经支气管冷冻肺活检对间质性肺病疾病诊断的有效性和安全性

Efficacy and Safety of Transbronchial Cryobiopsy in the Etiologic Diagnosis of Interstitial Lung Disease

目的探讨经支气管冷冻肺活检(transbronchial cryobiopsy,TBCB)对间质性肺病疾病诊断的有效性和安全性。方法回顾性收集2018年8月至2020年6月期间广东省人民医院入院诊断为病因不明的间质性肺病患者25例,患者均签署知情同意后使用软性支气管镜下实施TBCB。收集患者病理检查、影像学及预后结果,明确TBCB对于间质性肺病具体分型诊断的有效性和安全性,并观察记录TBCB并发症的特征。结果25例患者接受软性支气管镜TBCB,操作时间为20~30 min,组织标本数量为3(1,5)块/例,标本大小为15(2,38)mm2。其中19例经临床⁃影像⁃病理(clinical⁃radiological⁃pathological,CRP)诊断后得到明确间质性肺病分型,6例患者被确诊为间质性肺病但准确分型未能获得确定,疾病诊断率为76%(19/25)。发生气胸8例(其中轻度气胸4例,中度2例,重度2例),经抽气或闭式引流后气胸均吸收;25例患者行TBCB均有不同程度的出血,其中1级出血8例,2级出血7例,3级出血10例,部位主要集中于中左下叶(左基底段10例,左下叶3例,右上叶出血4例,右下叶基底段出血8例),所有出血经镜下止血后停止,对明确诊断的25例患者进行相应的治疗,所有患者中,痊愈4例(16%),好转18例(72%),稳定3例(12%),恶化0例。结论TBCB有利于间质性肺病的疾病分型诊断,同时应注意防治基底段活检部位的出血。

Objective To investigate the efficacy and safety of transbronchial cryobiopsy(TBCB)in the diagnosisof interstitial lung disease(ILD).Methods Between August 2018 to June 2020,25 patients with ILD were included,all patients met the inclusion criteria for TBCB in Guangdong Provincial People’ s Hospital,all of them consented to undergo TBCB by flexible bronchoscope. Histopathological and microbiological evaluations were performed on the tissues obtained from the patients. The diagnosis was made according to the result of TBCB and multidisciplinary team(MDT),and treatments were conducted on the basis of TBCB diagnosis. The complications of TBCB were recorded as well.Results 25 patients underwent TBCB by flexible bronchoscope. The operation time of TBCB spanned 20~30 mins on average,the median number of biopsy tissues was 3(1,5),and the median area of tissues was 15(2,38)mm2. 25 patients were diagnosed definitely in which 19 patients acquired the specific etiology classification. Diagnostic yield of accurate etiological classification was 76%(19/25). Pneumothorax occurred in 7 patients(4 patients mild,1 moderate and 2 severe)and all those patients relived by medical conservative treatment,thoracic puncture or pleural drainage.Bleeding occurred in all 25 patients(8 patients in grade 1,7 in grade 2,10 in grade 3,0 in grade 4)and all were controlled by implementing coagulation measures. According to the diagnoses acquired by cryobiopsy,proper treatments were conducted. 4(18%)patients were cured,18(72%)patients were alleviated,3(12%)patients were stable and no patients deteriorated.Conclusions TBCB has good diagnostic value which can acquire enough specimen with minor damage,less complication and high security. It is an effective method for the pathological diagnosis of ILD.