Yang Wei, He Bei
Department of Respiratory Disease, Peking University Third Hospital, Beijing 100191, China.
Zhonghua Yi Xue Za Zhi. 2009 Jan 13;89(2):109-13.
To investigate the complication rate of lung biopsy in patients with idiopathic interstitial pneumonia (IIP) and the risk factors thereof.
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).
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, chi2 = 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.
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.
探讨特发性间质性肺炎（IIP）患者肺活检的并发症发生率及其危险因素。
分析66例行肺活检的IIP患者的临床资料。66例患者中，21例行外科肺活检（SLB），包括开胸肺活检（OLB）（n = 11）和电视辅助胸腔镜手术（VATS）（n = 10），45例患者行非SLB活检，包括经支气管肺活检（TBLB，n = 28）和CT或B超引导下经皮经胸肺穿刺活检（n = 17）。
术后总并发症发生率为40.9%（27/66），SLB组术后并发症发生率为71.4%（15/21），显著高于非SLB组（26.7%，12/45，χ2 = 4.55，P = 0.03）。SLB组并发症包括漏气时间延长（n = 10，47.6%）、胸腔积液（n = 5，23.8%）、急性肺水肿（n = 5，23.8%）和术后肺部感染（n = 4，19.0%），非SLB组并发症包括经皮经胸肺穿刺活检或TBLB后气胸（n = 12，26.7%）、急性加重（AE）（n = 2，4.4%）、需要机械通气超过72小时的呼吸衰竭（n = 1，2.2%）和术后肺部感染（n = 1，2.2%）。SLB组有术后并发症患者的预测肺一氧化碳弥散量（DLCO%）为（46.83±17.01）%，显著高于无术后并发症的SLB组患者[（75.93±25.62）%，t = 2.55，P = 0.02]。然而，不同肺活检方法的患者，无论有无术后并发症，其肺功能和血气指标差异均无统计学意义。66例患者中有6例在术后90天内死亡，死亡率为9.1%，其中3例死亡原因与肺活检有关。
与其他肺活检方法相比，接受SLB的IIP患者术后并发症更多，DLCO%降低可能是相关因素。CT引导下经皮经胸肺穿刺活检和TBLB可诱发IIP患者发生AE并导致死亡。
