经支气管镜肺活检对弥漫性肺间质性疾病的诊断价值及文献复习

目的探讨经支气管镜肺活检（TBLB）对弥漫性肺间质性疾病（DILD）的诊断价值。方法对71例DILD患者在无X线电视透视下行TBLB,并对临床资料及病理诊断结果进行回顾性分析。结果 71例DILD中22例明确诊断,确诊率达31.0%,确诊的疾病种类主要有肺结核7例（31.8%）,普通型间质性肺炎5例（22.7%）,肺泡细胞癌4例（18.2%）,转移性肺癌2例（9.1%）,肺真菌病1例（4.5%）结节病1例（4.5%）,肺泡微石症1例（4.5%）,隐原性机化性肺炎1例（4.5%）;临床诊断病例共31例,诊断率达43.7%,其中特发性肺纤维化15例（48.4%）,结缔组织病相关肺疾病11例,弥漫性泛细支气管炎2例（6.5%）,癌性淋巴管炎2例（6.5%）,炎性假瘤1例（3.2%）;未能明确诊断18例（25.4%）。结论 TBLB对DILD的诊断是一种安全、简便、有效的方法,特别是在除外结节病、肿瘤和某些特殊类型的感染（结核）有重要价值。肺间质性疾病的病理诊断特别是病理分型需要较大的组织,必要时可行胸腔镜（VATS）肺活检或开胸肺活检,以提高对DILD的诊断水平。

Diagnostic value of transbronchial lung biopsy in diffuse pulmonary disease and literature review

Objective To evaluate the efficacy and limitations of trans bronchial lung biopsy (TBLB) in the diagnosis of diffuse interstitial lung disease (DILD). Methods 71 DILD patients were diagnosed with TBLB via fiber optic bronchoscope without fluoroscopic guidance. The result of clinical data and pathologic diagnosis were underwent retrospectively analyses. ResultsConfirmed diagnosis by TBLB was obtained in 22 patients ,the total positive diagnostic rate was 31.0%. The diseases included pulmonary tuberculosis (7/22, 31.8%), lung cancer (4/22,18.2%), usual interstitial pneumonia (5/22, 22.7%), metastatic lung cancer (2/22,9.1%), pulmonary sarcoidosis (1/22, 4.5%), lung fungal infection (1/22, 4.5%), bronchiolitis obliterans organizing pneumonia/organizing pneumonia (1/22, 4.5%), pulmonary alveolar microlithiasisetc (1/22, 4.5%). The clinical data diagnosis was 31 patients, the total positive diagnostic rate was 43.7%. The diseases included diffuse interstitial pulmonary fibrosis (15/31, 48.4%), connective tissus disease-associated lung disease (11/31, 35.5%), diffuse panbronchiolitis (2/31, 6.5%), pulmonary lymphangitic carcinomatosis (2/31, 6.5%), inflammatory pseudotumor (1/31, 3.2%) the diagnosis was undetermined in 18 cases(18/71, 25.4%). Conclusions TBLB in diagnoses of DILD is a reliable, safe, handy cheap, repeatable operational method. It is highly valuable diagnostic to exclude infectious and malignant diseases. Surgical lung biopsy is often necessary to make a definitive diagnosis.