Chang Chih-Hao, Kao Kuo-Chin, Hu Han-Chung, Hung Chen-Yiu, Li Li-Fu, Wu Ching-Yang, Wang Chih-Wei, Fu Jui-Ying, Huang Chung-Chi, Chen Ning-Hung, Yang Cheng-Ta, Tsai Ying-Huang
J Cardiothorac Surg. 2013 May 16;8:128. doi: 10.1186/1749-8090-8-128.
This retrospective study evaluated the utility and safety of surgical lung biopsy (SLB) in cancer patients with acute respiratory distress syndrome (ARDS).
All cases of critically ill patients with cancer and diagnosed with ARDS who underwent SLB in a tertiary care hospital from January 2002 to July 2009 were reviewed. Clinical data including patient baseline characteristics, surgical complications, pathological findings, treatment alterations, and survival outcomes were retrospectively collected and analyzed.
A total of 16 critically ill patients with cancer diagnosed with ARDS who underwent SLB were enrolled. The meantime from ARDS onset to SLB was 3.0 ± 1.5 days. All SLB specimens offered a pathological diagnosis, and specific diagnoses were made in 9 of 16 patients. Biopsy findings resulted in a change in therapy in 11 of 16 patients. Overall, the SLB surgical complication rate was 19% (3/16). SLB did not directly cause the observed operative mortality. The ICU mortality rate was 38% (6/16). Patients who switched therapies after SLB had a trend toward decreased mortality than patients without a change in therapy (27% versus 60%; P = 0.299).
In selected critically ill cancer patients with ARDS, SLB had a high diagnostic yield rate and an acceptable surgical complication rate.
本回顾性研究评估了手术肺活检（SLB）在急性呼吸窘迫综合征（ARDS）癌症患者中的实用性和安全性。
回顾了2002年1月至2009年7月在一家三级护理医院接受SLB的所有患有癌症且被诊断为ARDS的重症患者病例。回顾性收集并分析了包括患者基线特征、手术并发症、病理结果、治疗改变和生存结局在内的临床数据。
共有16例患有癌症且被诊断为ARDS的重症患者接受了SLB。从ARDS发病到SLB的时间为3.0±1.5天。所有SLB标本均提供了病理诊断，16例患者中有9例做出了明确诊断。活检结果导致16例患者中有11例治疗发生改变。总体而言，SLB手术并发症发生率为19%（3/16）。SLB并未直接导致观察到的手术死亡率。ICU死亡率为38%（6/16）。SLB后改变治疗的患者死亡率有低于未改变治疗患者的趋势（27%对60%；P = 0.299）。
在选定的患有ARDS的重症癌症患者中，SLB具有较高的诊断率和可接受的手术并发症发生率。
