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Vol. 33. Issue 7.
Pages 341-345 (July - August 1997)
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Vol. 33. Issue 7.
Pages 341-345 (July - August 1997)
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La videotoracoscopia frente a la toracotomía en el diagnóstico de la enfermedad intersticial difusa
Video thoracoscopy or thoracotomy for the diagnosis of diffuse interstitial disease
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T. Martín, R. Larraga1, I. Badorrey, S. Bello, A. Hernández
Servicios de Neumología, Hospital Miguel Servet. Zaragoza
J.L. de Andrés*, F. Sánchez*
* Servicios de Cirugía Torácica. Hospital Miguel Servet. Zaragoza
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El estudio histológico desempeña un importante papel en el diagnóstico de las enfermedades pulmonares intersticiales difusas (EPID). El desarrollo de las nuevas técnicas endoscópicas ha permitido la obtención de la pieza quirúrgica con un alto rendimiento diagnóstico y menos complicaciones que la técnica abierta.

Hemos evaluado nuestra experiencia en biopsia videotora-coscópica (VT) comparando el rendimiento diagnóstico, tiempo de drenaje y estancia hospitalaria, tamaño y número de piezas y complicaciones respecto a la toracotomía en la EPID. Comparamos retrospectivamente un grupo de 30 pacientes sometidos a biopsia pulmonar con videotoracoscopia en un período comprendido entre marzo de 1993 y enero de 1995 con otro grupo de 28 pacientes a los que se practicó biopsia pulmonar abierta por toracotomía (BPA) desde mayo de 1987 a enero de 1995.

Con la VT se llegó al diagnóstico en el 96,66% de los casos mientras que con la BPA en el 92,85%. El número de piezas obtenidas fue VT: 1,5 (DE=0,5); BPA: 2,1 (DE=1,3); (p=0,47). El tamaño de las piezas en conjunto expresado en cm3 fue VT: 13,3 (DE=15,4); BPA: 18,5 (DE=21); (p=0,284). El tiempo de drenaje torácico expresado en horas fue VT: 52 (DE=39,9); BPA: 89,1 (DE=47); (p=0,002). La estancia hospitalaria en días fue VT: 3,5 (DE=2); BPA: 8,7 (DE=3,5); (p=0,001). Las complicaciones fueron menores en número y entidad con la VT.

La VT demuestra ser una técnica de rentabilidad tan alta como la toracotomía en la obtención de biopsias pulmonares en las EPID, presentando además menos complicaciones y una disminución del gasto económico en relación con un menor tiempo de drenaje y estancia hospitalaria requeridos.

Palabras clave:
Enfermedad intersticial pulmonar
Videotoracoscopia
Biopsia pulmonar

Histopathology plays an important role in the diagnosis of diffuse interstitial lung disease. New endoscopic techniques allow performance of sampling procedures that have the same diagnostic accuracy and fewer complications that open lung biopsy (OLB).

We evaluated our experience with video thoracoscopic lung biopsy (VTLB) in comparison with OLB in terms of diagnostic accuracy, duration of pleural drainage and hospital stay, number and size of samples and complications. Thirty patients who underwent VTLB from March 1987 to January 1995, and 28 patients who underwent OLB from May 1987 to January 1995 were studied retrospectively.

Diagnosis was achieved in the VLTB group in 96.66% of cases and in the OLB group in 92.85%. The number of specimens obtained was 1.5 (SD 0.5) in the VTLB group (p=0.47). Overall specimen size expressed in cm3 was 13.3 (SD-15.4) in the VTLB group and 18.5 (SD 21) in the OLB group (p=0.284). Length of pleural drainage in hours was 52 (SD 39.9) in the VTLB group and 89.1 (SD 47) in the OLB group (p=0.002). Length of hospital stay in days was 3.5 (SD 2) in the VTLB group and 8.7 (3.5) in the OLB group (p=0.001). Complications were fewer and less severe after VLTB.

VLTB is as useful as OLD for obtaining lung biopsies in diffuse interstitial lung disease. VLTB also causes fewer complications and is less expensive because drainage times and hospital stays are shorter

Key words:
Interstitial lung diseases
Videothoracoscopy
Lung biopsy
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Copyright © 1997. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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