经支气管肺活检术诊断肺移植术后患者的并发症  

of post-transplantation complications Transbronchial lung biopsy for the diagnosis

作　　者：陈国勤[1] 顾莹莹[2] 赵瑾[2] 莫明聪[1] 刘蓉[2] 肖东[2] 何健行[2] 

机构地区：[1]广州医科大学附属第一医院病理科,510120 [2]国家重点实验室广州呼吸疾病研究所

出　　处：《中华生物医学工程杂志》2014年第2期142-145,共4页Chinese Journal of Biomedical Engineering

基　　金：广东省科技项目（粤科社字[2011]106号）

摘　　要：目的采用经支气管肺活检术（TBLB）观察肺移植术后患者并发症的病理特点。方法回顾性分析2003年1月至2013年08月本院的16例行TBLB的肺移植术后患者的活检组织，常规HE染色后观察各种并发症的发生情况和急、慢性排斥反应患者肺组织的病理特点，感染的病例行病毒包涵体、PAS及六胺银染色观察感染情况。结果16例肺移植术后患者中有6例细菌感染，2例真菌感染，3例巨细胞病毒感染，2例出现急性排斥反应，2例出现慢性排斥反应，1例送检物为纤维素性渗出物，未能提供病理诊断。2例急性排斥反应患者肺组织以血管周单核样淋巴细胞浸润为特点，可往肺间质浸润；2例慢性排斥反应患者肺组织可见小气道和（或）血管内皮下纤维增生伴瘢痕形成。11例感染患者肺组织PAS和六胺银染色可见孢子和菌丝，病毒包涵体染色可见嗜酸性病毒包涵体。结论TBLB可以诊断肺移植术后并发症的发生，感染是肺移植术后最常见的并发症，其次是急、慢性排斥反应。Objective To investigate the pathological characteristics of post- transplantation complications by using transbronchial lung biopsies （TBLB）. Methods A retrospective analysis with TBLB was conducted on 16 patients who underwent lung transplantation in the First Affiliated Hospital, Guangzhou Medical University, between January 2003 and August 2013. Pathological features of lung tissues from patients with acute or chronic rejection were observed after HE staining. The cases with signs of infection were further studied by viral inclusion, PAS and methenamine silver staining. Results Of the 16 cases, 6 had bacterial, 2 fungal and 3 CMV infection. Two cases developed acute rejection （AR） and 2 chronic rejection （CR）. In one case, the pathological diagnosis was not determined because of the massive fibrous exudates. Lung tissue in 2 AR cases was characterized by perivascular infiltration of mononuclear lymphocytes with possible signs of interstitial pulmonary infiltration. In 2 CR cases with, the lung tissue was characterized by fibroplasia and cicatrization inferior to the endothelia of small airways and/or blood vessels. Spores and hyphae were observed in lung tissues from 11 cases with infection, based on PAS and methenamine silver staining. Eosinophilic viral inclusion bodies were demonstrated by viral inclusion staining. Conclusion TBLB can be applied to diagnose the complications after lung transplantation, in particular the infection, followed by acute and chronic rejection.

关 键 词：肺移植 支气管镜检查 并发症 

分 类 号：R655.3[医药卫生—外科学]