纤支镜检和胸膜活检在中老年人胸水病因诊断中的应用

Diagnostic Application of Fibrobronchoscopy and Pleural Biopsy in Middle and Elder Patients with Pleural Effusion

目的 :通过对 46例中老年胸水患者同时行纤支镜检和胸膜活检 ,以探讨其联合应用在良恶性胸水鉴别中的意义。方法分析 46例胸水患者的纤维支气管镜检、胸膜活检的分别诊断阳性率及两者联合诊断的阳性率。结果 :纤支镜对胸水病因的诊断阳性率为 30 .4% (其中肺内有病变者 19例 ,确诊为肺癌 11例、肺结核 1例 ,确诊率为6 3 % ,肺内无病变者 2 7例 ,确诊为肺癌 2例 ,确诊率为 7.4% )。胸膜活检对胸水病因诊断的阳性率为 5 6 .5 % (其中肺内有病变者 19例 ,确诊为肺癌 5例、肺结核 2例、其它 1例 ,确诊率为 42 .1% ,肺内无病变者 2 7例 ,确诊为肺癌 4例、肺结核 10例、其它 4例 ,确诊率为 6 6 .6 % )。两项联合应用对胸水病因的诊断阳性率为 84.7%。结论 :纤支镜检对肺内有病变的胸水尤其是肺癌所至的胸水诊断率较高 ,胸膜活检总阳性率较纤支镜高 。

Objective: To evaluate the diagnostic application of combination of fibrobronchoscopy with pleural biopsy in middle and elder aged patients with pleural effusion. Methods: All cases were examined with chest radiograph, fibrobronchoscopy, and pleural biopsy. Results:14 (30.4%) of 46 cases with pleural effusion were diagnosed with fibrobronchoscopy, while 26 (56.5%) of the 46 cases were diagnosed with pleural biopsy. 8 of 19 cases with pathological changes were diagnosed with chest radiograph.However, 18 of 27 cases without pathological changes were diagnosed with chest radiograph.Conclusion:The diagnostic rate of pleural biopsy for pleural effusion is higher than that of fibrobronchoscopy.Fibrobronchoscopy, however,shows a higher diagnostic rate for pathological changes of pulmonary in pleural effusion cases.Combining pleural biopsy with fibrobronchoscopy would be favorable to diagnosis in pleural effusion.