I. Interstitial pneumonia and lung biopsy
”Interstitial pneumonia” is the abbreviation for “diffuse interstitial lung disease” or “interstitial lung disease”. Interstitial pneumonia is a large group of diffuse parenchymal lung diseases that occur primarily in the interstitial lung, involving alveolar epithelial cells, pulmonary capillary endothelial cells, and pulmonary arterioles. In general, the interstitium comprises a large portion of the lung parenchyma, consisting of tissue located between the alveoli, and is therefore now also referred to as diffuse parenchymal lung disease.
More than 180 known diseases have been found to involve the interstitial lung, and regardless of their etiology, most interstitial lung diseases share a common pathologic underlying process. Initial injury is followed by the involvement of inflammatory and immune effector cells, and in most interstitial lung disease processes, the inflammatory-immune response progresses with eventual irreversible pulmonary scarring (fibrosis) of the alveolar walls, airways and blood vessels.
Surgical lung biopsy is quite important to clarify the clinical and pathological diagnosis unless the patient has typical clinical manifestations and imaging changes of idiopathic pulmonary fibrosis/universal interstitial pneumonia (UIP/IPF). Of course, this does not consider lung biopsy to be necessary for a definitive clinical diagnosis. Pathology performed at advanced stages of the disease or after initiation of treatment is of lesser significance.
The clinical significance of a surgical lung biopsy is as follows.
1, After affirming the clinicopathologic diagnosis, it gives physicians and patients more confidence in treatment.
2, All drugs currently used to treat idiopathic interstitial pneumonia (IIP) have some potential side effects or dangers, and it is not very reasonable to risk treating patients before a definitive diagnosis is made.
3. Associated occupational diseases, such as asbestosis, can be identified.
As mentioned above, the diagnosis can be made without surgical lung biopsy in patients with idiopathic pulmonary fibrosis/general interstitial pneumonia with typical clinical presentation and imaging features. However, if a definitive diagnosis and exclusion of other types of IIP is required, only a surgical lung biopsy should be performed. In most cases, surgical lung biopsy can provide a histologic diagnosis for patients with IIP, confirm or exclude other diagnoses, and allow for specific staining to diagnose certain infectious diseases.
Dissecting lung biopsy
Open lung biopsy (OLB) is the gold standard for direct open lung biopsy of lung, pleural, hilar and mediastinal tissues for localized or extensive lung disease of unknown diagnosis.
2.1 Indications
1.The nature of the lesion is still not clear by various methods of examination, and a clear diagnosis is helpful to guide treatment and improve prognosis; 2.The diagnosis cannot be confirmed by general methods but there is no condition for thoracoscopy, and a clear diagnosis is really needed.
2.2 Contraindications
1.Poor general condition, serious heart and lung dysfunction and other organ dysfunction, unable to tolerate surgery; 2.Serious coagulation dysfunction.
2.3 Patient preparation and instrument preparation should be in accordance with the preoperative preparation for open thoracic surgery.
2.4 Operation method
1. Position: lateral or supine position.
2. Anesthesia: general anesthesia tracheal intubation.
3. Determine the operation style as appropriate: (1) limited anterior thoracic open biopsy or lateral open biopsy. Through a 6-8 cm intercostal incision, the lung tissue is biopsied after a large tidal volume is given to the inflated incision. This method can be used to diagnose diffuse interstitial lung disease and limited peripheral lung disease with few complications and low morbidity and mortality, and requires closed drainage of the thoracic cannula after surgery. (2) Full range incision open thoracotomy. Access to the pleura, hilum, mediastinum and whole lung is possible. It is suitable for those who suspect lung tumor or those who need biopsy of multiple parts of unilateral lung. (3) Median sternotomy lung biopsy. For those who need biopsy of lesions in both lungs.
2.5 Specimen processing
The specimen is fixed in 10% formalin solution and sent for examination.
2.6 Complications and their management Complications of open-heart surgery are more frequent than those of minimally invasive biopsy methods, such as anesthesia accidents, intraoperative and postoperative bleeding, intra-thoracic or incisional infection, pneumothorax, bronchopleural fistula, pneumonia and atelectasis, respiratory failure, cardiac insufficiency, arrhythmia, etc.
Preoperative improvement of the function of the heart and lungs and other important organs is the prerequisite for the prevention of surgical complications; intraoperative careful and standardized operation is the key to reduce surgical complications; postoperative strengthening of monitoring and timely and correct treatment is an important guarantee for timely detection and treatment of complications and improvement of prognosis.
For various complications, corresponding treatment measures are taken, such as hemostasis, anti-infection, cardioplegia, diuresis, anti-arrhythmia, ventilator-assisted breathing, bronchoscopic drainage, closed chest drainage, and open-chest surgery again if necessary.