经支气管镜肺活检对肺淋巴管肌瘤病的诊断价值

Diagnostic value of transbronchial lung biopsy in lymphangioleiomyomatosis

肺淋巴管肌瘤病（lymphangioleiomyomatosis,LAM）可根据临床、血清学和影像学等标准诊断,仍有部分患者需经病理明确诊断。LAM 需和其他肺部囊性病变鉴别,病理是重要的鉴别诊断依据。经支气管镜肺活检的创伤性小、安全性高,在诊断其他弥漫性肺实质病变中应用广泛,但在 LAM 中的应用尚存争议。根据现有文献,诊断阳性率在33%~87%,气胸发生率为6%,出血发生率为4%。经支气管镜肺活检可以安全地用于 LAM 的有创诊断。

The clinical definite diagnosis of lymphangioleiomyomatosis （LAM）can be made based on the clinical presentations,serology and radiology,but lung biopsy remains a gold standard to achieve diagnosis.Pathology is important in differential diagnosis for LAM and other cystic lung diseases. Transbronchial lung biopsy （TBLB）is less invasive and safer than other biopsy methods.TBLB has been widely applied in the diagnosis of other diffuse lung diseases.Its value in LAM,however,is a matter of debate.According to the available literature,the positive rate of TBLB in diagnosis of LAM is 33% -87%,the occurrence rate of pneumothorax and bleeding is 6% and 4% respectively.TBLB could be safely applied as an invasive procedure to obtain pathological diagnosis of LAM.