内科胸腔镜检术在不明原因胸腔积液中的应用分析

Analysis of Thoracoscopy in Pleural Effusion of Unkown Reason

目的：探讨胸腔镜检查术对不明原因胸腔积液的诊断价值。方法：85例不明原因的胸腔积液患者行胸腔镜检术,取病变组织行病理检查。结果：镜下表现可以分为5种,分别是乳白色、鲜红色弥漫性粟粒样结节38例(44．7%),单发或多发菜花样、乳突状结节34例(40%),胸膜充血、水肿6例(7．1%),胸膜增厚及纤维分隔或粘连带形成4例(4．7%),无明显异常3例(3．5%)。胸腔镜检术确诊率91．7%。确诊病例中恶性肿瘤32例(37．6%),其中肺癌转移24例(腺癌20例,鳞癌3例,小细胞肺癌1例),恶性胸膜间皮瘤2例,胃癌胸膜转移3例,肝癌2例,淋巴瘤1例。良性疾病共50例(58．8%),其中结核性胸膜炎46例(54．1%),慢性炎症4例(4．7%)。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 diagnostic value of thoracosocopy in pleural effusion of unknown reason. Methods： Eighty-five patients with plural effusion of unknown reason underwent thoracoscopy and for histopathologic examination. Results： Thoracoscopic presentations could be divided into 5 types, ivory, bright red miliary nodules in 38 cases （44. 7%）, single or multi cauliflower or papillary nodules in 34 cases （40%）, pleural congestion and edama in 6 cases （7. 1%）, pleural thickness and formation of fibrous septa or adhesion in 4 cases （4. 7%）, no obvious abnormalities in 3 cases （3.5%）. The accurate diagnostic rate of thoracoscopy was 91.7%. Among 32 malignant cases （37. 6%）, there were 24 cases with metastasis of lung cancer （adenocarcinoma 20 cases, squamous cell lung cancer 3 cases, small cell lung cancer 1 case）, 2 cases with malignant mesothelioma, 3 cases with pleural metastasis from stomach cancer, 2 cases with pleural metastasis from liver cancer, 1 case with lymphoma. Among 50 benign cases （58. 8%）, there were 46 cases （54. 1%） with tuberculous pleurisy, 4 cases （4. 7%） with chronic inflammation. There was no severe complication. Conclusion： Thoracoscopy is safe and with high diagnostic rate in pleural effusions of unknown reason.