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作 者:彭敏[1] 许文兵[1] 徐作军[1] 蔡柏蔷[1] 朱元珏[1] 刘鸿瑞[2] 张伟宏[3] 宋兰[3] 王孟昭[1] 李单青 施举红[1] 冯瑞娥[2] Peng Min;Xu Wenbing;Xu Zuojun;Cai Baiqiang;Zhu Yuanjue;Liu Hongrui;Zhang Weihong;Song Lan;Wang Mengzhao;Li Shanqing;Shi Juhong;Feng Ruie(Department of Pulmonary and Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Thoracic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)
机构地区:[1]中国医学科学院北京协和医学院北京协和医院呼吸与危重症科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院病理科,北京100730 [3]中国医学科学院北京协和医学院北京协和医院放射科,北京100730 [4]中国医学科学院北京协和医学院北京协和医院胸外科,北京100730
出 处:《中华结核和呼吸杂志》2022年第3期255-260,共6页Chinese Journal of Tuberculosis and Respiratory Diseases
摘 要:目的观察经外科肺活检诊断弥漫性实质性肺疾病(DPLD)的疾病谱变迁并探讨外科肺活检在DPLD中的诊断价值。方法回顾性分析北京协和医院1993年1月至2020年12月28年间连续455例接受外科肺活检的DPLD病例资料,其中男211例,女244例,接受活检时年龄(45±14)岁。按照1993—2002、2003—2012、2013—2020年分为3个时间段进行疾病谱比较。结果411例(411/455,90.3%)经病理形态学明确诊断,441例(441/455,96.9%)经临床-影像-病理多学科讨论后确诊。术后30 d病死率为2.4%(11/455),术后3个月病死率为3.3%(15/455)。本组患者中间质性肺炎209例(209/455,45.9%),其中非特异性间质性肺炎105例,寻常性间质性肺炎33例;其他类型DPLD为166例(166/455,36.5%),其中过敏性肺炎49例;肿瘤39例(39/455,8.6%);感染性疾病27例(27/455,5.9%)。1993—2002、2003—2012、2013—2020年外科肺活检数量分别为76例(76/455,16.7%)、297例(297/455,65.3%)和82例(82/455,18%)。在上述3个时间段内,间质性肺炎占DPLD的比例分别为68.4%、45.1%和28.0%,其他类型DPLD为22.4%、39.4%和39.0%,肿瘤为2.6%、7.4%和18.3%,感染为5.3%、5.1%和9.8%。结论DPLD外科肺活检疾病谱随时间的变化反映了临床医生对DPLD和间质性肺炎认识不断深入的过程以及诊治策略的变化。对于某些疑难的、诊断困难、治疗方向不明的DPLD,外科肺活检仍然具有重要价值。Objective To investigate the changes of disease spectrum in diffuse parenchymal lung disease(DPLD)diagnosed by surgical lung biopsy,and to explore the diagnostic value of surgical lung biopsy in DPLD.Methods Four hundred and fifty-five consecutive DPLD patients,who underwent surgical lung biopsy in Peking Union Medical College Hospital during the past 28 years,were analyzed retrospectively.Results There were 211 males and 244 females.The average age at biopsy was(45±14)years.Four hundred and eleven cases(90.3%)were diagnosed by pathologic findings.Four hundred and forty-one cases(96.9%)were diagnosed by clinical-radiologic-pathologic multidisciplinary discussion.The 30-day mortality and 90-day mortality were 2.4%and 3.3%respectively.The disease spectrum included interstitial pneumonia in 209 cases(45.9%)(nonspecific interstitial pneumonia in 105 cases,usual interstitial pneumonia in 33 cases),other miscellaneous DPLD in 166 cases(36.5%)(including hypersensitivity pneumonitis in 49 cases),tumor in 39 cases(8.6%),and infectious diseases in 27 cases(5.9%).In the three consecutive periods(1993-2002,2003-2012 and 2013-2020),the number of biopsies was 76(16.7%),297(65.3%)and 82(18%)respectively.The disease spectrum changes over time:in the above three periods,the percentage of interstitial pneumonia in DPLD was 68.4%,45.1%and 28%,other miscellaneous DPLDs were 22.4%,39.4%and 39.0%,the tumors were 2.6%,7.4%and 18.3%,the infectious diseases were 5.3%,5.1%and 9.8%.Conclusions This study presented the changes of disease spectrum in DPLD diagnosed by surgical lung biopsy through single center real-world data,reflecting the progress of clinicians′understanding of DPLD and interstitial pneumonia.Surgical lung biopsy is still valuable for some difficult and complicated DPLD cases.
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