Role of open lung biopsy for diagnosis in lung transplant recipients: ten-year experience.
Role of open lung biopsy for diagnosis in lung transplant recipients: ten-year experience.
复制标题
开放性肺活检在肺移植受者诊断中的作用：十年经验。
DOI：
10.1016/0003-4975(95)00015-d
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
T. Todd
中科院分区：
文献类型：
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作者：
Cecilia Chaparro;J. R. Maurer;Dean Chamberlain;T. Todd
从1983年11月到1993年8月，多伦多肺移植项目在144名受者中进行了153例移植：53例单肺移植（SLT）和100例双肺移植（DLT）。32例（占所有受者的22%）进行了38例开放式肺活检（olb）： SLT患者19例（占SLT患者的36%）DLT患者12例（占DLT患者的12%），SLT患者1例，然后进行了两次再移植。6名受者接受了两次OLB: 1名DLT， 3名SLT， 2名在再移植前后都有OLB。11例早期olb（术后≤45天）的指征为持续性实质浸润。27例晚期OLBs（术后45天）的适应症包括有临床表现的进行性放射学疾病或肺功能进行性丧失（18例），持续性移植物功能不良（3例），肿块或结节（3例），持续性浸润但无功能丧失（2例），支气管肺泡灌洗时持续性淋巴细胞增多（1例）。开放肺活检证实既往临床或病理诊断11例，提示诊断2例，获得非特异性信息16例，提供不同诊断9例。11例早期olb中有1例，27例晚期olb中有8例做出了新的诊断并改变了治疗方法。SLT中的这9种诊断包括：SLT中的闭塞性细支气管炎（2例）、闭塞性细支气管炎合并肺炎（1例）、恶性淋巴瘤（1例）和慢性血管排斥反应（1例）；DLT中的闭塞性细支气管炎合并肺炎（3例）和洋葱伯克霍尔德菌感染（1例）。我们得出结论，OLB在围手术期价值不大，但在大约30%的患者中，当手术后期进行时，OLB提供了有用的信息。
Between November 1983 and August 1993, The Toronto Lung Transplant Program performed 153 transplantations in 144 recipients: 53 single-lung transplantations (SLT) and 100 double-lung transplantations (DLT). Thirty-eight open lung biopsies (OLBs) were done in 32 (22% of all recipients): 19 in SLT (36% of SLT) 12 in DLT (12% of DLT), and 1 in a patient who had a SLT and then a double retransplantation. Six recipients underwent OLB twice: 1 DLT, 3 SLT, and 2 who had OLB both before and after retransplantation. Indication for 11 early OLBs (≤45 days postoperative) was persistent parenchymal infiltrates. Indications for 27 late OLBs (>45 days postoperative) included progressive radiologic disease with clinical findings or progressive loss of pulmonary function (18), persistent poor graft function (3), mass or nodules (3), persistent infiltrates without functional loss (2), and persistent lymphocytosis in bronchoalveolar lavage (1). Open lung biopsy confirmed a previous clinical or pathologic diagnosis in 11, suggested a diagnosis in 2, yielded nonspecific information in 16, and provided different diagnosis in 9. New diagnosis that changed therapy was made in 1 of 11 early OLBs and in 8 of 27 late OLBs. These 9 diagnoses included in SLTs: bronchiolitis obliterans (2), bronchiolitis obliterans organizing pneumonia (1), malignant lymphoma (1), and chronic vascular rejection (1) in SLT, and bronchiolitis obliterans organizing pneumonia (3) and Burkholderia cepacia infection (1) in DLT. We conclude that OLB is of little value in the perioperative period but yields useful information in approximately 30% of patients when performed late.