Department of Surgery, Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Department of Medicine, Division of Anesthesiology and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA.
Reg Anesth Pain Med. 2020 Apr;45(4):255-259. doi: 10.1136/rapm-2019-100686. Epub 2020 Feb 16.
Interstitial lung disease (ILD) management guidelines support lung biopsy-guided therapy. However, the high mortality associated with thoracoscopic lung biopsy using general anesthesia (GA) in patients with ILD has deterred physicians from offering this procedure and adopt a diagnostic approach based on high-resolution CT. Here we report that thoracoscopy under regional anesthesia could be a safer alternative for lung biopsy and effectively guide ILD treatment.
This was a single-center retrospective review of prospectively maintained database and consisted of patients who underwent thoracoscopic lung biopsy between March 2016 and March 2018. Patients were divided into two groups: (A) GA, and (B) regional anesthesia using monitored anesthesia care (MAC) and thoracic epidural anesthesia (TEA).
During the study period, 44 patients underwent thoracoscopic lung biopsy. Of these, 15 underwent MAC/TEA. There were no significant differences between the two groups with regard to pulmonary function test and clinicodemographic profile. However, operative time and hospital stay were shorter in MAC/TEA group (32.5±18.5 min vs 50.8±18.4; p=0.004, 1.0±1.3 days vs 10.0±34.7 days; p<0.001, respectively). Eight patients in the GA group, but none in the MAC/TEA group, experienced worsening of ILD after lung biopsy (p=0.03). Additionally, one patient in the GA group died due to acute ILD worsening. No cases of MAC/TEA group had to be converted to GA. In all cases a pathological diagnosis could be made.
Thoracoscopy using regional anesthesia might be a safer alternative to lung biopsy in patients with ILD.
间质性肺疾病（ILD）管理指南支持基于肺活检的治疗。然而，由于 ILD 患者全身麻醉（GA）下经胸腔镜肺活检的高死亡率，医生不愿提供这种手术，并采用基于高分辨率 CT 的诊断方法。在此，我们报告称，区域麻醉下的胸腔镜检查可能是一种更安全的肺活检替代方法，可有效指导ILD 治疗。
这是一项对前瞻性维护的数据库进行的单中心回顾性研究，纳入了 2016 年 3 月至 2018 年 3 月期间接受胸腔镜肺活检的患者。患者分为两组：（A）GA，（B）采用监测麻醉护理（MAC）和胸段硬膜外麻醉（TEA）的区域麻醉。
在研究期间，44 名患者接受了胸腔镜肺活检。其中 15 名患者接受了 MAC/TEA。两组患者的肺功能测试和临床特征无显著差异。然而，MAC/TEA 组的手术时间和住院时间更短（32.5±18.5 分钟比 50.8±18.4 分钟；p=0.004，1.0±1.3 天比 10.0±34.7 天；p<0.001）。GA 组 8 例患者（p=0.03），而 MAC/TEA 组无患者，在肺活检后ILD 恶化。此外，GA 组有 1 例患者死于急性ILD 恶化。MAC/TEA 组无一例需要转换为 GA。所有病例均可作出病理诊断。
在 ILD 患者中，区域麻醉下的胸腔镜检查可能是一种比肺活检更安全的选择。
