摘要
目的探讨经支气管冷冻肺活检(TBCB)在尘肺病诊断中的有效性和安全性。方法收集2016年5月至2018年11月重庆医科大学附属第一医院收治的接尘且诊断不明患者14例。将肺活检组织的病理结果,结合粉尘接触史、临床及影像学特征等进行综合分析,明确TBCB对尘肺病诊断的有效性。观察并记录术中、术后并发症的发生率及严重程度,明确TBCB对尘肺病诊断的安全性。结果 14例接受TBCB的患者中有13例在硬质支气管镜联合软性支气管镜下完成,1例在气管插管联合软性支气管镜下完成,操作时间(50.71±21.86)min。每例获得组织标本数量为(6.71±1.27)块,标本大小为8(1,25)mm^2。病理诊断提示:11例职业相关的间质性肺病;1例普通型间质性肺炎;1例提示肉芽肿,考虑增殖性结核或结节病可能;1例过敏性肺泡炎可能。经多学科会诊,最终确诊尘肺病7例,普通间质性肺炎1例,结节病1例,过敏性肺泡炎1例,4例诊断不明,明确诊断率71.43%(10/14)。根据2013英国胸科协会制定的成人支气管镜检查指南行术中出血分级,术中严重出血2例,中度出血3例,经止血处理后出血均停止;气胸1例,肺压缩约30%,行胸腔穿刺抽气后吸收。结论 TBCB是一种安全有效的肺活检技术,可获得尘肺病病理学证据,对尘肺病的诊断及鉴别诊断具有较高的应用价值。
Objective To investigate the efficacy and safety of transbronchial cryobiopsy(TBCB) in the diagnosis of pneumoconiosis. Methods A total of 14 cases with a history of exposure to dust but without a confirmed diagnosis were included in the study and underwent TBCB from May 2016 to November 2018. Lung tissue obtained with TBCB was subjected to pathological examination, and the results were analyzed based on dust exposure history, clinical manifestations and radiologic findings in order to evaluate the effectiveness of TBCB in the diagnosis of pneumoconiosis. Meanwhile, the incidence and severity of complications were observed and recorded to determine the safety of TBCB in the diagnosis of pneumoconiosis. Results TBCB was performed in 13 cases under rigid bronchoscopy combined with flexible bronchoscopy, and in 1 case under flexible bronchoscopy with endotracheal intubation. The duration of the procedure of TBCB was(50.71 ± 21.86)minutes on average. The number of tissue samples obtained in each case was6.71±1.27,and the median size of tissues was 8 mm^2(ranging 1-25 mm^2). Pathological diagnosis revealed11 cases of occupation-related interstitial lung diseases, 1 case of usual interstitial pneumonia, 1 case of granuloma indicative of proliferative tuberculosis or sarcoidosis, and 1 possible case of allergic alveolitis.After multidisciplinary discussion, the final diagnoses were 7 cases of pneumoconiosis, 1 case of usual interstitial pneumonia, 1 case of sarcoidosis,1 case of allergic alveolitis, and the diagnosis of 4 cases was unknown. The diagnostic rate was 71.43%(10/14).Among them, 2 cases were classified as severe hemorrhage and 3 cases as moderate hemorrhage according to British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults. After hemostastic treatment, the hemorrhages stopped. A moderate pneumothorax occurred in 1 case with 30% of lung collapse, which was absorbed after thoracic drainage. Conslusion TBCB is a safe and effective lung biopsy technique which provides information on pathological changes of pneumoconiosis, and is of great value in the diagnosis and differential diagnosis of pneumoconiosis.
作者
曾婉
敖知
李一诗
金盛辉
易祥华
李娴
江瑾玥
金星星
肖洋
江涛
刘心竹
郭述良
ZENG Wan;AO Zhi;LI Yi-shi;JIN Sheng-hui;YI Xiang-hua;LI Xian;JIANG Jin-yue;JIN Xing-xing;XIAO Yang;JIANG Tao;LIU Xin-zhu;GUO Shu-liang(Department of Respiratoty and Critical Care Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2020年第2期133-139,共7页
Chinese Journal of Practical Internal Medicine
基金
重庆市卫计委首批重庆市中青年医学高端人才工作室项目(编号渝卫人〔2018〕2号)
重庆市卫生计生委2016年适宜卫生技术推广项目气道疾病微创介入诊疗适宜技术推广(2016jstg005)
关键词
尘肺病
经支气管冷冻肺活检
病理
诊断
pneumoconiosis
transbronchial cryobiopsy
pathology
diagnosis
