肺组织活检术对弥漫性间质性肺疾病诊断价值的临床研究

目的 评价肺组织活检术在弥漫性间质性肺疾病中的诊断价值。方法 回顾性分析1997年7月-2002年12月在我院住院治疗的17例行肺活检术的间质性肺疾病患者临床资料。结果 17例患者均获病理确诊,其中结节病3例,肺泡蛋白沉积症2例,普通型间质性肺炎1例,闭塞性细支气管炎伴机化性肺炎1例,非特异性间质性肺炎1例,Castleman病(浆细胞型)1例,淋巴管平滑肌瘤病1例,肺泡细胞癌2例,类风湿性关节炎肺间质纤维化合并肺鳞癌伴肺内多发转移1例,肺淋巴管癌2例,肺鳞癌伴肺内淋巴管转移1例,肺原发性副神经节细胞瘤1例。结论 肺活检术获取肺组织是弥漫性间质性肺疾病、不典型肺疾病或罕见疑难病症最直接的诊断方法,对常规、胸部高分辨CT检查等未能确诊的病例,具有较高的诊断价值。     

高分辨CT及经支气管镜肺活检、C反应蛋白在弥漫性间质性肺病的临床病理研究

目的探讨纤维支气管镜肺活检(T BLB)、C-反应蛋白(C R P)与H R C T并结合临床用于诊断弥漫性肺疾病(D LD)的价值。方法回顾性分析该院2003年1月-2013年6月接受支气管镜肺活检(T BLB)并行血C R P监测的257例具有临床和病理诊断资料D LD患者。结果 257例D LD患者中行T BLB确诊138例(53.85%),病理诊断包括其中特发性间质性肺纤维化(IPF)50例,肺泡癌10例,肺结核15例,结节病10例,癌性淋巴管炎10例,肺泡蛋白沉积症5例,过敏性肺泡炎8例,非特异性间质性肺炎(N SIP)5例,结缔组织肺病10例,隐原性机化性肺炎(C O P)12例。特发性间质性肺炎、结缔组织肺病及结核血C R P明显升高。结论T BLB对弥漫性肺疾病有较高的诊断价值,安全性好,创伤小,临床、影像和病理诊断之间的统一和协调对临床难确诊的弥漫性肺疾病有着重要的意义。C R P对一些间质性肺病诊断提供了一定的数据依据。     

不同肺活检方法对肺部弥漫性间质性疾病的诊断价值

目的 探讨不同肺活检方法在肺部弥漫性问质性疾病诊断中的价值.方法 回顾性分析因弥漫性肺问质性疾病接受经支气管镜肺活检(transbronchial lung biopsy,TBLB)、CT引导下经皮肺活检(CT-guided percutaneous needle aspiration biopsy,PCNA)、外科电视胸腔镜(lung biopsy by video-assisted thoracoscopic surgery,VATS)及小开胸肺活检(openlungbiopsy,OLB)患者的临床和病理诊断资料.结果 73例患者接受TBLB,36例病理诊断为肺间质纤维化,7例诊断UIP,8例诊断结核,2例诊断为肺泡蛋白沉着症.28例患者接受经皮肺活检,其中18例得到病理分型.外科电视胸腔镜肺活检28例,小开胸肺活检20例,除1例未明确外,其余全部病理分类.结论 在诊断弥漫性肺问质性疾病时,可首先考虑创伤性小的经纤维支气管镜肺活检,可除外感染、肿瘤及结节病.肺部弥漫性间质性疾病中特发性问质性肺炎的病理诊断特别是病理分型需要较大的活检组织,应考虑进行外科电视胸腔镜或小开胸肺活检.     

肺弥漫性疾病经电视胸腔镜肺活检诊断

目的：评价电视胸腔镜肺活检术对肺弥漫性疾病的诊断价值。方法：对30例肺弥漫性疾病经电视胸腔镜肺活检取得肺组织进行病理检查并与其他肺活检方法进行对比分析。结果：30例肺弥漫性疾病均获确诊，诊断率100％，病种主要有特发性肺纤维化、继发性肺纤维化、肺结核、肺癌、弥漫性肺泡细胞癌、弥漫性间皮瘤、肺转移癌、肺转移肉瘤、肺实质炎症、肺支气管扩张症和肺化学感受器瘤。结论：电视胸腔镜肺活检术对确诊肺弥漫性疾病具有最佳的诊断价值。     

经纤维支气管镜肺活检对弥漫性肺疾病的诊断价值

目的探讨经纤维支气管镜肺活检（transbronchial lung biopsy，TBLB）对弥漫性肺疾病的诊断价值。方法对31例弥漫性肺疾病患者行非影像直视下TBLB术。结果31例患者均肺活检成功。病理诊断为肺泡癌4例，肺鳞癌1例，结节病5例，肺结核2例，过敏性肺炎1例，肺间质纤维化9例，结缔组织病肺损害表现9例（系统性硬化病3例，类风湿性关节炎4例，皮肌炎2例）。结论TBLB术易于获取目标肺组织标本，对弥漫性肺疾病患者经各项非创伤性辅助检查不能确立诊断者具有较高的临床应用价值。     

电视胸腔镜手术肺活检对弥漫性肺疾病的诊断价值

目的 探讨电视胸腔镜手术肺活检用于诊断肺部弥漫性疾病的应用价值和安全性.方法 对10例诊断不明的弥漫性肺部疾病,行电视胸腔镜肺活检.观察其诊断价值.结果 10例病例均得到确诊,确诊率100%;病理诊断包括肺间质纤维化3例,肺癌4例,肺结核2例,肺组织细胞增多症1例.术后无并发症发生.结论 电视胸腔镜手术肺活检是诊断弥漫性肺部疾病安全、有效的方法.     

原发性肺淋巴瘤的临床特征分析

目的探讨原发性肺淋巴瘤(PPL)的临床诊断要点,以提高对该病的认识。方法收集该院2015年1月-2017年3月经肺活检病理确诊的共11例PPL的临床资料,其中大部分(10例)均经超声支气管镜肺活检确诊,并对有关资料进行回顾性分析。结果 11例PPL患者中,男7例(63.6%),女4例(36.4%),年龄35~72岁,平均(53.2±9.7)岁,以50岁以上(72.7%)多见。临床症状以咳嗽(7例,63.6%)、咯痰(5例,45.5%)、气促(4例,36.4%)多见;无症状者2例(18.2%)。胸部CT表现为四种类型:(1)肺炎型(8例,72.7%);(2)结节(或肿块)型(5例,45.5%);(3)支气管淋巴管型(间质型)(1例,9.1%);(4)粟粒型(1例,9.1%)。72.7%伴支气管充气征,典型者呈枯树枝征。确诊前误诊8例(72.7%),均首诊肺炎或机化性肺炎。结论 PPL的临床表现缺乏特异性,首诊常常容易误诊为肺炎,但影像学改变仍具有一定特征性,如病灶形态多变、多发,伴支气管枯树征等,确诊依赖于病理组织学和免疫组化检测。支气管腔内超声引导下的肺活检阳性率也很高。     

局麻小切口开胸肺活检对弥漫性肺疾病的诊疗价值及护理体会

弥漫性实质性肺疾病(DPLD)多数需要通过病理才能确诊.全麻开胸肺活检(包括胸腔镜)是诊断弥漫性肺疾病的金标准[1].     

特发性间质性肺炎的临床病理特点

特发性间质性肺炎(IIP)是一组原因不明的肺部间质性疾病。组织病理学分类在区别不同亚类的IIP及指导IIP的治疗和判断预后方面起着重要作用。这组疾病在组织学上的诊断要点包括:炎症、纤维母细胞增殖、胶原沉积和肺组织结构重建等几方面。寻常型间质性肺炎是最常见的IIP类型,具有典型的形态学特征。IIP的其他亚型包括:非特异性间质性肺炎、脱屑性间质性肺炎、细支气管炎相关性间质性肺病和急性间质性肺炎等,这类疾病形态学表现相互重叠,并与其他弥漫性间质性肺疾病难以区别,虽然纤支镜支气管肺活检、胸腔镜肺活检是IIP病理诊断的重要依据,但在诊断时必须结合临床和影像学资料才能作出正确诊断。     

经支气管镜肺活检诊断弥漫性肺疾病30例分析

目的 探讨经支气管镜肺活检(TBLB)的操作体会及对弥漫性肺部疾病的诊断价值.方法 30例肺部弥漫性疾病患者行TBLB,对临床资料及病理诊断结果进行回顾分析.结果 30例弥漫性肺疾病均成功取得肺组织标本,20例明确诊断,确诊率达66.7%.患者耐受性较好,术后发生气胸4例(13.3%),咯血5例(16.7%).结论 经支气管镜肺活检对弥漫性肺疾病的诊断是一种可靠、安全、简便、经济的方法,熟练的操作技术是提高成功率的关键.     

结核性毁损肺微创治疗初步探讨

目的探讨肺结核毁损肺胸腔镜微创手术的可行性。方法回顾分析绍兴市立医院与绍兴市人民医院近6年来,使用胸腔镜辅助小切口(VAMT)施行结核性毁损肺切除术45例患者。结果行右肺上叶切除术11例,右全肺切除术2例,左肺上叶切除术20例,左全肺切除术12例,全组未作胸廓成形术。手术时间3.0~5.5 h,术中出血量200~2 000 ml,输血35例,输血量400~2 000 ml。术后并发胸腔渗血3例,心律失常15例,心衰10例,均采用相应的治疗而痊愈。死亡2例,均为健肺肺部感染导致呼吸衰竭,其余43例随访2~70个月,效果满意,生活质量明显提高。结论 VAMT行结核性毁损肺切除术,具有损伤少、容易分离粘连、暴露好、无死角和出血少等优点,在肺结核外科手术中值得推广应用。     

CT引导下经皮穿刺肺活检术诊断肺部弥漫性病变

目的 评价CT引导下经皮穿刺肺活检术在诊断肺部弥漫性病变中的价值.方法 回顾性分析68例接受CT引导下经皮穿刺肺活检术的肺部弥漫性病变患者的资料.主要影像学改变包括弥漫性网状结节或结节、弥漫性线网状影、弥漫性磨玻璃样密度.采用18CT或20G穿刺活检针进行活检.结果 68例患者均一次性穿刺成功,且均能做出明确诊断.其中恶性病变19例,包括细支气管肺泡癌9例,转移癌10例;良性病变49例,为血型播散型肺结核27例,结节病8例,矽肺与煤工肺7例,间质性肺炎2例,肺泡蛋白沉着症4例,过敏性肺炎1例;主要并发症为气胸和出血,并发症的发生率为17.65%.结论 在肺部弥漫性疾病的诊断中,CT引导下经皮肺穿刺肺活检术是一种实用、安全、并发症少、准确性高、创伤小的定性诊断方法.     

Interstitial lung disease

The interstitial lung diseases are comprised of a group of pulmonary disorders characterized clinically by diffuse infiltrates on the chest radiograph and histologically by distortion of the gas exchanging portion of the lung. The physiologic correlates are restriction of lung volumes and impaired oxygenation. The term "interstitial" when applied to these diseases is actually a misnomer because it implies that the inflammatory process is limited specifically to the area between the alveolar epithelial and capillary endothelial basement membranes. The diseases currently grouped as "interstitial" also frequently involve the alveolar epithelium, alveolar space, pulmonary microvasculature, and less commonly, the respiratory bronchioles, larger airways, and even the pleura. The enormous differential diagnosis of interstitial lung disease can be made manageable by understanding that pneumoconiosis, drug-induced disease, and hypersensitivity pneumonitis account for over 80% of the responsible entities and can usually be identified from the patient's history. The nine remaining diseases/disease categories include: sarcoidosis, idiopathic pulmonary fibrosis, bronchiolitis obliterans-organizing pneumonia, histiocytosis X, chronic eosinophilic pneumonia, collagen vascular disease-associated interstitial lung disease, granulomatous vasculitis (Wegener's granulomatosis, Churg-Strauss syndrome, lymphomatoid granulomatosis), Goodpasture's syndrome, and pulmonary alveolar proteinosis. The diagnosis of a specific interstitial lung disease can be made via various means including the patient's history, specific serologies, bronchoalveolar lavage, transbronchial biopsy, and biopsy of extrathoracic tissues or open lung biopsy. A directed diagnostic approach can be formulated based on an understanding of these techniques and a thorough knowledge of the clinical presentations and specific diagnostic criteria for each of the major diseases. This monograph will serve as a guide for the clinician to use in evaluating and treating patients with interstitial lung disease. We begin by reviewing the clinical presentation, diagnostic criteria, and management of specific interstitial lung diseases excluding pulmonary infection, neoplasm, and sarcoidosis. Pneumoconiosis and drug-induced syndromes are not discussed in detail, but the agents responsible and pertinent exposures are presented in tabular form in the discussion of the general diagnostic approach.     

肺血管内淋巴瘤的临床及病理特征

  目的  探讨肺血管内淋巴瘤的临床及病理特征。  方法  回顾性观察及总结了2008年3月至2011年6月北京协和医院经肺活检病理诊断的5例肺血管内淋巴瘤患者的临床、胸部电子计算机断层摄影(computed tomography, CT)及病理资料, 并复习文献。活检标本经10%中性福尔马林固定, 常规石蜡切片, HE及免疫组化染色。  结果  5例肺血管内淋巴瘤患者中, 男3例, 女2例; 年龄36~59岁, 中位年龄45岁。临床症状主要为发热(5/5)、体重减轻(5/5)、咳嗽(4/5)、乏力(3/5)和气短(2/5)等; 5例患者血清乳酸脱氢酶均有不同程度升高(316~1025 U/L)。肺功能以弥漫性功能障碍为主。肺部CT:3例表现为双肺多发磨玻璃及实变影, 1例为多发结节影、胸膜下楔形实变影及支气管血管束增粗, 1例表现为右肺下叶实变影。病理组织学:肺血管内淋巴瘤主要表现为单个或小簇淋巴瘤细胞分布于狭小的肺泡间隔毛细血管腔内, 保留肺泡结构, 伴有肺泡上皮增生, 其病变微小, 易漏诊。1例肿瘤细胞形成瘤栓伴肺梗死。免疫组化显示3例为B细胞性, 2例为T细胞性。随访20 d~6个月(平均3.17个月), 3例B细胞性血管内淋巴瘤患者均行R-CHOP方案化疗, 2例化疗后病情平稳存活, 1例化疗6程后病情进展, 更换Hyper-CVAD方案化疗后病情平稳存活; 2例T细胞性血管内淋巴瘤患者, 1例失访, 1例经CHOP方案化疗效果不佳, 于诊断后20 d死于消化道出血和呼吸衰竭。  结论  肺血管内淋巴瘤非常少见, 常见于中老年人, 其临床症状缺乏特异性, 胸部CT常表现为弥漫性间质性病变。病理组织学显示, 淋巴瘤细胞主要分布于狭小的肺泡间隔毛细血管腔内, 其病变微小、易漏诊, 免疫组化有助于其诊断。     

Pulmonary involvement in Henoch-Schönlein purpura

OBJECTIVE: To describe pulmonary involvement in Henoch-Sch?nlein purpura (HSP). PATIENTS AND METHODS: We retrospectively reviewed the medical records of patients with HSP who were seen at the Mayo Clinic in Rochester, Minn, during a 6-year period (January 1, 1997, to December 31, 2002). Patients with HSP and pulmonary involvement were identified through a review of clinical records, radiological studies, pulmonary function data, and lung biopsy findings. RESULTS: We identified 124 patients with HSP during the study period; 72 (58.1%) were males. The median age was 15 years (range, 8 months to 81 years). Among the 124 patients with HSP, 3 (2.4%), all adults, had pulmonary involvement. Of these 3 patients, aged 20, 67, and 76 years, 2 were women. Pulmonary manifestations consisted of diffuse alveolar hemorrhage (DAH) (2 patients) and usual interstitial pneumonia that improved with corticosteroid therapy (1 patient). CONCLUSIONS: Pulmonary involvement in HSP is rare. It occurs more often in adults and commonly manifests as DAH and occasionally as usual interstitial pneumonia or interstitial fibrosis. Our cases and previously reported cases suggest that DAH is the most common manifestation of pulmonary involvement in HSP.     

Acute exacerbation of subclinical pulmonary fibrosis after red blood cell transfusion: a case report

BACKGROUND: Red blood cell (RBC) transfusion is associated with lung injury in susceptible hosts, although many cases do not meet criteria for transfusion‐related acute lung injury. Patients with underlying pulmonary fibrosis can exhibit precipitous deteriorations in respiratory status of unknown etiology defined as acute exacerbations due to superimposed lung injury syndrome. It is unclear whether RBC transfusion is associated with acute exacerbation of underlying pulmonary fibrosis. CASE REPORT: We describe a patient who underwent an uneventful elective left total hip replacement but developed anemia postoperatively. Twenty‐four hours after transfusion of her fifth nonleukoreduced AS‐5 RBC unit, she developed new bilateral airspace infiltrates associated with progressive hypoxemia. These RBC units were 35 to 38 days old. Despite supportive care and diuresis, the patient remained profoundly hypoxemic with infiltrates that progressed to fibrosis. RESULTS: The patient had mild subclinical lower‐lobe predominant interstitial pulmonary fibrosis but developed diffuse bilateral ground glass opacities with areas of consolidation 24 hours after receiving her last RBC unit. Transbronchial biopsy of the right lower lobe showed active organizing pneumonia and underlying interstitial fibrosis, supporting the clinical diagnosis of acute exacerbation of pulmonary fibrosis. The bronchoalveolar lavage showed progressive bloody effluent, consistent with diffuse alveolar hemorrhage, a marker of lung injury. There was no evidence of viral inclusions, fungal elements, pneumocystis, or bacterial organisms. CONCLUSION: Transfusion of multiple units of aged RBCs was temporally associated with an acute exacerbation and rapid progression of underlying subclinical pulmonary fibrosis.     

婴幼儿尼曼-皮克病肺部病变高分辨率CT表现

目的 观察婴幼儿尼曼-皮克病肺部病变的高分辨率CT（HRCT）表现。方法 回顾性分析11例经基因检测/骨髓穿刺活检/酶学活性检测确诊尼曼-皮克病患儿的胸部HRCT表现，包括气道病变征象、间质病变征象、肺泡病变征象及其他肺或肺外改变。对双肺主动脉弓层面、气管隆嵴层面及膈面上层面的HRCT异常及累及范围分别进行评分。比较不同种类病变及累及范围的差异。结果 气道病变和间质病变发生率均为100%（11/11），肺泡受累为81.82%（9/11）；上述3类病变累及范围差异有统计学意义（H=10.57，P<0.01），而左、右肺野病变累及范围相近（U=27.5，P=0.64）。气道病变所致各种异常累及范围差异有统计学意义（H=8.81，P=0.03），以支气管壁增厚和树芽征范围最广。肺间质病变所致小叶间隔增厚、小叶内线及小叶中心阴影累及范围差异无统计学意义（H=5.67，P=0.06）。9例患儿肺部见磨玻璃影，累及范围相近。结论 尼曼-皮克病肺部病变HRCT表现以肺间质和肺泡受累为主，间质病变多见于上肺野和下肺野，气道病变多见于上肺野，而肺泡病变分布较广泛、均匀。     

临床非特异性间质性肺炎3例报告及文献复习

目的:探讨非特异性间质性肺炎(NSIP)的临床特征。方法:对3例经支气管镜肺活检病理诊断的NSIP患者的发病诱因、临床表现、影像学、肺功能检查、病理资料及预后进行回顾分析。结果:3例中女性2例,男性1例,平均年龄45～47岁;发病至就诊时间15 d～4个月。发病前有吸烟史1例,慢性胃炎1例,3例均有咳嗽、进行性呼吸困难,2例有吸气相爆裂音,有发热和杵状指各1例。胸部高分辨CT(HRCT)均示有弥漫性斑片状磨玻璃样变,以两下肺及胸膜下为甚。肺功能检查示2例为限制性肺通气功能障碍,1例为混合性肺通气功能障碍,低氧血症1例。组织类型:细胞型2例,混合型1例。1例低氧血症给予无创机械通气治疗,3例均给予糖皮质激素治疗后病情明显好转。结论:对中年以上的患者,临床表现、胸部影像学等检查拟诊为间质性肺病变者要及时行支气管镜肺活检,以明确NSIP的病理诊断及组织学类型。确诊NSIP患者,加用糖皮质激素治疗可提高临床治疗效。