经支气管冷冻活检在肺移植术后并发症的诊断价值和安全性研究  

Diagnostic value and safety of transbronchial cryobiopsy in postoperative complications after lung transplantation

作　　者：肖仁森 赵丽[1] 郭丽娟 邢斌[1] 侯刚 赵玲 王蓓[3] 陈文慧[1] Xiao Rensen;Zhao Li;Guo Lijuan;Xing Bin;Hou Gang;Zhao Ling;Wang Bei;Chen Wenhui(Department of Lung Transplantation,Center of Respiratory Medicine,China-Japan Friendship Hospital,National Center for Respiratory Medicine,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,National Clinical Research Center for Respiratory Diseases,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention,Beijing 100029,China;Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,National Center for Respiratory Medicine,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,National Clinical Research Center for Respiratory Diseases,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention,Beijing 100029,China;Department of Pathology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院呼吸中心肺移植科,国家呼吸医学中心,中国医学科学院呼吸病学研究院,国家呼吸疾病临床医学研究中心,世界卫生组织戒烟与呼吸疾病预防合作中心,北京100029 [2]中日友好医院呼吸中心呼吸与危重症医学科,国家呼吸医学中心,中国医学科学院呼吸病学研究院,国家呼吸疾病临床医学研究中心,世界卫生组织戒烟与呼吸疾病预防合作中心,北京100029 [3]中日友好医院病理科,北京100029

出　　处：《中华结核和呼吸杂志》2024年第11期1091-1096,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-049);国家高水平医院临床科研经费(2022-NHLHCRF-LX-01)。

摘　　要：目的比较经支气管肺冷冻活检(TBCB)和经支气管肺活检(TBLB)在肺移植术后并发症的诊断率和安全性。方法回顾性分析中日友好医院肺移植科2017年6月至2024年6月间连续接受TBCB或TBLB的肺移植术后患者,以确定其术后并发症,并分析患者临床特征、操作流程、诊断率及安全性。结果35例和153例肺移植术后患者分别接受了TBCB和TBLB,接受TBCB的患者操作前氧合指数更低(t=2.4,P<0.01),接受TBCB的患者病理诊断率(85.7%vs 45.7%,χ^(2)=18.27,P<0.01)和临床诊断率(94.2%vs 69.9%,χ^(2)=8.80,P<0.01)明显高于接受TBLB的患者。接受TBCB和TBLB的患者重度出血发生率(2.9%vs 0.7%,χ^(2)=1.30,P=0.86)和气胸的发生率(0vs 3.9%,χ^(2)=0.43,P=0.24)差异无统计学意义。接受TBCB患者肺移植术后常见并发症为慢性肺移植物功能障碍(45.4%,15/33)、抗体介导排异反应(18.2%,6/33)、机化性肺炎(12.2%,4/33),而TBLB患者为抗体介导排异反应(29.9%,32/107)、慢性肺移植物功能障碍(16.8%,18/107)、肺炎(16.8%,18/107)。结论TBCB对于肺移植术后的并发症诊断价值高,出血和气胸风险可控。Objective To compare the diagnostic rate and safety of postoperative complications between transbronchial cryobiopsy(TBCB)and transbronchial lung biopsy(TBLB)in patients with lung transplantation.Methods A retrospective analysis of patients who underwent TBCB or TBLB in the Department of Lung Transplantation in China-Japan Friendship Hospital from June 2017 to June 2024 was conducted to determine the postoperative complications and analyze clinical characteristics,procedures,diagnostic rates and safety.Results Thirty-five and 153 patients with lung transplantation received TBCB and TBLB,respectively.Patients who received TBCB had lower preoperative oxygenation index(t′=2.4,P<0.01).Meanwhile,the pathological diagnosis rate(85.7%vs.45.7%,χ^(2)=18.27,P<0.01)and clinical diagnosis rate(94.2%vs.69.9%,χ^(2)=8.80,P<0.01)of patients who received TBCB were significantly higher than those who received TBLB.There was no significant difference in the incidence of severe bleeding(2.9%vs.0.7%,χ^(2)=1.3,P=0.86)and pneumothorax(0 vs.3.9%,χ^(2)=0.43,P=0.24)between patients receiving TBCB and TBLB.The most common complications after lung transplantation in the group of TBCB were chronic lung allograft dysfunction(45.4%,15/33),antibody mediated rejection(18.2%,6/33)and organizing pneumonia(12.2%,4/33).While antibody mediated rejection(29.9%,32/107),chronic lung allograft dysfunction(16.8%,18/107),and pneumonia(16.8%,18/107)were more frequent in the patients who received TBLB.Conclusions TBCB has a high diagnostic value for postoperative complications after lung transplantation,with an acceptable complication rate of bleeding and pneumothorax.

关 键 词：肺移植 冷冻疗法 活组织检查 手术后并发症 安全性 

分 类 号：R655.3[医药卫生—外科学]