Doenças pulmonares intersticiais: Acuidade diagnóstica e riscos da biópsia pulmonar cirúrgica

 

Miguel Guerra 1

José António Miranda 1

Francisco Leal 1

Luís Vouga 1

 

 

Resumo

Os autores descrevem a sua casuística de biópsias pulmonares cirúrgicas em doentes com doença pulmonar intersticial, de forma a determinar a acuidade diagnóstica, os riscos e a morbimortalidade associados ao procedimento. Entre Janeiro de 1998 e Dezembro de 2007, 53 doentes (idade média de 47,2±13 anos) foram referenciados para a realização de biópsia pulmonar cirúrgica, dos quais 22 eram mulheres (41,5%). As biópsias pulmonares foram realizadas quer por videotoracoscopia (37 doentes, 69,8%), quer por minitoracotomia (16 doentes, 30,2%). Foi escolhido o pulmão direito para biopsar em 88,7% dos casos. Registaram-se complicações pós-operatórias em 5 doentes (9,4%): fuga aérea prolongada em 3 doentes (5,7%), persistência de loca de pneumotórax num doente (1,9%) e hemorragia com necessidade de revisão de hemostase noutro doente (1,9%). Ocorreu um óbito de causa desconhecida num doente sem risco acrescido. A duração média da drenagem foi de 4,4±3 dias e o tempo de internamento médio de 5,5±4 dias. O diagnóstico histológico definitivo foi conseguido em 50 doentes, registando-se uma acuidade diagnóstica de 94,3%. Em conclusão, o potencial benefício de um diagnóstico histopatológico conclusivo através de uma biópsia pulmonar cirúrgica deve ser balanceado com os riscos associados ao procedimento cirúrgico, especialmente para aqueles doentes com disfunção cardiopulmonar severa.

Palavras-chave: Doença pulmonar intersticial, biópsia pulmonar cirúrgica, acuidade diagnóstica, complicações pós-operatórias, morbimortalidade.

 

 

Interstitial lung disease: Diagnostic accuracy and safety of surgical lung biopsy 

Abstract

This study reports our experience, diagnostic accuracy and safety of surgical lung biopsy in patients with interstitial lung diseases. From January 1998 – December 2007 surgical lung biopsy was performed in 53 patients (22 female [41.5%]; age 47.2±13 years). A total of 37 patients (69.8%) underwent videothoracoscopic lung biopsy and minithoracotomy was performed in 16 patients (30.2%). Right lung was the choice in 47 patients (88.7%). Postoperative complications were rare (9.4%) and included three prolonged air leaks (5.7%), one pneumothorax requiring a chest drain (1.9%), and one haemothorax requiring reoperation (1.9%). One patient died of cardiac arrest of unknown cause. Average chest tube duration was 4.4±3 days and average hospital stay 5.4±4 days. Lung biopsy contributed to the diagnosis in 50 patients (94.3%). In conclusion, the potential benefits of diagnostic surgical lung biopsy must be considered against the risks of the procedure especially in patients with severe cardiopulmonary dysfunction.

Key-words: Interstitial lung disease, surgical lung biopsy, diagnostic accuracy, postoperative complications, morbimortality.

 

 

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1 Serviço de Cirurgia Cardiotorácica/Cardiothoracic Surgery Unit

Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal

 

Correspondência/Correspondence to:

Miguel Guerra

Serviço de Cirurgia Cardiotorácica

Centro Hospitalar de Vila Nova de Gaia/Espinho

Rua Conceição Fernandes

4434-502 Vila Nova de Gaia, Porto, Portugal

Tel: (+351) 227865100

Tlm: (+351) 933734217

Fax: (+351) 227865170

Email: migueldavidguerra@yahoo.com

 

 

Recebido para publicação/received for publication: 08.06.20

Aceite para publicação/accepted for publication: 08.12.30