Lerman Y, Ribak J, Selikoff I J
Br J Ind Med. 1986 Mar;43(3):165-9. doi: 10.1136/oem.43.3.165.
An investigation into the problem of the frequency and hazards of lung biopsy in asbestos workers was performed in two ways. The first study was into the frequency of lung biopsy among 2907 long term asbestos insulation workers in 1981-3 and the second was into the frequency of fatal complications of lung biopsy in 168 deaths from asbestosis among 2271 consecutive deaths of asbestos insulation workers 1967-76. Only 25 (0.9%) of the 2907 asbestos insulation workers reported having had either an open lung biopsy, a needle biopsy, or a transbronchial biopsy. Seven (24%) of these men suffered difficulties as a result of the biopsy. Lung biopsies had been performed on 14 of the 168 workers who died of asbestosis. Three (21%) of these 14 patients had died within 30 days of biopsy as a direct result of the procedure. In most cases there is no need for lung biopsy to establish a diagnosis of asbestosis; generally, it may be defined by history of exposure, clinical and radiological findings, and other well established non-invasive diagnostic procedures. Certainly, legal and compensation recommendation for biopsy should be considered with the possibility of death in mind. If biopsy is performed precautions should be taken, including adequate observation in hospital.
针对石棉工人肺活检的频率及风险问题,开展了两方面的调查。第一项研究针对1981年至1983年间2907名长期从事石棉绝缘工作的工人进行肺活检的频率;第二项研究针对1967年至1976年间2271名石棉绝缘工人连续死亡案例中,因石棉沉着病死亡的168例中肺活检致命并发症的频率。在2907名石棉绝缘工人中,仅25人(0.9%)报告曾接受过开胸肺活检、针吸活检或经支气管活检。其中7人(24%)因活检出现了并发症。在168名死于石棉沉着病的工人中,有14人接受过肺活检。这14名患者中有3人(21%)在活检后30天内直接因该操作死亡。在大多数情况下,无需进行肺活检来确诊石棉沉着病;一般来说,可通过接触史、临床和放射学检查结果以及其他成熟的非侵入性诊断程序来确诊。当然,考虑到活检存在死亡风险,应权衡活检在法律及赔偿方面的建议。若进行活检,应采取预防措施,包括在医院进行充分观察。