Cherchi Roberto, Grimaldi Giulia, Pinna-Susnik Matteo, Riva Laura, Sarais Sabrina, Santoru Massimiliano, Perra Roberto, Allieri Roberto, Porcu Giuseppe S, Nemolato Sonia, Mameli Antonella, Loi Federica, Ferrari Paolo A
Division of Thoracic Surgery, "A. Businco" Oncology Hospital, Azienda Ospedaliera Brotzu, Cagliari, Italy.
Pulmonology Unit and Respiratory Physiopathology Laboratory, "R. Binaghi" and "SS. Trinità" Hospitals, ATS Sardegna, Cagliari, Italy.
J Thorac Dis. 2020 Sep;12(9):4717-4730. doi: 10.21037/jtd-20-1551.
Surgical lung biopsy for interstitial lung disease (ILD) is traditionally performed through video-assisted thoracic surgery (VATS) and general anesthesia (GA). The mortality and morbidity rates associated with this procedure are not negligible, especially in patients with significant risk factors and respiratory impairment. Based on these considerations, our center evaluated a safe non-intubated VATS approach for lung biopsy performed in ILD subjects.
Ninety-nine patients affected by undetermined ILD were enrolled in a retrospective cohort study. In all instances, lung biopsies were performed using a non-intubated VATS technique, in spontaneously breathing patients, with or without intercostal nerve blockage. The primary end-point was the diagnostic yield, while surgical and global operating room times, post-operative length of stay (pLOS), numeric pain rating scale (NPRS) after surgery and early mortality were considered as secondary outcomes.
All the procedures were carried out without conversion to GA. The pathological diagnosis was achieved in 97 patients with a diagnostic yield of 98%. The mean operating room length-of-stay and operating time were 73.7 and 42.5 min, respectively. Mean pLOS was 1.3 days with a low readmissions rate (3%). No mortality in the first 30 days due to acute exacerbation of ILD occurred. Both analgesia methods resulted in optimal feasibility with a mean NPRS score of 1.13.
In undetermined ILD patients, surgical lung biopsy with a non-intubated VATS approach and spontaneous ventilation anesthesia appears to be both a practical and safe technique with an excellent diagnostic yield and high level of patient satisfaction.
间质性肺疾病（ILD）的外科肺活检传统上是通过电视辅助胸腔镜手术（VATS）和全身麻醉（GA）进行的。与该手术相关的死亡率和发病率不可忽视，尤其是在有显著危险因素和呼吸功能受损的患者中。基于这些考虑，我们中心评估了一种用于ILD患者肺活检的安全非插管VATS方法。
99例未确诊ILD的患者纳入一项回顾性队列研究。在所有情况下，肺活检均采用非插管VATS技术，在自主呼吸的患者中进行，有或无肋间神经阻滞。主要终点是诊断率，而手术和总手术室时间、术后住院时间（pLOS）、术后数字疼痛评分量表（NPRS）和早期死亡率被视为次要结果。
所有手术均未转为GA。97例患者获得病理诊断，诊断率为98%。平均手术室住院时间和手术时间分别为73.7分钟和42.5分钟。平均pLOS为1.3天，再入院率较低（3%）。未发生因ILD急性加重导致的30天内死亡。两种镇痛方法均具有最佳可行性，平均NPRS评分为1.13。
在未确诊的ILD患者中，采用非插管VATS方法和自主通气麻醉进行外科肺活检似乎是一种实用且安全的技术，具有出色的诊断率和较高的患者满意度。
