经支气管冷冻肺活检对弥漫性实质性肺疾病的临床诊断分析

Clinical analysis of transbronchial cryobiopsy for diffuse parenchymal lung disease

摘要:

目的 探讨经支气管冷冻肺活检（TBCB）对弥漫性实质性肺疾病（DPLD）的诊断价值。方法 回顾性分析2017年10月－2019年12月中山大学附属第一医院30例经支气管镜肺活检（TBLB）联合TBCB患者的临床资料，胸部CT主要表现为DPLD。其中，男16例，女14例；年龄25～71岁，平均（57.1±9.4）岁。结果 TBCB组标本（19.9±5.4）mm²，明显较TBLB组的（2.2±0.6）mm²大，两组比较，差异有统计学意义（t = -39.31，P = 0.000）；TBCB组提供有价值的病理结果为80.0%（24/30），明显高于TBLB组的36.7%（11/30），两组比较，差异有统计学意义（􀱽² = 115.88，P = 0.000）；TBCB对26例DPLD患者的诊断率为76.9%（20/26）；16例经硬镜下TBCB和14例经非硬镜下TBCB的诊断率分别为75.0%和85.7%，两组比较，差异无统计学意义（P > 0.05）；术中使用预置球囊及无预置球囊的平均出血量分别为6.1和10.2 mL，中度出血情况分别为20.0%（2/10）和37.5%（6/16），两组比较，差异均无统计学意义（P > 0.05）。结论 经硬质支气管镜与非硬质支气管镜下进行TBCB均能达到检查目的，TBCB对DPLD有良好的诊断阳性率，且安全性较高。术中使用预置球囊止血可减少术中出血量及中度出血的病例数，虽然与非预置球囊组比较差异无统计学意义，但仍建议术中使用预置球囊止血，以提高对大出血风险的干预能力，提高病理科诊断水平可提高DPLD诊断率。

Abstract:

Objective To explore the diagnostic value of transbronchial cryobiopsy (TBCB) for diffuse parenchymal lung disease (DPLD).Method The clinical data of 30 patients with bronchoscopic lung biopsy (TBLB) + TBCB and chest CT mainly presenting as DPLD were retrospectively analyzed from October, 2017 to December, 2019. Among them, 16 were male and 14 were female. The average age was (57.1 ± 9.4) years from 25 to 71 years old.Result The sample size of TBCB group was (19.9 ± 5.4) mm², significantly larger than that of TBLB group (2.2 ± 0.6) mm², and the difference between the two groups was statistically significant (t = -39.31, P = 0.000); The value of pathological findings in TBCB group was 80.0% (24/30), significantly higher than that in TBLB group (36.7%, 11/30), and the difference between the two groups was statistically significant (χ² = 115.88, P = 0.000); The diagnostic rate of TBCB in 26 patients with DPLD was 76.9% (20/26). The diagnostic rates of TBCB in 16 cases by rigid bronchoscope and 14 cases by non-rigid bronchoscopy were 75.0% and 85.7% respectively, with no significant difference between the two groups (P > 0.05). The average amount of intraoperative bleeding with or without pre-placed balloon was 6.1 mL and 10.2 mL respectively, and moderate bleeding was 20.0% (2/10) and 37.5% (6/16) respectively. There was no significant difference between the two groups (P > 0.05).Conclusion TBCB can be achieved under rigid bronchoscopy and non-rigid bronchoscopy. TBCB has a good diagnostic positive rate for DPLD and high safety. The intraoperative use of pre-placed balloon for hemostasis can reduce the amount of intraoperative bleeding and the number of moderate bleeding cases. Although there is no statistical significance compared with the non pre-placed balloon group, it is still recommended to use pre-placed balloon for hemostasis during the operation to improve the ability to intervene in the risk of major bleeding. Improving the diagnosis level of the pathology department can increase the diagnosis rate of DPLD.