经支气管冷冻肺活检对弥漫性肺疾病病因诊断的有效性和安全性

Efficacy and safety of transbronchial cryobiopsy in the etiologic diagnosis of diffuse lung disease

目的探讨经支气管冷冻肺活检（TBCB）对弥漫性肺疾病（DLD）病因诊断的有效性和安全性。方法2015年12月至2017年4月期间于重庆医科大学附属第一医院纳入病因不明的DLD患者38例，其中35例同意在硬质支气管镜或软性支气管镜下实施了TBCB。将获取的35例患者标本分别作病理、病原微生物培养等检查，并结合临床和影像学特征综合分析，确定DLD的病因，明确TBCB对DLD病因诊断的有效性，制定治疗方案及随诊，并观察记录TBCB并发症的发生率和严重程度。结果35例DLD患者接受了TBCB，其中硬质支气管镜下完成24例，软性支气管镜下完成11例。有3例患者因不愿再接受有创检查而退出。TBCB操作时间（51．8±19．2）min，组织标本数量为6（5，8）块／例，标本大小为15（9，20）mm^2。明确诊断33例（特发性非特异性间质性肺炎8例，结缔组织病相关问质性肺病8例，职业性肺损伤4例，特发性肺纤维化3例，自身免疫特征的问质性肺炎3例，结核2例，隐源性机化性肺炎1例，急性间质性肺炎1例，特殊细菌感染1例，过敏性肺炎1例，结节病1例），病因确诊率94．3％（33／35）。发生气胸3例（其中少量1例，中量1例，大量1例），经抽气或闭式引流后气胸均吸收；24例硬镜下TBCB均有出血（轻度11例，中度12例，重度1例），经止血处理后出血均停止。对明确诊断的33例患者进行相应治疗，随访1个月，痊愈1例（3．0％），好转17例（51．5％），稳定11例（33．3％），恶化4例（12．1％）。结论TBCB对DLD病因确诊率高，安全性好。

Objective To assess the efficacy and safety of transbronchial cryobiopsy （TBCB） for the etiologic evaluation of diffuse lung disease （DLD）. Methods Between December 2015 to April 2017, a total of 38 patients with DLD met the inclusion criteria for TBCB in the First Affiliated Hospital of Chongqing Medical University, and 55 of them consented to undergo the procedure under rigid or flexible bronchoseopy. On the tissues obtained from the 35 patients, histopathologic and microbiological evaluations were performed, and together with clinical and radiological manifestations, diagnoses were made and the efficacy of TBCB in the diagnosis of DLD was confirmed, and then therapies were planned accordingly. Complications of the biopsy procedures were recorded. Results Of the 35 patients who were enrolled, 24 underwent TBCB under rigid bronchoscopy and 11 under flexible bronchoscopy. Another 3 patients refused the procedure due to disinclination to invasive examinations. One single procedure of TBCB took （51.8 ＋ 19. 2） min on average, the median number of tissues obtained was 6 （5,8）, and the median area of tissues was 15 （9,20） mm2. Definite diagnoses were reached in 33 patients, including idiopathic nonspecific interstitial pneumonia （ n = 8 ）, connective tissue disease-interstitial lung disease （ n = 8 ）, occupational lung disease （ n = d ）, idiopathic pulmonary fibrosis （n = 3 ）, interstitial pneumonia with autoinunune features （n = 3 ）, tuberculosis （n=2）, cryptogenic organization pneumonia （ n = 1 ）, acute interstitial pneumonia （ n = 1 ）, pulmonary infection （ n = 1 ）, hypersensitivity pneumonia （n = 1 ） and sarcoidosis （ n = 1 ）. Diagnostic yield was 94. 3% （33 out of 35 cases diagnosed）. Pneumothorax occurred in 3 patients （ 1 patients with mild pneumothorax , 1 moderate and 1 severe）, and were resolved with thoracic puncture or pleural drainage. Bleeding occurred in all 24 patients who received TBCB under rigid bronchoscopy （ 11 patients with mild bleeding, 12 moderate and 1 severe） and was controlled after coagulation measures. After one month of treatment according to the diagnoses acquired with cryobiopsy, the condition was cured in I patient （3.0%）, alleviated in 17 （51.5%）, stable in 11 （33.3%）, and deteriorated in 4 （12.1%）. Conclusion TBCB yields reliable diagnoses with a good safetv orofile.