|摘要||目的 了解特发性间质性肺病(IIP)患者肺活检并发症的发生率并分析相关危险因素.方法 对1993年11月至2008年2月行肺活检的66例IIP患者的临床资料进行回顾性分析.患者按肺活检方式分2组:(1)外科肺活检(SLB)组,21例,其中开胸肺活检11例,胸腔镜引导下肺活检10例;(2)非SLB组,45例,其中纤维支气管镜引导下肺活检(TBLB)28例,CT或B超引导下肺活检17例.统计患者肺活检并发症发生率,并将2组患者分别按有、无并发症分组,进行人院时一般情况、症状、体征、肺功能、动脉血气分析、病理分型比较.肺活检并发症包括肺部感染、胸腔引流管拔管时间≥5 d、机械通气时间>72 h、急性左心衰竭、胸腔积液、气胸、咯血量>50 ml/d和IIP急性加重.统计患者术后90 d内病死率.结果 术后并发症总发生率为40.9%(27/66),SLB组为71.4%(15/21),非SLB组为26.7%(12/45)(x2=4.55,P=0.03).SLB组并发症为胸腔引流管拔管时间延长(10例,47.6%)、胸腔积液(5例,23.8%)、急性左心衰竭(5例,23.8%)和肺部感染(4例,19.0%);非SLB组并发症为气胸(12例,26.7%)、IIP急性加重(2例,4.4%)、机械通气>72 h(1例,2.2%)和肺部感染(1例,2.2%).SLB组有、无并发症患者的一氧化碳弥散量(DLCO)占预计值百分比分别为(46.83 ±17.01)%和(75.93 ±25.62)%(t=2.55,P=0.02),其余各项指标比较差异均无统计学意义.非SLB组有、无并发症患者各项指标比较差异均无统计学意义.肺活检后90 d内6例(9.1%)患者死亡,其中3例考虑与肺活检相关(CT导引下肺活检和TBLB术后出现IIP急性加重各1例,CT导引下肺穿刺后出现气胸致呼吸衰竭1例).结论 接受SLB患者较接受非SLB患者术后并发症发生率高.DLCO占预计值百分比低于正常可能是外科肺活检出现合并症的相关因素.Cr引导下肺活检或TBLB也可能诱发IIP急性加重而致死亡.
Objective To investigate the complication rate of lung biopsy in patients with idiopathic interstitial pneumonia (IIP) and the risk factors thereof. Methods The clinical data of 66 IIP patients underwent lung biopsy were analyzed. Of the 66 patients, 21 undergoing surgical lung biopsy ( SLB ) including open lung biopsy (OLB) (n = 11 ) and video-assisted thoracic surgery (VATS) (n = 10), and 45 patients undergoing biopsy other than SLB, including transbronchial lung biopsy (TBLB, n = 28 ) and CT or B mode ultrasonography-guided percutaneous transthoracic needle lung biopsy ( n = 17 ) . Results The general postoperative complication rate was 40. 9% (27/66), and the postoperative complication rate was 71.4% ( 15/21 ) in the SLB group, significantly higher than that of the non-SLB group (26.7% , 12/45, X2 = 4.55, P = 0. 03 ). The complications of the SLB group included prolonged air leakage (n = 10, 47.6% ), pleural effusion (n = 5, 23.8% ), acute pulmonary edema (n = 5, 23.8% ) , and postoperative pulmonary infection (n =4, 19.0% ), and the complications of the non-SLB group included pneumothorax after percutaneous transthoracic lung needle biopsy or TBLB (n = 12, 26.7% ), acute exacerbation (AE) ( n = 2, 4.4% ), respiratory failure requiring mechanical ventilation for more than 72 h ( n = 1, 2.2% ), and postoperative pulmonary infection ( n = 1, 2.2% ). The predicted diffusing capacity of the lings for carbon monoxide ( DLCO% ) of the SLB group patients with postoperative complications was (46. 83 ±17.01 )%, significantly higher than that of the SLB group patients without postoperative complication [ (75.93±25.62) %, t = 2.55, P = 0. 02 ]. However, there were not significant differences in the lung function and blood gas indexes among the patients undergoing different procedures of lung biopsy, with and without postoperative complications. Six of the 66 patents died within 90 postoperative days with a mortality of 9.1%, the causes of death of 3 of which were associated with lung biopsy. Conclusions The IIP patients undergoing SLB suffer from more postoperative complications than those undergoing other lung biopsy procedures with the lower DLCO% as the probable associated factor. AE in the IIP patients can be induced by CT-guided percutaneous transthoracic needle lung biopsy and TBLB, and results in death.|