不同肺活检方法诊断老年患者肺部弥漫性间质性疾病的价值研究
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摘要
目的探讨分析不同肺活检方法诊断老年患者肺部弥漫性间质性疾病的临床价值。方法选择2009年3月~2017年9月我院收治的117例弥漫性肺间质性疾病患者,根据患者自愿选择肺活检方式进行分组,其中51例行纤维支气管镜肺活检(TBLB)患者作为TBLB组,穿刺组35例患者行CT引导下经皮穿刺肺活检,外科肺活检组31例患者行电视胸腔镜肺活检或小开胸肺活检,比较分析三种肺活检方法的诊断价值、术后并发症发生率、患者住院时间及手术费用。结果 TBLB组明确检出34例(66.67%),穿刺组明确检出24例(68.57%),外科肺活检组明确检出30例(96.77%),外科肺活检组的检出率显著高于TBLB组与穿刺组(P<0.05),而TBLB组与穿刺组的检出率比较,差异无统计学意义(P>0.05)。外科肺活检组的术后并发症发生率明显高于TBLB组与穿刺组(P<0.05),TBLB组与穿刺组的术后并发症发生率比较,差异无统计学意义(P>0.05)。外科肺活检组患者的术后住院时间长于TBLB组与穿刺组,活检费用显著高于TBLB组与穿刺组(P<0.05),TBLB组与穿刺组的术后住院时间、活检费用比较,差异无统计学意义(P>0.05)。结论对于老年肺部弥漫性间质性肺疾病,可首先考虑采取纤维支气管镜肺活检,而对于全面临床评估后仍无法明确诊断或病理分型需要较大活检组织的患者,可考虑采取电视胸腔镜或开胸肺活检。
Objective To explore and analyze the clinical value of different lung biopsy methods in the diagnosis of diffuse interstitial lung disease in elderly patients. Methods A total of 117 patients with diffuse interstitial lung disease were selected in our hospital from March 2009 to September 2017. According to the patients′ voluntary selection of lung biopsy, 51 patients underwent fiberoptic bronchoscopic lung biopsy(TBLB) were selected as the TBLB group, 35 patients in the puncture group underwent CT guided percutaneous lung biopsy, and 31 patients in the surgical lung biopsy group underwent video-assisted thoracoscopy or lung biopsy and small thoracotomy lung biopsy were performed. The diagnostic value, the incidence rate of postoperative complications, hospitalization time and operative cost of three lung biopsy methods were compared. Results The TBLB group clearly detected 34 cases(66.67%), the puncture group clearly detected 24 cases(68.57%), the surgical lung biopsy group was clearly detected in 30 cases(96.77%). The surgical lung biopsy group was significantly higher than that of the TBLB group and the puncture group(P<0.05), and there was no significant difference between the TBLB group and the puncture group(P >0.05). The incidence of postoperative complications in surgical lung biopsy group was significantly higher than that in the TBLB group and the puncture group(P<0.05). There was no significant difference in the incidence of postoperative complications between the TBLB group and the puncture group(P>0.05). Postoperative hospitalization time in the surgical lung biopsy group were significantly longer than that in the TBLB group and the puncture group,and biopsy cost in the surgical lung biopsy group was significantly higher than that in the TBLB group and the puncture group(P<0.05). There was no significant difference in postoperative hospitalization time and biopsy cost between the TBLB group and the puncture group(P>0.05).Conclusion For elderly patients with pulmonary diffuse interstitial lung disease, first consider transbronchial lung biopsy, and for the full clinical assessment is not clear diagnosis, or pathological type large biopsy patients, which can be taken open or video-assisted thoracoscopic lung biopsy.
Objective To explore and analyze the clinical value of different lung biopsy methods in the diagnosis of diffuse interstitial lung disease in elderly patients. Methods A total of 117 patients with diffuse interstitial lung disease were selected in our hospital from March 2009 to September 2017. According to the patients′ voluntary selection of lung biopsy, 51 patients underwent fiberoptic bronchoscopic lung biopsy(TBLB) were selected as the TBLB group, 35 patients in the puncture group underwent CT guided percutaneous lung biopsy, and 31 patients in the surgical lung biopsy group underwent video-assisted thoracoscopy or lung biopsy and small thoracotomy lung biopsy were performed. The diagnostic value, the incidence rate of postoperative complications, hospitalization time and operative cost of three lung biopsy methods were compared. Results The TBLB group clearly detected 34 cases(66.67%), the puncture group clearly detected 24 cases(68.57%), the surgical lung biopsy group was clearly detected in 30 cases(96.77%). The surgical lung biopsy group was significantly higher than that of the TBLB group and the puncture group(P<0.05), and there was no significant difference between the TBLB group and the puncture group(P >0.05). The incidence of postoperative complications in surgical lung biopsy group was significantly higher than that in the TBLB group and the puncture group(P<0.05). There was no significant difference in the incidence of postoperative complications between the TBLB group and the puncture group(P>0.05). Postoperative hospitalization time in the surgical lung biopsy group were significantly longer than that in the TBLB group and the puncture group,and biopsy cost in the surgical lung biopsy group was significantly higher than that in the TBLB group and the puncture group(P<0.05). There was no significant difference in postoperative hospitalization time and biopsy cost between the TBLB group and the puncture group(P>0.05).Conclusion For elderly patients with pulmonary diffuse interstitial lung disease, first consider transbronchial lung biopsy, and for the full clinical assessment is not clear diagnosis, or pathological type large biopsy patients, which can be taken open or video-assisted thoracoscopic lung biopsy.
引文
[1]管莎,黄宏,赵建平,等.透视引导下103例纤支镜肺活检临床分析[J].中国内镜杂志,2013,19(1):13-18.
[2]王昌国,曾大雄,雷伟,等.CT引导下经皮肺穿刺与超声引导下经支气管镜肺活检对肺周围型病变的诊断价值[J].中华结核和呼吸杂志,2015,38(12):897-900.
[3]Yaffe D,Koslow M,Haskiya H,et al.A novel technique for CT-guided transthoracic biopsy of lung lesions:improved biopsy accuracy and safety[J].Eur Radiol,2015,25(11):3354-3360.
[4]Rotolo N,Imperatori A,Dominioni L,et al.Efficacy and safety of surgical lung biopsy for interstitial disease.Experience of 161 consecutive patients from a single institution in Italy[J].Sarcoidosis Vasc Diffuse Lung Dis,2015,32(3):251-258.
[5]董文,黄奕江,吴海洪,等.内科胸腔镜肺活检对弥漫性间质性肺疾病诊断价值及安全性分析[J].中国内镜杂志,2016,22(2):95-98.
[6]黄禹,任红岩,何碧芳,等.气管内超声非实时引导下经气管镜肺活检对肺周围型病变的诊断价值[J].中华结核和呼吸杂志,2013,36(1):12-16.
[7]Lim CS,Tan LE,Wang JY,et al.Risk factors of pneumothorax after CT-guided coaxial cutting needle lung biopsy through aerated versus nonaerated lung[J].J Vasc Interv Radiol,2014,25(8):1209-1217
[8]图门乌力吉,马忠森.特发性间质性肺炎经支气管镜肺活检组织中TGF-β1的表达及其意义[J].中国实验诊断学,2013,17(7):1219-1222.
[9]Chowdhry VK,Chowdhry AK,Goldman N,et al.Complications from computed tomography-guided core needle biopsy for patients receiving stereotactic body radiation therapy for earlystage lesions of the lung[J].Clin Lung Cancer,2014,15(4):302-306.
[10]Ishii H,Hiraki T,Gobara H,et al.Risk factors for systemic air embolism as a complication of percutaneous CT-guided lung biopsy:multicenter case-control study[J].Cardiovasc Intervent Radiol,2014,37(5):1312-1320.
[11]罗建光,杨东益,陈平,等.支气管镜肺活检在肺泡蛋白沉积症中的诊断价值[J].中南大学学报(医学版),2015,40(5):528-532.
[12]Dhooria S,Sehgal IS,Aggarwal AN,et al.Diagnostic yield and safety of cryoprobe transbronchial lung biopsy in diffuse parenchymal lung diseases:systematic review and Metaanalysis[J].Respir Care,2016,61(5):700-712.
[13]兰学立,李海潮,熊焰,等.经支气管镜肺活检在特发性间质性肺炎中的诊断价值[J].中国呼吸与危重监护杂志,2013,12(1):69-74.
[14]Chami HA,Faraj W,Yehia ZA,et al.Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy:the role of quantitative CT[J].Clin Radiol,2015,70(12):1382-1387.
[2]王昌国,曾大雄,雷伟,等.CT引导下经皮肺穿刺与超声引导下经支气管镜肺活检对肺周围型病变的诊断价值[J].中华结核和呼吸杂志,2015,38(12):897-900.
[3]Yaffe D,Koslow M,Haskiya H,et al.A novel technique for CT-guided transthoracic biopsy of lung lesions:improved biopsy accuracy and safety[J].Eur Radiol,2015,25(11):3354-3360.
[4]Rotolo N,Imperatori A,Dominioni L,et al.Efficacy and safety of surgical lung biopsy for interstitial disease.Experience of 161 consecutive patients from a single institution in Italy[J].Sarcoidosis Vasc Diffuse Lung Dis,2015,32(3):251-258.
[5]董文,黄奕江,吴海洪,等.内科胸腔镜肺活检对弥漫性间质性肺疾病诊断价值及安全性分析[J].中国内镜杂志,2016,22(2):95-98.
[6]黄禹,任红岩,何碧芳,等.气管内超声非实时引导下经气管镜肺活检对肺周围型病变的诊断价值[J].中华结核和呼吸杂志,2013,36(1):12-16.
[7]Lim CS,Tan LE,Wang JY,et al.Risk factors of pneumothorax after CT-guided coaxial cutting needle lung biopsy through aerated versus nonaerated lung[J].J Vasc Interv Radiol,2014,25(8):1209-1217
[8]图门乌力吉,马忠森.特发性间质性肺炎经支气管镜肺活检组织中TGF-β1的表达及其意义[J].中国实验诊断学,2013,17(7):1219-1222.
[9]Chowdhry VK,Chowdhry AK,Goldman N,et al.Complications from computed tomography-guided core needle biopsy for patients receiving stereotactic body radiation therapy for earlystage lesions of the lung[J].Clin Lung Cancer,2014,15(4):302-306.
[10]Ishii H,Hiraki T,Gobara H,et al.Risk factors for systemic air embolism as a complication of percutaneous CT-guided lung biopsy:multicenter case-control study[J].Cardiovasc Intervent Radiol,2014,37(5):1312-1320.
[11]罗建光,杨东益,陈平,等.支气管镜肺活检在肺泡蛋白沉积症中的诊断价值[J].中南大学学报(医学版),2015,40(5):528-532.
[12]Dhooria S,Sehgal IS,Aggarwal AN,et al.Diagnostic yield and safety of cryoprobe transbronchial lung biopsy in diffuse parenchymal lung diseases:systematic review and Metaanalysis[J].Respir Care,2016,61(5):700-712.
[13]兰学立,李海潮,熊焰,等.经支气管镜肺活检在特发性间质性肺炎中的诊断价值[J].中国呼吸与危重监护杂志,2013,12(1):69-74.
[14]Chami HA,Faraj W,Yehia ZA,et al.Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy:the role of quantitative CT[J].Clin Radiol,2015,70(12):1382-1387.