷32例,44例即使經外科肺活檢仍未能明確診斷.確診的135例病例中,以慢性外源性過敏性肺泡炎(33例)最多見,其次為非特異性間質性肺炎(27例);114例經外科肺活檢結果而改變瞭原有的治療方案.術後髮熱16例,其中11例需要使用抗感染治療;其他術後併髮癥:傷口延遲愈閤6例(＞10 d),需再次留置引流管或抽氣的氣胸4例次,術後呼吸機脫機睏難4例,呼吸衰竭3例,胸腔齣血5例,胸腔內感染2例.2例患者因呼吸衰竭于術後30 d內死亡.結論 接受外科肺活檢的瀰漫性間質病肺疾病患者以青、中年人為主,手術部位以雙下肺及左舌葉、右中葉為主;外科肺活檢有助于明確這類患者的診斷、指導調整治療方案;術後併髮癥以髮熱、傷口延遲愈閤為主要錶現,手術相關病死率低;對于診斷不明的瀰漫性間質性肺疾病患者建議接受外科肺活檢以助于明確診斷、指導治療.
목적 평개외과폐활검술재미만성간질성폐질병진단중적안전성화유효성.방법 회고성분석북경협화의원2006년1월지2012년12월기간수치적미만성간질성폐질병환자적림상자료、영상학자료화병이학자료,경지기관경상관검사화(혹)CT인도하경피폐천자등비창상성화소창상성검사,미명학진단진이접수외과폐활검적179례환자중,남91례,녀88례,년령(16 ～ 76)세,평균(47±13)세.결과 179례환자중＜20세6례(6/179,3.3％),20 ～ 59세148례(148/179,82.7％),≥60세25례(25/179,14.0％).자2006년기매년도례수분별위16례(16/179,8.9％)、17례(17/179,9.5％)、19례(19/179,10.6％)、44례(44/179,24.6％)、33례(33/179,18.4％)、31례(31/179,17.3％)화19례(19/179,10.6％).환자평균주원시간위(33±14)d,술후주원천수위(19±10)d,인류관방치시간평균(3.2±1.1)d.흉강경폐활검150례,소개흉폐활검례29례,활검부위위:좌설협54례차、좌고유상협16례차、좌하협기저단56례차、우상협30례차、우중협40례차급우하협기저단56례차.매차활검취득폐조직1～4괴불등,기중126례≥2괴.폐활검병리학진103례;결합폐활검병리급림상자료명학진단32례,44례즉사경외과폐활검잉미능명학진단.학진적135례병례중,이만성외원성과민성폐포염(33례)최다견,기차위비특이성간질성폐염(27례);114례경외과폐활검결과이개변료원유적치료방안.술후발열16례,기중11례수요사용항감염치료;기타술후병발증:상구연지유합6례(＞10 d),수재차류치인류관혹추기적기흉4례차,술후호흡궤탈궤곤난4례,호흡쇠갈3례,흉강출혈5례,흉강내감염2례.2례환자인호흡쇠갈우술후30 d내사망.결론 접수외과폐활검적미만성간질병폐질병환자이청、중년인위주,수술부위이쌍하폐급좌설협、우중협위주;외과폐활검유조우명학저류환자적진단、지도조정치료방안;술후병발증이발열、상구연지유합위주요표현,수술상관병사솔저;대우진단불명적미만성간질성폐질병환자건의접수외과폐활검이조우명학진단、지도치료.
Objective To evaluate the role of surgical lung biopsy (SLB) in the management of diffuse interstitial lung disease (DILD) with no specific diagnosis.Methods We conducted a retrospective analysis of 179 cases with DILD of non-specific diagnosis after non-invasive methods and minimally invasive processes,including bronchoscopy and CT-guided lung biopsy,were performed SLB at Peking Union Medical College Hospital between 2006 and 2012.Patient demographics,surgical approach,number and site of biopsies,post-operative complications and postoperative pathological diagnosis and treatment were analyzed.Results Of 179 cases,there were 91 males (50.8％) and 88 females (49.2％),with a median age of 47.3 years (range 16-76).There were 6 cases(3.4％) who were younger than 20 years and 25 cases(14％) older than 60 years.From 2006 to 2012,every year there were 16 case (8.9％),17 cases (9.5％),19 cases(10.6％),44 cases(24.6％),33 cases(18.4％),31 cases(17.3％) and 19 cases (10.6％) respectively.The total median hospital stay was 33.4 days (range 6-76) and the mean postoperative stay was 18.6 days (range 2-56).The mean duration for chest drainage was 3.2 days (range 2-18).Among them,150 cases were arranged with video-assisted thoracoscopy surgery (VATS) and 29 cases were arranged with minithoracotomy.The number of biopsies taken was ranged from one to four and there were 126 cases (70.4％) had more than one biopsy.The biopsy was performed in left lingular lobe (54 cases/30.2％),left natural upper lobe (16 cases/8.9％),left inferior basal segments (56 cases/ 31.3％),right upper lobe (30 cases/16.7％),right meddle lobe (40case/22.3％) and right inferior basal segments (56 case/31.3％) respectively.Definitive pathological diagnosis was reached in 103 cases (57.5％),diagnosis was reached after combination of pathological,clinical and radiological manifestations in 32 cases (17.9％) and there were 44 cases (24.6％) could not achieved diagnosis even after the SLB.Chronic extrinsic allergic alveolitis was the most common diagnosis (33/24.4％),following nonspecific interstitial pneumonia (27/20％) for the 135 cases with a definite diagnosis.Among 179 cases,there were 114 cases had a change in their treatment following the results of SLB.There were 16 cases had a fever after surgery and antibiotics were administrated for eleven of them.Other complication were included delayed wound healing (＞ 10 days after surgery,6 cases),thoracic hemorrhage (5 cases),chest tube re-indwelling because of pneumothorax (4 cases),delayed weaning of ventilator (＞ 3 days after surgery,4 cases),respiratory failure (3 cases),and thoracic infection (2 cases).There were two cases died within 30 days following surgery because of respiratory failure.Conclusions Most of the DILD patients who were arranged with SLB were young and middle-aged cases.The left lingular lobe,right meddle lobe and both inferior lobes were the preferred biopsy sites.The results of biopsy surgery could provides a diagnosis for most of the DILD patients and could modulate the treatment for more than half of them.Fever and delayed wound healing were the major complications.The SLB related mortality was low.SLB was suggested to the undiagnosed DILD patients.
