Con objeto de evaluar una técnica quirúrgica alternativa a la biopsia pulmonar a cielo abierto en el diagnóstico de las neumopatías intersticiales difusas, se realizó biopsia pulmonar transpleural por toracoscopía en 31 pacientes con enfermedad pulmonar intersticial difusa. Después de provocar neumotorax artificial, se introdujo un toracoscopio bajo anestesia local, obteniéndose bajo control visual varios framentos de tejido con un promedio de 5 X 3,6 mm. La única complicación atribuible al procedimiento fue una hemorragia peroperatoria de 300 ml que cedió rápidamente.
En 30 de los 31 pacientes fue posible obtener el diagnóstico de certeza que incluyó: alveolitis fibrosante mural (15), alveolitis alérgica extrínseca (7), histiocitosis X (2), carcinoma bronquioloalveolar (3), bronquiolitis obliterante (1), neumonía intersticial linfoidea (1), e histoplasmosis pleuropulmonar (1).
Estos resultados sugieren que este método quirúrgico es una opción que debería contemplarse en pacientes en los que no es posible realizar la biopsia pulmonar a cielo abierto.
Morphologyc diagnosis by lung biopsy is the main tool for the treatment-planning and prognosis in patients with interstitial lung disease (ILD). Although open lung biopsy is the most reliable method for histologic diagnosis, there are some patients with severe pulmonary function compromise in which this procedure cannot be recommended. For this reason, a study which evaluates the thoracoscopic route has been carried out. 31 patients with the clinical diagnosis of ILD underwent thoracoscopy, two to five samples per patient were obtained. The tissue was processed for light microscopic analysis. The results showed that in almost all the patients, a specific diagnosis was made including: hypersensitivity pneumonitis (7), lymphoid interstitial pneumonia (1), bronchiolitis obliterans (1), bronchiolo-alveolar carcinoma (3), histiocytosis-X (2), histoplasmosis (1) and usual interstitial pneumonia (15). In only one case the diagnosis was not established. Any complications related with the thoracoscopic procedure was reported. These preliminary results suggest that lung biopsy with the thoracoscopic technique is an alternative procedure in patients with ILD and severe pulmonary function impairment.
