Complications of video-assisted thoracoscopic lung biopsy in patients with interstitial lung disease
Complications of video-assisted thoracoscopic lung biopsy in patients with interstitial lung disease
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DOI：
10.1016/j.athoracsur.2006.10.002
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发表时间：
2007-03-01
影响因子：
4.6
通讯作者：
Shrager, Joseph B.
中科院分区：
文献类型：
--
作者：
Kreider, Mary Elizabeth;Hansen-Flaschen, John;Shrager, Joseph B.
背景。目前的指南推荐手术肺活检诊断间质性肺疾病（ILDs）在选定的患者。为了阐明这一建议的风险-收益比，我们检查了一组门诊患者与电视胸腔镜手术（VATS）肺活检相关的发病率和死亡率。一项回顾性队列研究在6年期间对68例影像学上明显的间质性肺疾病（ILD）的连续门诊患者进行了VATS活检。计算了术后死亡率、长时间漏气、肺炎和再次入院的发生率。检查手术并发症的危险因素。活检后60天内发生3例死亡，死亡率为4.4%(95%可信区间[CI]， 1%至12%),19.1% （95% CI， 11%至31%）出现一种或多种手术并发症。发病的危险因素包括术前依赖氧疗和肺动脉高压。死亡的3例患者活检标本显示为常见的间质性肺炎，术后因急性肺损伤重新插管。汇总过去10年发表的关于外科肺活检诊断ILD的文章，得出术后死亡率为2%至4.5%。VATS肺活检诊断ILD，即使在门诊患者，也不是一个完全良性的程序。活检很少会引起通常的间质性肺炎的急性加重。术后并发症的风险在依赖氧气和肺动脉高压的患者中最大。该信息可用于衡量个别患者活检的风险-收益比。
Background. Current guidelines recommend surgical lung biopsy for diagnosis of interstitial lung diseases (ILDs) in selected patients. To shed light on the risk-benefit ratio for this recommendation, we examined the morbidity and mortality associated with video-assisted thoracoscopic surgical (VATS) lung biopsy in a group of outpatients.Methods. A retrospective cohort study was conducted of 68 consecutive ambulatory patients with radiographically apparent interstitial lung disease (ILD) referred for VATS biopsy during a 6-year period. Incidence of postoperative mortality, prolonged air leaks, pneumonias, and re-admissions were calculated. Risk factors for complications of surgery were examined.Results. Three deaths occurred within 60 days after biopsy for a mortality rate of 4.4% (95% confidence interval [CI], 1% to 12%), and 19.1% (95% CI, 11% to 31%) experienced one or more complications of surgery. Risk factors for morbidity included preoperative dependence on oxygen therapy and pulmonary hypertension. The three patients who died had usual interstitial pneumonia on their biopsy specimen and were reintubated postoperatively for acute lung injury. Aggregation of articles published over the past 10 years reporting on surgical lung biopsy for the diagnosis of ILD yielded a postoperative mortality rate of 2% to 4.5%.Conclusions. VATS lung biopsy for diagnosis of ILD, even in ambulatory patients, is not an entirely benign procedure. Biopsy rarely may trigger an acute exacerbation of usual interstitial pneumonitis. The risk of postoperative complications appears to be greatest in those dependent on oxygen and those who have pulmonary hypertension. This information may be used in weighing the risk-benefit ratio of biopsy in individual patients.