Sugino Keishi, Otsuka Hajime, Matsumoto Yusuke, Nakamura Yasuhiko, Matsumoto Keiko, Azuma Yoko, Makino Takashi, Iyoda Akira, Shibuya Kazutoshi, Homma Sakae
Department of Respiratory Medicine.
Department of Respiratory Medicine, Jizankai Medical Fundation Tsuboi Cancer Center Hospital, Asakamachi, Koriyama City, Fukushima, Japan.
Sarcoidosis Vasc Diffuse Lung Dis. 2019;36(2):148-156. doi: 10.36141/svdld.v36i2.7797. Epub 2019 May 1.
When a clinical context is indeterminate for idiopathic pulmonary fibrosis (IPF), or a chest high-resolution computed tomography (HRCT) pattern is not indicative of typical or probable usual interstitial pneumonia (UIP) in patients with interstitial lung disease (ILD), surgical lung biopsy should be considered to make a confident diagnosis on the basis of multidisciplinary diagnosis (MDD).
The aim of this study was to evaluate the role and safety of video-assisted thoracoscopic surgery (VATS) in patients with ILD.
A total of 143 patients with ILD underwent VATS at Toho University Medical Center Omori Hospital between March 2004 and April 2017. We conducted a retrospective study on the usefulness and safety of VATS in the diagnosis of ILD under MDD.
The 30-day mortality was 0%. The postoperative complication rate was 12.6%, which included 5 cases of pneumothorax after discharge (3.5%), 4 cases of prolonged air leakage (2.8%), and 2 cases of acute exacerbation (1.4%). Three of 9 cases (33.3%) complicated by pneumothorax after discharge or prolonged air leakage were resected specimens of pleuroparenchymal fibroelastosis (PPFE). Two patients had acute exacerbation, who were ultimately diagnosed as having idiopathic unclassifiable IP and had histologically significant irregular dense fibrosis and numerous fibroblastic foci. The comparison between chest HRCT and histopathological findings revealed 55 cases of possible UIP [UIP (45%), NSIP (25%), and unclassifiable IP (29%)] and 21 cases of inconsistent with UIP [UIP (10%), NSIP (33%), organizing pneumonia (10%), unclassifiable IP (24%), and PPFE (24%)].
VATS can be safely performed to obtain a confident diagnosis for appropriate treatment strategies in patients with ILD.
当特发性肺纤维化（IPF）的临床情况不明确，或者间质性肺疾病（ILD）患者的胸部高分辨率计算机断层扫描（HRCT）表现不提示典型或可能的普通型间质性肺炎（UIP）时，应考虑进行外科肺活检，以便在多学科诊断（MDD）的基础上做出可靠诊断。
本研究旨在评估电视辅助胸腔镜手术（VATS）在ILD患者中的作用和安全性。
2004年3月至2017年4月期间，共有143例ILD患者在东邦大学医学中心大森医院接受了VATS。我们对VATS在MDD诊断ILD中的有效性和安全性进行了回顾性研究。
30天死亡率为0%。术后并发症发生率为12.6%，其中包括出院后气胸5例（3.5%）、持续漏气4例（2.8%）和急性加重2例（1.4%）。出院后气胸或持续漏气的9例患者中有3例（33.3%）为胸膜实质纤维弹性组织增生症（PPFE）切除标本。2例患者发生急性加重，最终被诊断为特发性无法分类的IPF，组织学检查显示有明显的不规则致密纤维化和大量成纤维细胞灶。胸部HRCT与组织病理学结果的比较显示，55例可能为UIP[UIP（45%）、非特异性间质性肺炎（NSIP）（25%）和无法分类的IP（29%）]，21例与UIP不一致[UIP（10%）、NSIP（33%）、机化性肺炎（10%）、无法分类的IP（24%）和PPFE（24%）]。
VATS可以安全地进行，以便为ILD患者制定合适的治疗策略获得可靠诊断。
