摘要
目的探讨经支气管冷冻肺活检(TBLC)协助诊断电焊工尘肺的临床应用,总结电焊工尘肺患者的临床和病理特征。方法本研究为病例系列研究。总结复旦大学附属中山医院于2020年8月至2022年1月TBLC确诊的3例电焊工尘肺患者的临床症状、胸部高分辨率CT表现和组织病理学改变情况,以及TBLC在电焊工尘肺诊断和鉴别诊断中的应用。结果3例患者均为男性,年龄范围37~49岁,电焊工职业史12~24年,主要临床症状为咳嗽、气喘,胸部CT主要表现为弥漫性小斑片状磨玻璃影及结节。3例患者均进行TBLC,活检过程中有轻度出血,但无气胸、血胸发生,肺组织病理可见肺泡内沉积含铁血黄素颗粒。结论电焊工尘肺的主要临床特征为咳嗽、气喘,胸部CT提示弥漫性磨玻璃影及结节,肺组织病理见肺泡内含铁血黄素颗粒。TBLC可协助电焊工尘肺的诊断和鉴别诊断。电焊工尘肺的临床症状无特异性。结合电焊工职业史、肺泡内和支气管肺泡灌洗液中观察到含铁血黄素颗粒有助于电焊工尘肺的诊断。
ObjectiveTo explore the clinical application of transbronchial lung cryobiopsy(TBLC)in assisting the diagnosis of welder pneumoconiosis,and to summarize the clinical and pathological characteristics of welder pneumoconiosis.MethodsThis was a case series study.Clinical symptoms,high resolution computed tomography(HRCT)findings and histopathology of 3 patients with welder pneumoconiosis diagnosed by TBLC in Zhongshan Hospital,Fudan University from August 2020 to January 2022 were analyzed.The application of TBLC in the diagnosis and differential diagnosis of welder pneumoconiosis was summarized.ResultsAll three patients were male,aged from 37 to 49 years old,had an occupational history of being welders for 12-24 years.The main clinical symptoms included cough and wheezing.Diffusedly distributed small patchy ground-glass opacities and nodules were frequently seen on HRCT in bilateral lung fields.Three patients underwent TBLC.No pneumothorax and hemopneumothorax occurred.Mild intraoperative bleeding occurred in all patients.The lung specimen showed numerous macrophages containing iron particles within the alveolar space.ConclusionThe main clinical features of welder pneumoconiosis are cough and wheezing.HRCT shows diffuse ground-glass opacities and nodules.The lung specimen shows numerous macrophages containing iron particles within the alveolar space.TBLC can assist in the diagnosis and differential diagnosis of welder pneumoconiosis.The clinical symptoms of welder pneumoconiosis are not specific.Combining the occupational history of welders with the observation of hemosiderin particles in alveoli and bronchoalveolar lavage fluid is helpful for the diagnosis of welder pneumoconiosis.
作者
王林林
叶茂松
李春
侯英勇
宋元林
洪群英
Wang Linlin;Ye Maosong;Li Chun;Hou Yingyong;Song Yuanlin;Hong Qunying(Department of Pulmonary and Critical Care Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Pathology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《国际呼吸杂志》
2025年第5期405-410,共6页
International Journal of Respiration
基金
国家自然科学基金(82000087)。
关键词
尘肺
经支气管冷冻肺活检
电焊工
职业史
Pneumoconiosis
Transbronchial lung cryobiopsy
Welder
Occupational history
