应用经气管镜冷冻活检诊断弥漫性肺疾病_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

李晓 ¹ ,  潘金兵 ¹ , 任颖 ² , 林香花 ¹ , 马芸 ¹

1. ;
2. ;

Corresponding author：

潘金兵, Email: jinwu9636@126.com

Keywords：

弥漫性肺疾病; 冷冻活检; 气管镜; 喉罩

DOI：

10.7507/1671-6205.201710011

Video：

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目的探讨经气管镜进行冷冻肺组织活检于弥漫性肺疾病诊断的应用价值。方法选择河南省人民医院呼吸与危重症医学科自 2016 年 5 月至 2017 年 4 月收治的弥漫性肺疾病患者 53 例行经支气管镜肺活检，其中采用冷冻活检者 17 例（冷冻组），采用常规活检钳活检者 36 例（常规组）。全身麻醉后置入喉罩，常规检查气管镜后，术前据胸部影像选定支气管，冷冻组患者经支气管镜活检孔道送入冷冻探头至肺部病变，冷冻 3～5 s 后冷冻探头随支气管镜一同取出。比较冷冻活检标本与常规活检标本的组织面积、人工伪差、临床诊断率及出血和气胸并发症等的发生率。结果经气管镜冷冻活检标本的组织面积［（44.2±17.2）mm² 比（7.5±6.1）mm²］、临床诊断率（88.2% 比 36.1%）明显高于常规活检标本（均 P<0.05），而人工伪差（11.8% 比 52.8%）明显降低（P<0.05），患者出血和气胸发生率却未明显增多。结论在弥漫性肺疾病经气管镜进行冷冻活检是一个安全有效的诊断方法。

Citation： 李晓, 潘金兵, 任颖, 林香花, 马芸. 应用经气管镜冷冻活检诊断弥漫性肺疾病. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(3): 301-304. doi: 10.7507/1671-6205.201710011 Copy

1.	Noble PW, Albera C, Bradford WZ, et al; CAPACITY Study Group. Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials. Lancet, 2011, 377(9779): 1760-1769.
2.	Richeldi L, Costabel U, Selman M, et al. Efficacy of a tyrosine kinase inhibitor in idiopathic pulmonary fibrosis. N Engl J Med, 2011, 365(12): 1079-1087.
3.	Nguyen W, Meyer KC. Surgical lung biopsy for the diagnosis of interstitial lung disease: a review of the literature and recommendations for optimizing safety and efficacy. Sarcoidosis Vasc Diffuse Lung Dis, 2013, 30(1): 3-16.
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5.	Babiak A, Hetzel J, Krishna G, et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration, 2009, 78(2): 203-208.
6.	李一诗, 郭述良, 曹友德. 经支气管冷冻肺活检二例. 中华结核和呼吸杂志, 2016, 39(11): 905-907.
7.	李一诗, 郭述良, 贾晋伟, 等. 软性支气管镜下经支气管冷冻肺活检六例. 中华医学杂志, 2017, 97(10): 782-784.
8.	陶峰, 刘加良, 张齐, 等. 支气管镜冷冻肺活检对中老年弥漫性肺疾病的诊断价值. 全科医学临床与教育, 2017(3): 276-278.
9.	中华医学会呼吸病学分会. 诊断性可弯曲支气管镜应用指南(2008 年版). 中华结核和呼吸杂志, 2008, 31(1): 14-17.
10.	Shim HS, Park MS, Park IK. Histopathologic findings of transbronchial biopsy in usual interstitial pneumonia. Pathol Int, 2010, 60(5): 373-377.
11.	Hetzel J, Eberhardt R, Herth F J F, et al. Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial. Eur Respir J, 2012, 39(3): 685-690.
12.	Eberhardt R, Schuhmann M, Gompelmann D, et al. Ultrasound guided transbronchial cryobiopsy in the diagnosis of peripheral lung lesions: a feasibility and safety trial. Chest, 2011, 140(4): 940A.
13.	Pajares V, Puzo C, Castillo D, et al. Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial. Respirology, 2014, 19(6): 900-906.
14.	Berbescu EA, Katzenstein AL, Snow JL, et al. Transbronchial biopsy in usual interstitial pneumonia. Chest, 2006, 129(5): 1126-1131.
15.	Tomassetti S, Cavazza A, Colby TV, et al. Transbronchial biopsy is useful in predicting UIP pattern. Respir Res, 2012, 13(1): 1-7.
16.	Yarmus L, Akulian J, Gilbert C, et al. Cryoprobe transbronchial lung biopsy in patients after lung transplantation: a pilot safety study. Chest, 2013, 143(3): 621-626.
17.	Ganganah O, Guo SL, Chiniah M, et al. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: a systematic review and meta-analysis. Respirology, 2016, 21(5): 834-841.
18.	Casutt A, Prella M, Beigelman-Aubry C, et al. Fluoroscopic-guided radial endobronchial ultrasound without guide sheath for peripheral pulmonary lesions: a safe and efficient combination. Arch Bronconeumol, 2015, 51(7): 338-343.
19.	Berim IG, Saeed AI, Awab A, et al. Radial probe ultrasound-guided cryobiopsy. J Bronchology Interv Pulmonol, 2017, 24(2): 170-173.
20.	Lentz RJ, Argento AC, Colby TV, et al. Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges. J Thorac Dis, 2017, 9(7): 2186-2203.

1. Noble PW, Albera C, Bradford WZ, et al; CAPACITY Study Group. Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials. Lancet, 2011, 377(9779): 1760-1769.
2. Richeldi L, Costabel U, Selman M, et al. Efficacy of a tyrosine kinase inhibitor in idiopathic pulmonary fibrosis. N Engl J Med, 2011, 365(12): 1079-1087.
3. Nguyen W, Meyer KC. Surgical lung biopsy for the diagnosis of interstitial lung disease: a review of the literature and recommendations for optimizing safety and efficacy. Sarcoidosis Vasc Diffuse Lung Dis, 2013, 30(1): 3-16.
4. Poletti V, Patelli M, Poggi S, et al. Transbronchial lung biopsy and bronchoalveolar lavage in diagnosis of diffuse infiltrative lung diseases. Respiration, 1988, 54 (Suppl 1): 66-72.
5. Babiak A, Hetzel J, Krishna G, et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration, 2009, 78(2): 203-208.
6. 李一诗, 郭述良, 曹友德. 经支气管冷冻肺活检二例. 中华结核和呼吸杂志, 2016, 39(11): 905-907.
7. 李一诗, 郭述良, 贾晋伟, 等. 软性支气管镜下经支气管冷冻肺活检六例. 中华医学杂志, 2017, 97(10): 782-784.
8. 陶峰, 刘加良, 张齐, 等. 支气管镜冷冻肺活检对中老年弥漫性肺疾病的诊断价值. 全科医学临床与教育, 2017(3): 276-278.
9. 中华医学会呼吸病学分会. 诊断性可弯曲支气管镜应用指南(2008 年版). 中华结核和呼吸杂志, 2008, 31(1): 14-17.
10. Shim HS, Park MS, Park IK. Histopathologic findings of transbronchial biopsy in usual interstitial pneumonia. Pathol Int, 2010, 60(5): 373-377.
11. Hetzel J, Eberhardt R, Herth F J F, et al. Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial. Eur Respir J, 2012, 39(3): 685-690.
12. Eberhardt R, Schuhmann M, Gompelmann D, et al. Ultrasound guided transbronchial cryobiopsy in the diagnosis of peripheral lung lesions: a feasibility and safety trial. Chest, 2011, 140(4): 940A.
13. Pajares V, Puzo C, Castillo D, et al. Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial. Respirology, 2014, 19(6): 900-906.
14. Berbescu EA, Katzenstein AL, Snow JL, et al. Transbronchial biopsy in usual interstitial pneumonia. Chest, 2006, 129(5): 1126-1131.
15. Tomassetti S, Cavazza A, Colby TV, et al. Transbronchial biopsy is useful in predicting UIP pattern. Respir Res, 2012, 13(1): 1-7.
16. Yarmus L, Akulian J, Gilbert C, et al. Cryoprobe transbronchial lung biopsy in patients after lung transplantation: a pilot safety study. Chest, 2013, 143(3): 621-626.
17. Ganganah O, Guo SL, Chiniah M, et al. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: a systematic review and meta-analysis. Respirology, 2016, 21(5): 834-841.
18. Casutt A, Prella M, Beigelman-Aubry C, et al. Fluoroscopic-guided radial endobronchial ultrasound without guide sheath for peripheral pulmonary lesions: a safe and efficient combination. Arch Bronconeumol, 2015, 51(7): 338-343.
19. Berim IG, Saeed AI, Awab A, et al. Radial probe ultrasound-guided cryobiopsy. J Bronchology Interv Pulmonol, 2017, 24(2): 170-173.
20. Lentz RJ, Argento AC, Colby TV, et al. Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges. J Thorac Dis, 2017, 9(7): 2186-2203.

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Chinese Journal of Respiratory and Critical Care Medicine

应用经气管镜冷冻活检诊断弥漫性肺疾病

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