不同肺活检方法对肺部弥漫性间质性疾病的诊断价值

Diagnosis of diffuse interstitial lung diseases by different lung biopsy approaches

目的探讨不同肺活检方法在肺部弥漫性间质性疾病诊断中的价值。方法回顾性分析因弥漫性肺间质性疾病接受经支气管镜肺活检(transbronchial lung biopsy,TBLB)、CT引导下经皮肺活检(CT-guided percutaneous needle aspiration biopsy,PCNA)、外科电视胸腔镜(lung biopsy by video-assisted thoracoscopic surgery,VATS)及小开胸肺活检(open lung biopsy,OLB)患者的临床和病理诊断资料。结果73例患者接受TBLB,36例病理诊断为肺间质纤维化,7例诊断UIP,8例诊断结核,2例诊断为肺泡蛋白沉着症。28例患者接受经皮肺活检,其中18例得到病理分型。外科电视胸腔镜肺活检28例,小开胸肺活检20例,除1例未明确外,其余全部病理分类。结论在诊断弥漫性肺间质性疾病时,可首先考虑创伤性小的经纤维支气管镜肺活检,可除外感染、肿瘤及结节病。肺部弥漫性间质性疾病中特发性间质性肺炎的病理诊断特别是病理分型需要较大的活检组织,应考虑进行外科电视胸腔镜或小开胸肺活检。

[Objective] To evaluate the diagnostic significances of pathological studies from lung samples obtained by different lung biopsy modalities in diffuse interstitial lung disease （ILD）. [Methods] Clinical and pathological data were retrospectively analyzed from patients with ILD of unknown etiology. Transbronchial lung biopsy （TBLB）, CT-guided percutaneous needle aspiration biopsy （PCNA）, lung biopsy by video-assisted thoracoscopic surgery （VATS） or open lung biopsy were performed to obtain lung tissues for a pathological diagnosis. [Results] TBLB was performed in 73 patients in which 36 cases were diagnosed as interstitial pulmonary fibrosis, 7 cases as UIP, 8 cases as Tuberculosis, 2 cases as pulmonary alveolar proteinosis （PAP）. PCNA was performed in 28 patients in whom pathologic patterns were recognized in 18. Among 28 cases underwent VATS and 20 cases underwent surgical lung biopsy, all the cases but one got pathological diagnosis. [Conclusions] TBLB should be considered to be the first choice to exclude infections, malignant diseases and sarcoidosis. Masquerading as ILD, surgical lung biopsy /VATS are often necessary to make a definitive diagnosis and a histologic classification of IIP.