https://scholars.lib.ntu.edu.tw/handle/123456789/473910
標題: | Surgical lung biopsy for diffuse pulmonary disease: Experience of 196 patients | 作者: | Lee Y.-C. CHEN-TU WU HSAO-HSUN HSU PEI-MING HUANG YIH-LEONG CHANG |
公開日期: | 2005 | 出版社: | Mosby Inc. | 卷: | 129 | 期: | 5 | 起(迄)頁: | 984-990 | 來源出版物: | Journal of Thoracic and Cardiovascular Surgery | 摘要: | Objective: Surgical lung biopsy is considered the final method of diagnostic modality in patients with undiagnosed diffuse pulmonary disease. Nevertheless, the effect of surgical lung biopsy on the diagnosis, treatment, and outcome of the patient still remains controversial. This study reviewed the experiences of surgical lung biopsies in 196 consecutive patients during the past 7 years. Methods: Surgical lung biopsy was performed after achievement of general anesthesia through video-assisted thoracoscopic surgery or a 7-cm minithoracotomy. Biopsy specimens were swabbed for aerobic and anaerobic bacterial, fungal, and mycobacterial cultures. The sections of specimens were routinely stained with hematoxylin and eosin, and acid-fast, Gomori methenamine silver, Gram stain, or other special stains were added if necessary. Results: The pathologic diagnosis after surgical lung biopsy included infection (30.6%), interstitial pneumonia or fibrosis (21.9%), diffuse alveolar damage (17.3%), neoplasm (13.3%), autoimmune diseases (8.2%), and others (8.2%). After surgical lung biopsy, 165 (84.2%) patients had changes in their therapy, 124 (63.3%) patients had clinical improvement of their conditions, and 119 (60.7%) patients survived to hospital discharge. Comparison between immunocompromised and immunocompetent patients showed that diagnosis of infection was significantly higher (P < .01) in the former group (41.2% vs 20.2%). In addition, there was no significant difference in the distribution of diagnosis and rate of change in therapy between the respiratory failure and nonrespiratory failure groups. However, the rates of response to therapy and patient survival were significantly lower in the respiratory failure group (51.2% and 41.5%) than in the nonrespiratory failure group (71.9% and 78.1%, P < .05). There was no surgical mortality directly related to the procedure. The surgical morbidity rate was 6.6%. Conclusion: Surgical lung biopsy is a safe and accurate diagnostic tool for diffuse pulmonary disease. For a large proportion of the patients, change of therapy and then clinical improvement can be achieved after surgical lung biopsy. Surgical lung biopsy should be considered earlier in patients with undiagnosed diffuse pulmonary disease, especially when the respiratory condition is deteriorating. Copyright ? 2005 by The American Association for Thoracic Surgery. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-18244389670&doi=10.1016%2fj.jtcvs.2004.07.033&partnerID=40&md5=f0dcf888d6adf5cf348b460b02aeb7e7 https://scholars.lib.ntu.edu.tw/handle/123456789/473910 |
ISSN: | 0022-5223 | DOI: | 10.1016/j.jtcvs.2004.07.033 | SDG/關鍵字: | antineoplastic agent; corticosteroid; eosin; hematoxylin; immunosuppressive agent; silver derivative; silver methenamine; steroid; unclassified drug; adolescent; adult; aerobic bacterium; aged; anaerobic bacterium; artificial ventilation; autoimmune disease; bacterium culture; bone marrow suppression; bone marrow transplantation; cancer chemotherapy; cancer radiotherapy; child; controlled study; endoscopic surgery; experience; female; fibrosing alveolitis; fungus culture; general anesthesia; Gram staining; hematologic malignancy; hospital discharge; human; human tissue; immune deficiency; immunocompetence; infant; infection; interstitial pneumonia; lung alveolus; lung alveolus proteinosis; lung cancer; lung disease; lung embolism; lung infection; lymphangioleiomyomatosis; major clinical study; male; morbidity; Mycobacterium; occupational lung disease; open lung biopsy; priority journal; respiratory failure; review; sepsis; staining; surgical mortality; survival time; thoracoscopy; thoracotomy; upper gastrointestinal bleeding |
顯示於: | 病理學科所 |
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