电视胸腔镜肺活检与开胸肺活检在间质性肺疾病诊断中的比较。

Comparison of video thoracoscopic lung biopsy to open lung biopsy in the diagnosis of interstitial lung disease.

作者信息

Bensard D D, McIntyre R C, Waring B J, Simon J S

机构信息

Department of Surgery, University of Colorado Health Sciences Center, Denver.

出版信息

Chest. 1993 Mar;103(3):765-70. doi: 10.1378/chest.103.3.765.

DOI:10.1378/chest.103.3.765

PMID:8449066

Abstract

BACKGROUND

Up to one third of patients with interstitial lung disease will require a lung biopsy for diagnosis. Open lung biopsy is generally accepted as the most reliable method of biopsy and tissue diagnosis. The purpose of this study was to compare the efficacy and safety of video thoracoscopic lung biopsy, a minimally invasive technique, with open lung biopsy in the diagnosis of interstitial lung disease.

METHODS

From December 1990 to January 1992, 43 patients were referred for diagnostic lung biopsy. Twenty-two consecutive patients undergoing video thoracoscopic lung biopsy (VTLB) over a 6-month period were retrospectively studied and compared with 21 consecutive patients who had undergone open lung biopsy (OLB) in the preceding 6-month period.

RESULTS

VTLB (46 +/- 4 minutes) did not add to operative time when compared with OLB (38 +/- 3 min, p = 0.09). The same number of biopsies per patient were performed (VTLB, 1.9 +/- 0.1; OLB, 2.0 +/- 0.1; p = 0.48), the same amount of tissue was obtained per biopsy (VTLB, 6.69 +/- 0.82 cm3; OLB, 5.78 +/- 0.54 cm3; p = 0.36), and the diagnostic accuracy of each method was comparable (VTLB, 95 percent; OLB, 100 percent). However, patients undergoing VTLB demonstrated a significant reduction in length of pleural drainage (1.36 +/- 0.25 days) and hospital stay (2.57 +/- 0.46 days) relative to patients undergoing OLB (3.20 +/- 0.34 days, 5.71 +/- 0.63 days; p < 0.05). Complications occurred in 2/22 VTLB patients (9 percent, 0 deaths) and 4/21 OLB patients (19 percent, 1 death).

CONCLUSIONS

When compared with OLB, VTLB does the following: (1) provides equivalent specimen volume; (2) achieves equal diagnostic accuracy; (3) does not add to operative time or complications; and (4) reduces the time necessary for pleural drainage and length of hospital stay. Our findings suggest that VTLB is an effective and safe alternative to OLB in the diagnosis of interstitial lung disease.

摘要

背景

高达三分之一的间质性肺疾病患者需要进行肺活检以明确诊断。开胸肺活检通常被认为是最可靠的活检及组织诊断方法。本研究旨在比较电视胸腔镜肺活检（一种微创技术）与开胸肺活检在间质性肺疾病诊断中的有效性和安全性。

方法

1990年12月至1992年1月，43例患者被转诊进行诊断性肺活检。对连续22例在6个月期间接受电视胸腔镜肺活检（VTLB）的患者进行回顾性研究，并与前6个月连续21例接受开胸肺活检（OLB）的患者进行比较。

结果

与OLB（38±3分钟）相比，VTLB（46±4分钟）并未增加手术时间（p = 0.09）。每位患者的活检次数相同（VTLB，1.9±0.1；OLB，2.0±0.1；p = 0.48），每次活检获取的组织量相同（VTLB，6.69±0.82立方厘米；OLB，5.78±0.54立方厘米；p = 0.36）且每种方法的诊断准确性相当（VTLB，95%；OLB，100%）。然而，与接受OLB的患者（3.20±0.34天，5.71±0.63天）相比，接受VTLB的患者胸腔引流时间（1.36±0.25天）和住院时间（2.57±0.46天）显著缩短（p < 0.05）。22例VTLB患者中有2例（9%，无死亡）发生并发症，21例OLB患者中有4例（19%，1例死亡）发生并发症。