Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Analysis of Risk and Benefit of Open Lung Biopsy in Severe Immunocompromised Patients with Pulmonary Complications

폐합병증을 동반한 심한 면역저하 환자에서 폐생검술의 유효성 및 위험성에 대한 분석

  • 이호석 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 이성호 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 김관민 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 심영목 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 한정호 (성균관대학교 의과대학 삼성서울병원 진단병리과)
  • Published : 2001.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Pulmonary complications in immunocompromised patients are often fatal. Empirical treatment is usually applied based on the clinical and radiological findings because of the risk of the aggressive diagnostic procedures such as open lung biopsy. However, recent advancements in operative procedures and perioperative management has decreased the procedure-related risks. We have prospectively analyzed the risks and benefits of the early application of open lung biopsy in such patients. Material and Method: Forty-two consecutive immunocompromised patients with critical pulmonary complications were included from June, 1996 to December, 1999. The definition of the immunocompromised is as those with chemotherapy and/or other modality for hematologic disorders, with usage of immunosuppressive drug after transplantation, with usage of steroid for more than 1 month, and with primary immunodeficiency disorders. The indication of open lung biopsy was those with no significant improvement after a week of aggressive application of empirical treatment or with rapidly aggressive process. The underlying disease included hematologic disorder(31 patients), post-transplantation(3 patients), chemotherapy for solid tumor(2 patients), and others(6 patients). Operations were done through thoracotomy(conventional or mini-) or VATS.

배경: 면역저하 환자에게 발생하는 폐 합병증은 흔히 치명적이다. 폐생검술과 같은 침습적인 진단 술기의 위험도 때문에 일반적으로 임상 양상과 방사선 영상 소견에 근거하여 경험적인 치료가 적용된다. 그러나 최근 수술 술기와 수술 전후의 환자 관리의 발전으로 인해 술기와 연관된 위험도는 줄어든 실정이다. 이에 폐합병증을 동반한 심한 면역저하 환자에서 시행된 폐생검술의 위험성 및 유효성에 대하여 전향적으로 분석하였다. 대상 및 방법: 1996년 6월부터 1999년 12월까지 폐합병증을 동반한 면역저하 환자 42명에서 43례의 폐생검술을 실시하였다. 면역저하는 다음과 같이 정의하였고(1, 혈액학적인 질환으로 인해 화학요법이나 다른 치료를 동반하여 받은 경우, 2. 이식 수술 후 면역 억제제를 복용하는 경우, 3. 1 개월 이상의 스테로이드 복용, 4. 원발성 면역결핍 질환), 이상의 면역저하 환자에서 새로운 폐합병증을 동반하고 1 주간의 경험적 치료에 호전이 없거나 급속하게 진행되는 경우를 대상으로 하였다 기저 질환은 혈액학적 질환(31명), 이식 수술 환자(3명), 고형암으로 인한 화학요법(2명)등이었으며 수술은 개흉술이나 video-aided thoracoscopic surgery (VATS)를 통하여 이루어 졌다.

Keywords

References

  1. Am J Respir Crit Care Med v.161 The Utility of Open Lung Biopsy in Patients with Hematologic Malignancies Dorothy AW;Philip WW;Robert D
  2. Ann Intern Med v.117 Respiratory disease in the immunosuppressed patient Shelhamer JH;Toews GB;Masur H;Suffredini AF;Pizzo PA;Walsh TJ
  3. Am Rev Respir Dis v.131 The role of fiberoptic bronchoscopy in the evaluation of immunocompromised hosts with diffuse pulmonary infiltrates Williams D;Yungbluth M;Adams G;Glassroth J
  4. Am J Med v.78 Open lung biopsy in patients with acute leukemia McCabe RE;Brooks RG;Mark JBD;Remington JS
  5. Am J Surg v.154 Diagnostic value of open lung biopsy in immunocompromised patients Thomas JH;Farek PE;Hermreck AS;Pierce GE
  6. J pediatr Surg v.23 The usefulness of open lung biopsy in the pediatric bone marrow transplant population Shorter NA;Ross AJ Ⅲ;August C(et al.)
  7. Respiration v.59 Open lung biopsy: A safe, reliable, and accurate method for diagnosis in diffuse lung disease Shah SS;Tsang V;Goldstraw P
  8. Cancer v.52 Diagnosis of pneumonitis in immunocompromised patients by open lung biopsy Haverkos HW;Dowling JN;Pasculle AW(et al.)
  9. Mayo Clin Proc v.67 Outcome of recipients of bone marrow transplants who require intensive care unit support Afessa BA;Tefferi A;Hoagland C(et al.)
  10. Adv Int Med v.37 Lung biopsy Utz JP;Perrella MA;Rosenow EC
  11. J Pediatr Surg v.25 Diagnostic open lung biopsy after bone marrow transplantation Snyder DL;Ramsay NK;McGlave PB;Ferrell KL;Leonard AS
  12. Surg Gynecol Obstet v.175 Diagnosis of acute diffuse pulmonary infiltrates in immunosuppressed patients by open biopsy of the lung Robbins BE;Steiger Z;Wilson RF(et al.)
  13. Ann Thorac Surg v.65 The role of open lung biopsy in th management and outcome of patients with diffuse lung disease Kramer MR;Berkman N;Mintz b;Godfrey S;Saute M;Amir G
  14. Surgery v.92 The value of open lung biopsy in the immunosuppressed patient Hiatt JR;Gong H;Mulder DG;Ramsey KP
  15. Am Rev Respir Dis v.139 Open lung biopsy in patients with Hodgkin"s disease and pulmonary infiltrates Catterall JR;McCabe RE;Brooks RG;Remingtion JS.
  16. J Thorac Cardiovasc Surg v.106 Comparison of open versus thoracoscopic lung biopsy for diffuse infiltrative pulmonary disease Ferson PF;Landreneau RJ;Dowling RD(et al.)
  17. Ann Thorac Surg v.66 Videothoracoscopic lung biopsy in diffuse infiltrative lung diseases: a 5-year surgical experience Zegdi R;Azorin J;Tremblay B;Destable MD;Lajos PS;Valeyre D
  18. Chest v.115 The utility of open lung biopsy in patients requiring mechanical ventilation Arthas F;John M
  19. Am Surg v.60 Evaluation of outcome following open lung biopsy Bove P;Ranger W;Pursel S(et al.)
  20. J Thorac Cardiovasc Surg v.77 Open lung biopsy in the immunosuppressed patient: is it really beneficial? Rossiter SJ;Miller CD;Churg AM(et al.)
  21. J thorac Cardiovasc Surg v.97 Does open lung biopsy affect treatment in patients with diffuse pulmonary infiltrate? Walker WA;Cole FH;Khandekar A(et al.)