经硬质支气管镜冷冻肺活检对间质性肺疾病的诊断价值

Diagnostic value of rigid transbronchial lung cryobiopsy in interstitial lung disease

目的探讨经硬质支气管镜冷冻肺活检对间质性肺疾病的诊断价值和安全性。方法回顾性分析2017年12月至2019年12月期间就诊于南京大学医学院附属鼓楼医院行TBCB的91例间质性肺疾病患者及同期行TBLB的91例间质性肺疾病患者的临床影像病理资料,比较两种肺活检方法的手术情况、病理取材和诊断效率。结果TBCB组及TBLB组手术时间分别为(32.4±11.3)和(16.0±6.8)min(T=27.232,P=0.001),TBCB组及TBLB组活检标本大小分别为(9.8±3.8)和(1.8±1.2)mm 2(T=24.561,P<0.001),TBCB组及TBLB组病理诊断率分别为84.6%(77/91)和20.9%(19/91)(χ^(2)=74.158,P<0.001)。TBCB组使用球囊封堵预防性压迫止血,36例0级出血,40例1级出血,15例2级出血;TBLB组未使用球囊,56例0级出血,32例1级出血,3例2级出血(χ^(2)=13.237,P<0.001);TBCB组及TBLB组气胸发生率分别为11.0%(10/91)和8.8%(8/91)(χ^(2)=0.247,P=0.619)。结论经硬质支气管镜冷冻肺活检与常规经支气管镜肺活检相比,病理取材和诊断效率具有明显优势,安全可靠,是确诊间质性肺疾病的一种安全、有效的方法。

Objective To evaluate the efficacy and safety of rigid bronchoscopy lung cryobiopsy(TBCB)for the diagnosis of interstitial lung disease.Methods 91 patients with interstitial lung disease admitted to the Affiliated Drum Tower Hospital of Nanjing University Medical College from December 2017 to December 2019 underwent TBCB and other 91 patients with interstitial lung disease underwent TBLB.Their clinical imaging and pathological data were collected.The surgical status,pathological sampling and diagnostic efficiency of the two lung biopsy methods were compared.Results The operative time of the TBCB group and the TBLB group were(32.4±11.3)and(16.0±6.8)min(T=27.232,P<0.001).The size of biopsy specimens in the TBCB group and the TBLB group were(9.8±3.8)and(1.8±1.2)mm 2(T=24.561,P<0.001).The pathological diagnosis yield in the TBCB group and the TBLB group were 84.6%(77/91)and 20.9%(19/91)(χ^(2)=74.158,P<0.001).All the patients in the TBCB group underwent balloon sealing to prevent hemorrhage,with 36 cases of grade 0 bleeding,40 cases of grade 1 bleeding,and 15 cases of grade 2 bleeding.In the TBLB group,no patient underwent balloon sealing,with 56 cases of grade 0 bleeding,32 cases of grade 1 bleeding,and 3 cases of grade 2 bleeding(χ^(2)=13.237,P<0.001).The incidence of pneumothorax in the TBCB group and the TBLB group was 11.0%(10/91)and 8.8%(8/91)(χ^(2)=0.247,P=0.619).Conclusion Compared with TBLB,TBCB is a safe and effective method for the diagnosis of interstitial lung disease,and it can obtain reliable lung tissue and higher pathologic diagnostic efficiency.