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目的 评价外科肺活检术在弥漫性间质性肺疾病诊断中的安全性和有效性.方法 回顾性分析北京协和医院2006年1月至2012年12月期间收治的弥漫性间质性肺疾病患者的临床资料、影像学资料和病理学资料,经支气管镜相关检查和(或)CT引导下经皮肺穿刺等非创伤性和小创伤性检查,未明确诊断进而接受外科肺活检的179例患者中,男91例,女88例,年龄(16 ～ 76)岁,平均(47±13)岁.结果 179例患者中＜20岁6例(6/179,3.3％),20 ～ 59岁148例(148/179,82.7％),≥60岁25例(25/179,14.0％).自2006年起每年度例数分别为16例(16/179,8.9％)、17例(17/179,9.5％)、19例(19/179,10.6％)、44例(44/179,24.6％)、33例(33/179,18.4％)、31例(31/179,17.3％)和19例(19/179,10.6％).患者平均住院时间为(33±14)d,术后住院天数为(19±10)d,引流管放置时间平均(3.2±1.1)d.胸腔镜肺活检150例,小开胸肺活检例29例,活检部位为:左舌叶54例次、左固有上叶16例次、左下叶基底段56例次、右上叶30例次、右中叶40例次及右下叶基底段56例次.每次活检取得肺组织1～4块不等,其中126例≥2块.肺活检病理确诊103例;结合肺活检病理及临床资料明确诊断32例,44例即使经外科肺活检仍未能明确诊断.确诊的135例病例中,以慢性外源性过敏性肺泡炎(33例)最多见,其次为非特异性间质性肺炎(27例);114例经外科肺活检结果而改变了原有的治疗方案.术后发热16例,其中11例需要使用抗感染治疗;其他术后并发症:伤口延迟愈合6例(＞10 d),需再次留置引流管或抽气的气胸4例次,术后呼吸机脱机困难4例,呼吸衰竭3例,胸腔出血5例,胸腔内感染2例.2例患者因呼吸衰竭于术后30 d内死亡.结论 接受外科肺活检的弥漫性间质病肺疾病患者以青、中年人为主,手术部位以双下肺及左舌叶、右中叶为主;外科肺活检有助于明确这类患者的诊断、指导调整治疗方案;术后并发症以发热、伤口延迟愈合为主要表现,手术相关病死率低;对于诊断不明的弥漫性间质性肺疾病患者建议接受外科肺活检以助于明确诊断、指导治疗.“,”Objective To evaluate the role of surgical lung biopsy (SLB) in the management of diffuse interstitial lung disease (DILD) with no specific diagnosis.Methods We conducted a retrospective analysis of 179 cases with DILD of non-specific diagnosis after non-invasive methods and minimally invasive processes,including bronchoscopy and CT-guided lung biopsy,were performed SLB at Peking Union Medical College Hospital between 2006 and 2012.Patient demographics,surgical approach,number and site of biopsies,post-operative complications and postoperative pathological diagnosis and treatment were analyzed.Results Of 179 cases,there were 91 males (50.8％) and 88 females (49.2％),with a median age of 47.3 years (range 16-76).There were 6 cases(3.4％) who were younger than 20 years and 25 cases(14％) older than 60 years.From 2006 to 2012,every year there were 16 case (8.9％),17 cases (9.5％),19 cases(10.6％),44 cases(24.6％),33 cases(18.4％),31 cases(17.3％) and 19 cases (10.6％) respectively.The total median hospital stay was 33.4 days (range 6-76) and the mean postoperative stay was 18.6 days (range 2-56).The mean duration for chest drainage was 3.2 days (range 2-18).Among them,150 cases were arranged with video-assisted thoracoscopy surgery (VATS) and 29 cases were arranged with minithoracotomy.The number of biopsies taken was ranged from one to four and there were 126 cases (70.4％) had more than one biopsy.The biopsy was performed in left lingular lobe (54 cases/30.2％),left natural upper lobe (16 cases/8.9％),left inferior basal segments (56 cases/ 31.3％),right upper lobe (30 cases/16.7％),right meddle lobe (40case/22.3％) and right inferior basal segments (56 case/31.3％) respectively.Definitive pathological diagnosis was reached in 103 cases (57.5％),diagnosis was reached after combination of pathological,clinical and radiological manifestations in 32 cases (17.9％) and there were 44 cases (24.6％) could not achieved diagnosis even after the SLB.Chronic extrinsic allergic alveolitis was the most common diagnosis (33/24.4％),following nonspecific interstitial pneumonia (27/20％) for the 135 cases with a definite diagnosis.Among 179 cases,there were 114 cases had a change in their treatment following the results of SLB.There were 16 cases had a fever after surgery and antibiotics were administrated for eleven of them.Other complication were included delayed wound healing (＞ 10 days after surgery,6 cases),thoracic hemorrhage (5 cases),chest tube re-indwelling because of pneumothorax (4 cases),delayed weaning of ventilator (＞ 3 days after surgery,4 cases),respiratory failure (3 cases),and thoracic infection (2 cases).There were two cases died within 30 days following surgery because of respiratory failure.Conclusions Most of the DILD patients who were arranged with SLB were young and middle-aged cases.The left lingular lobe,right meddle lobe and both inferior lobes were the preferred biopsy sites.The results of biopsy surgery could provides a diagnosis for most of the DILD patients and could modulate the treatment for more than half of them.Fever and delayed wound healing were the major complications.The SLB related mortality was low.SLB was suggested to the undiagnosed DILD patients.