经支气管冷冻活检在肺移植术后并发症的诊断价值和安全性研究

Diagnostic value and safety of transbronchial cryobiopsy in postoperative complications after lung transplantation

目的比较经支气管肺冷冻活检(TBCB)和经支气管肺活检(TBLB)在肺移植术后并发症的诊断率和安全性。方法回顾性分析中日友好医院肺移植科2017年6月至2024年6月间连续接受TBCB或TBLB的肺移植术后患者,以确定其术后并发症,并分析患者临床特征、操作流程、诊断率及安全性。结果35例和153例肺移植术后患者分别接受了TBCB和TBLB,接受TBCB的患者操作前氧合指数更低(t=2.4,P<0.01),接受TBCB的患者病理诊断率(85.7%vs 45.7%,χ^(2)=18.27,P<0.01)和临床诊断率(94.2%vs 69.9%,χ^(2)=8.80,P<0.01)明显高于接受TBLB的患者。接受TBCB和TBLB的患者重度出血发生率(2.9%vs 0.7%,χ^(2)=1.30,P=0.86)和气胸的发生率(0vs 3.9%,χ^(2)=0.43,P=0.24)差异无统计学意义。接受TBCB患者肺移植术后常见并发症为慢性肺移植物功能障碍(45.4%,15/33)、抗体介导排异反应(18.2%,6/33)、机化性肺炎(12.2%,4/33),而TBLB患者为抗体介导排异反应(29.9%,32/107)、慢性肺移植物功能障碍(16.8%,18/107)、肺炎(16.8%,18/107)。结论TBCB对于肺移植术后的并发症诊断价值高,出血和气胸风险可控。

Objective To compare the diagnostic rate and safety of postoperative complications between transbronchial cryobiopsy(TBCB)and transbronchial lung biopsy(TBLB)in patients with lung transplantation.Methods A retrospective analysis of patients who underwent TBCB or TBLB in the Department of Lung Transplantation in China-Japan Friendship Hospital from June 2017 to June 2024 was conducted to determine the postoperative complications and analyze clinical characteristics,procedures,diagnostic rates and safety.Results Thirty-five and 153 patients with lung transplantation received TBCB and TBLB,respectively.Patients who received TBCB had lower preoperative oxygenation index(t′=2.4,P<0.01).Meanwhile,the pathological diagnosis rate(85.7%vs.45.7%,χ^(2)=18.27,P<0.01)and clinical diagnosis rate(94.2%vs.69.9%,χ^(2)=8.80,P<0.01)of patients who received TBCB were significantly higher than those who received TBLB.There was no significant difference in the incidence of severe bleeding(2.9%vs.0.7%,χ^(2)=1.3,P=0.86)and pneumothorax(0 vs.3.9%,χ^(2)=0.43,P=0.24)between patients receiving TBCB and TBLB.The most common complications after lung transplantation in the group of TBCB were chronic lung allograft dysfunction(45.4%,15/33),antibody mediated rejection(18.2%,6/33)and organizing pneumonia(12.2%,4/33).While antibody mediated rejection(29.9%,32/107),chronic lung allograft dysfunction(16.8%,18/107),and pneumonia(16.8%,18/107)were more frequent in the patients who received TBLB.Conclusions TBCB has a high diagnostic value for postoperative complications after lung transplantation,with an acceptable complication rate of bleeding and pneumothorax.