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目的 评价电视辅助胸腔镜肺活检术在弥漫性间质性肺疾病中的诊断价值及安全性.方法 回顾性分析2010年10月至2016年12月期间南京鼓楼医院收治的26例临床、影像及病理资料完整,因诊断不明而接受电视辅助胸腔镜肺活检的弥漫性间质性肺疾病患者.总结患者的临床症状、高分辨率CT表现、术前和术后诊断的对比、活检部位、活检数量及术后并发症等结果 .结果 26例患者接受电视辅助胸腔镜肺活检术后,结合临床、影像学和病理资料,有24例(92.31％)患者确诊,2例(7.69％)患者诊断不明.16例(61.54％)患者术后更改了治疗方案.活检取得肺组织1～3块不等,3例(11.54％)患者活检了1块组织,15例(57.69％)患者活检了2块组织,8例(30.77％)患者活检了3块组织,手术部位以右肺下叶最常见.9例(34.62％)患者出现术后并发症,最常见的并发症是气胸和肺部感染,未出现死亡及间质性肺疾病急性加重的情况.结论 对于大部分诊断不明的弥漫性间质性肺疾病,电视辅助胸腔镜肺活检术能提高其诊断率并指导调整治疗方案,其并发症少,病死率较低,是一个相对安全而有效的诊断手段,建议对诊断不明的弥漫性间质性肺疾病患者行电视辅助胸腔镜肺活检.

Objective To evaluate the safety and diagnostic yield of video-assisted thoracoscopic lung biopsies (VTLB) in the diffuse interstitial lung disease (ILD).Methods The clinical radiological and pathological data of 26 cases with ILD of non-specific diagnosis performed VTLB in Nanjing Drum Tower Hospiral during October 2010 to December 2016 were retrospectively analyzed.Outcomes included clinical symptoms,high-resolution computed tomography images,comparison between pre-operative and post-operative diagnosis,the site and number of biopsies and complications.Results Among 26 cases,definitive clinical diagnosis was reached in 24 cases (92.31％) after combination of pathological,clinical and radiological manifestations and 2 cases (7.69％) could not achieved diagnosis even after the VTLB lung biopsies.Sixteen cases (61.54％) had a change in their treatment following the results of VTLB lung biopsies.The number of biopsies taken was ranged from one to three and three cases (11.54％) had one biopsy,15 cases (57.69％) had two biopsies and 8 cases (30.77％) had three biopsies.The most common site of operation was right lower lobe.Nine cases (34.62％) had complications after VTLB,and pulmonary infection and pneumothorax were the most common complications.There was no death case and acute exacerbation of ILD.Conclusions The VTLB can provide a diagnosis for most of the ILD patients.The procedure leads to a change in treatment in almost half of all patients.The morbidity and mortality related with VTLB are low.It has been shown to be a relatively safe and effective procedure and thus,should be performed in all patients with suspected ILD.