Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital Hannover, Hannover, Germany.
Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.
Pediatr Pulmonol. 2018 Jul;53(7):948-953. doi: 10.1002/ppul.23999. Epub 2018 Mar 26.
Histopathological assessment of lung biopsies does play an important diagnostic role in children's interstitial lung disease (ChILD). Thoracoscopic lung biopsy has been shown to be safe and effective. The aim of this study was to evaluate the diagnostic accuracy of thoracoscopic lung biopsies in children with ChILD. Furthermore, therapeutic relevance of the procedure, operative details, and perioperative complications of our series were investigated.
We retrospectively reviewed all consecutive thoracoscopic lung biopsies taken from children with suspected ChILD in our institution over an 11-year period. Feasibility and complications were evaluated as well as histopathological diagnoses according to the recent ChILD classification and relevance of the procedure for medical treatment.
Fifty-nine patients (54.2% male, median age 7 years [8 d-18 y]) underwent 112 thoracoscopic lung biopsies. An endostapler (27%), endoloop ligature (63%), or cut and suture technique (10%) were used. A chest tube was placed in 54% of the cases. Complications occurred in 15% of cases and mainly consisted of pneumothoraces or bleedings. Adequate tissue was obtained in all but one case and the biopsy led to a specific diagnosis according to the ChILD classification in 98%. Medical treatment of the underlying disease was changed due to the results of the biopsy in 86%.
The diagnostic accuracy of thoracoscopic lung biopsies in children with suspected ChILD is high. The histopathologic results lead to a disease-specific treatment in the majority of the cases. Thoracoscopic lung biopsy is a safe and effective procedure with a low complication rate.
组织病理学评估在儿童间质性肺病（ChILD）的诊断中起着重要作用。胸腔镜肺活检已被证明是安全有效的。本研究旨在评估胸腔镜肺活检在儿童 ChILD 中的诊断准确性。此外，还研究了我们系列的手术相关的治疗效果、操作细节和围手术期并发症。
我们回顾性分析了 11 年来我院疑似 ChILD 的儿童连续接受的所有胸腔镜肺活检。评估了可行性和并发症，以及根据最新的 ChILD 分类进行的组织病理学诊断和该程序对治疗的相关性。
59 例患儿（男 27 例，女 32 例，男女性别比 0.81:1），中位年龄 7 岁（8 天-18 岁），共接受 112 例胸腔镜肺活检。使用吻合器（27%）、套扎器（63%）或切割缝合器（10%）。54%的病例放置了胸腔引流管。15%的病例发生了并发症，主要是气胸或出血。除 1 例外，所有病例均获得了足够的组织，根据 ChILD 分类，98%的病例获得了明确诊断。由于活检结果，86%的病例改变了基础疾病的治疗。
胸腔镜肺活检在疑似 ChILD 的儿童中具有较高的诊断准确性。组织病理学结果使大多数病例得到了特定的治疗。胸腔镜肺活检是一种安全有效的方法，并发症发生率低。
