224例胸腔积液胸腔镜检查术分析

Analysis of thoracoscopy in 224 cases

目的探讨胸腔镜检查术对疑难胸腔积液的诊断价值。方法224例不明原因的胸腔积液患者行胸腔镜检术,观察胸腔镜下表现,直视下取病变组织行病理检查。结果镜下表现可以分为5种,分别是胸膜充血、水肿34例(15.2%),灰白色弥漫性粟粒样结节49例(21.9%),单发或多发结节113例(50.4%),胸膜增厚及纤维分隔或粘连带形成9例(4.0%),未见明显异常19例(8.5%)。胸腔镜检术确诊率83.9%。确诊病例中恶性肿瘤126例(56.2%),其中肺癌转移99例(腺癌81例,鳞癌13例,小细胞肺癌5例),恶性胸膜间皮瘤9例,乳癌胸膜转移6例,胃癌胸膜转移4例,淋巴瘤3例,直肠癌胸膜转移2例,肾透明细胞癌胸膜转移1例,卵巢癌胸膜转移1例,白血病1例。良性疾病共62例(27.7%),其中结核性胸膜炎52例,慢性炎症9例,结节病1例。无严重并发症。结论胸腔镜检查术对不明原因的胸腔积液是一种安全、确诊率高的诊断方法。

[Objective] To evaluate the diagnosing value of thoracoscopy in the pleural effusion of unknown reason. [Methods] Thoracoscopy was down in 224 pleural effusion patients of unknown reason. To observe the under thoracoscopic presentations and take the illness tissues under direct view for histopathologic examination. [Results] The under thoracoseopic presentations could be divided into 5 types, they are pleural congestion and edema in 34 cases （15.2%）, greyish white military diffused nodes in 49 cases （21.9%）, single or multi nodes in 113 cases （50.4%）, pleural thickness and fibrostie septa or adhesion in 9 cases （4.0%）, no obviously abnormal in 19 cases （8.5%）. The diagnostic rate of thoraeoscopy was 83.9%. There were 126 malignant cases （56.2%） in the diagnosed patients. Among them, metastasis of lung cancer 126 eases （adenocareinoma 81 cases, squamous cell lung cancer 13 cases, small cell lung cancer 5 cases）, malignant mesothelioma 9 eases, pleural metastasis from breast cancer 6 cases, from stomach cancer 4 cases, lymphoma 3 cases, from carcinoma of rectum 2 cases, from hygiene carcinoma of kidney lcase, from carcinoma of ovaiy 1 case, leukemia 1 case. There were 62 benign cases （27.7%） in the diagnosed patients. Among them, tuberculous pleurisy 52 cases, chronic inflammation 9 cases, sarcoidosis 1 case. There were no severe complications. [Conclusion] Thoracoscopy is a safe and high diagnostic rate method in unknown reason pleural effusions.