冷冻肺活检对间质性肺疾病诊断有效性及安全性的前瞻性研究  

The efficacy and safety of transbronchial lung cryobiopsy in interstitial lung disease： a prospective study

作　　者：陈小波[1] 罗群[1] 陈愉[1] 韩茜[1] 钟长镐[1] 萧伟权 苏柱泉[1] 姚遥 李时悦[1] Chen Xiaobo;Luo Qun;Chen Yu;Han Qian;Zhong Changhao;Xiao Weiquan;Su Zhuquan;Yao Yao;Li Shiyue(State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China)

机构地区：[1]广州医科大学附属第一医院广州呼吸健康研究院呼吸疾病国家重点实验室国家呼吸系统疾病临床医学研究中心,510120

出　　处：《中华结核和呼吸杂志》2018年第6期467-471,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的通过对比经支气管冷冻肺活检（TBCB）和常规经支气管肺活检（TBLB）在间质性肺疾病（ILD）诊断中的有效性及安全性，探讨TBCB在ILD诊断中的应用价值。方法采用前瞻性自身对照研究，选择2017年1—4月在广州医科大学附属第一医院住院的诊断不明ILD需行肺活检的25例患者，男16例，女9例，年龄24～70岁，平均（51±13）岁。所有患者均在全身麻醉下先后行TBLB（TBLB组）及TBCB（TBCB组），比较两种活检方法的标本大小、操作时间、并发症和病理诊断效率。符合正态分布的计量资料组间比较采用t检验，非正态分布的计量资料采用Wilcoxon秩和检验，两组间出血发生率及病理活检阳性率的比较采用χ^2检验。结果TBCB组及TBLB组活检标本大小分别为（12.3±4.9）和（3.1±1.9）mm2（t＝－18.268，P＝0.000），操作时间分别为（7.8±3.2）和（5.4±2.1） min（Z＝－3.001，P＝0.003）。TBCB组18例（72%）明确病理分型诊断，2例（8%）提供有价值的病理诊断，5例（20%）未能分型；TBLB组3例（12%）明确病理分型诊断，22例（20%）未能分型。TBCB和TBLB病理诊断效率为80%（20/25）和12%（3/25）（χ^2＝20.779，P＝0.000）。两组均未发生气胸及严重的大出血，在轻中度出血方面TBCB组和TBLB组分别为47.2%（50/106）和18.9%（20/106），差异有统计学意义（χ^2＝19.195，P＝0.000）。结论相对于TBLB，TBCB在获得标本大小及病理诊断效率具有明显的优势，安全性良好，对诊断未明的ILD有较好的价值。Objective To evaluate the efficacy and safety of transbronchial lung cryobiopsy （TBCB） and conventional transbronchial lung biopsy （TBLB） in the diagnosis of interstitial lung diseases（ILD）.Methods A prospective, self-control study was conducted during January 2017 and April 2017 in First Affiliated Hospital of Guangzhou Medical University. A total of 25 patients [male 16, female 9; mean age （51±13） years, range 24 to 70 years] with inconclusive diagnosis of interstitial lung diseases were sequentially enrolled. In the study, TBCB （TBCB group） and TBLB （TBLB group） were performed successively under general anesthesia in all patients. The size of biopsy specimens, the duration of procedures, complications and pathological Results were recorded. Gaussian distribution data were compared between 2 groups by using Student′s t test, while abnormal distribution data were compared by using Wilcoxon rank sum test. The incidences of bleeding and pathologic diagnostic yield between the 2 groups were compared by using Pearson chi-square test. A P-value〈 0.05 was assumed to be statistically significant.Results The specimen sizes of TBCB group and TBLB group were （12.3＋ 4.9） and （3.1＋ 1.9） mm2 respectively （t=-18.268, P=0.000）. The duration of procedures was （7.8±3.2） and （5.4±2.1）min respectively （Z=-3.001, P=0.003）. In TBCB group, the diagnostic yield was 72% （18/25）, with valuable pathological Results in 2 cases （8%）, but in 5 cases （20%） it failed to provide valuable pathological Results . In TBLB group, the diagnostic yield was 12% （3/25）. There were no useful pathological Results in other 22 cases. The difference in the rate of useful pathological Results between TBCB group and TBLB group was significant （χ^2=20.779, P=0.000）. There was no pneumothorax or severe bleeding. The rate of mild to moderate bleeding in TBCB group and TBLB group was 47.2%（50/106） and 18.9%（20/106） （χ^2=19.195, P=0.000） respectively.Conclusion TBCB is

关 键 词：活组织检查 冷冻 肺疾病 间质性 支气管镜检查 

分 类 号：R563[医药卫生—呼吸系统]