电子支气管镜代替胸腔镜检查对不明原因胸腔积液的诊断价值

Role of electronic bronchoscope replacing thoracoscope to the detect unclear causes of pleural effussion

目的探讨电子支气管镜代替胸腔镜检查对不明原因胸腔积液的诊断价值。方法选择71例不明原因胸腔积液的患者采用电子支气管镜代替胸腔镜检查,观察镜下病变形态和病理结果。结果71例患者中,恶性病变45例。其中腺癌34例,胸膜间皮瘤5例,淋巴瘤2例,未能分类间皮细胞团生长4例;26例良性病变中,结核12例,脓胸8例,3例因胸膜粘连广泛而失败,3例未见明显异常。71例患者中61例明确诊断,诊断总阳性率为85.9%;45例恶性积液中41例明确诊断,诊断阳性率为91.1%。所有病例中,明确诊断恶性病变占57.7%,结核占16.9%,化脓性炎症占11.3%。并发症少,出血、疼痛、发热、胸腔内气体残留均极轻微且很快消失,无1例因不能耐受而终止。结论电子支气管镜代替胸腔镜检查具有诊断阳性率高、损伤小、操作简单安全等优点,对不明原因的胸腔积液有较高的临床应用价值,值得进一步研究。

[Objective] To investigate the role of electronic bronchoscope replacing thoracoseope to detect the unclear causes of pleural effusion. [Methodsl Seventy one patients with pleural effusion, whose causes were still unknown, were selected to be detected by the electronic bronchoscope replacing thoracescope, and the appearances of pathological changes under scope were described and the pathological results were defined. [Results] 45 of these 71 patients, were diagnosed to have malignant disease, which include 34 adenoearoinoma eases, 5 pleural endothe-liomas eases, 2 malignant lymphoma eases and 4 unelassitieation mesothelial cell clumps eases. The other 26 benign lesion eases include 12 tubereulesis eases, 8 empyema eases, 3 failed eases because of extensive pleura adhesions and 3 normal eases. Of these 71 patients, 61 eases had definite diagnosis （the positive rate was 85.9%）. Of all the patients, 57.7% eases were malignant disease, 16.9% were tuberculosis and 11.3% were purulent inflammation. And of 45 patients with malignant pleural,fluid, 41 eases had defined diagnosis （the positive rate was 91.1%）. There were few complications and no patients failed to finish this examine. [Conclusions] The electronic bronehoseope replacing the thomeoseope possesses higher positive diagnostic rate and salty. And it has preferable value in elinieal application for those unclear causes of pleural effusion.