摘要目的 通过对比经支气管冷冻肺活检(TBCB)和常规经支气管肺活检(TBLB)在间质性肺疾病(ILD)诊断中的有效性及安全性,探讨TBCB在ILD诊断中的应用价值.方法 采用前瞻性自身对照研究,选择2017年1—4月在广州医科大学附属第一医院住院的诊断不明ILD需行肺活检的25例患者,男16例,女9例,年龄24～70岁,平均(51±13)岁.所有患者均在全身麻醉下先后行TBLB(TBLB组)及TBCB(TBCB组),比较两种活检方法的标本大小、操作时间、并发症和病理诊断效率.符合正态分布的计量资料组间比较采用t检验,非正态分布的计量资料采用Wilcoxon秩和检验,两组间出血发生率及病理活检阳性率的比较采用 χ2检验.结果 TBCB组及TBLB组活检标本大小分别为(12.3±4.9)和(3.1±1.9)mm 2(t=-18.268,P=0.000),操作时间分别为(7.8±3.2)和(5.4±2.1)min(Z=-3.001,P=0.003).TBCB组18例(72％)明确病理分型诊断,2例(8％)提供有价值的病理诊断,5例(20％)未能分型;TBLB组3例(12％)明确病理分型诊断,22例(20％)未能分型.TBCB和TBLB病理诊断效率为80％(20/25)和12％(3/25)(χ2=20.779,P=0.000).两组均未发生气胸及严重的大出血,在轻中度出血方面TBCB组和TBLB组分别为47.2％(50/106)和18.9％(20/106),差异有统计学意义(χ2=19.195,P=0.000).结论 相对于TBLB,TBCB在获得标本大小及病理诊断效率具有明显的优势,安全性良好,对诊断未明的ILD有较好的价值.

abstractsObjective To evaluate the efficacy and safety of transbronchial lung cryobiopsy (TBCB) and conventional transbronchial lung biopsy (TBLB) in the diagnosis of interstitial lung diseases (ILD).Methods A prospective, self-control study was conducted during January 2017 and April 2017 in First Affiliated Hospital of Guangzhou Medical University .A total of 25 patients [male 16, female 9; mean age (51 ±13) years, range 24 to 70 years] with inconclusive diagnosis of interstitial lung diseases were sequentially enrolled.In the study, TBCB ( TBCB group ) and TBLB ( TBLB group ) were performed successively under general anesthesia in all patients .The size of biopsy specimens, the duration of procedures, complications and pathological results were recorded .Gaussian distribution data were compared between 2 groups by using Student ′s t test, while abnormal distribution data were compared by using Wilcoxon rank sum test.The incidences of bleeding and pathologic diagnostic yield between the 2 groups were compared by using Pearson chi -square test.A P-value < 0.05 was assumed to be statistically significant.Results The specimen sizes of TBCB group and TBLB group were (12.3 +4.9) and (3.1 +1.9) mm 2 respectively ( t =-18.268, P =0.000).The duration of procedures was (7.8 ±3.2) and (5.4 ±2.1)min respectively (Z =-3.001, P =0.003).In TBCB group, the diagnostic yield was 72％(18 /25), with valuable pathological results in 2 cases (8％), but in 5 cases (20％) it failed to provide valuable pathological results.In TBLB group, the diagnostic yield was 12％ (3/25).There were no useful pathological results in other 22 cases.The difference in the rate of useful pathological results between TBCB group and TBLB group was significant (χ2 =20.779, P =0.000).There was no pneumothorax or severe bleeding.The rate of mild to moderate bleeding in TBCB group and TBLB group was 47.2％(50 /106) and 18.9％(20 /106) (χ2 =19.195, P =0.000) respectively.Conclusion TBCB is superior to TBLB for lung biopsy as indicated by larger sample size , higher diagnostic yield and less complication .TBCB is valuable for the diagnosis of ILD.