胸腔镜在不明原因胸腔积液中的应用

Clinical application of medical thoracoscopy in unknown pleural effusion

目的探讨胸腔镜在不明原因胸腔积液中的临床应用。方法对60例不明原因胸腔积液患者行胸腔镜检查,观察镜下表现,直视下取病变组织行病理检查。结果60例患者经病理确诊57例,确诊率为95%,恶性肿瘤10例占16.66%,其中肺癌胸膜转移6例(腺癌5例、鳞癌1例),直肠腺癌胸膜转移1例,胸膜间皮瘤2例,淋巴细胞淋巴瘤1例;病理确诊结核性胸膜炎41例68.33%;病理示嗜酸性肉芽肿性炎症3例,非特异性炎症者2例,脓胸1例,胸膜未见异常1例;7例双侧胸腔积液患者中3例与肝吸虫相关,1例与类风湿性关节炎相关,1例与系统性红斑狼疮相关,1例与结核相关,1例未见异常者未作病理活检。结论对不明原因的胸腔积液行胸腔镜检查是首选的诊断方法。

Objective To study the clinical application of medical thoracoscopy in unknown pleural effusion. Method 60 cases unknown pleural effusion were performed with medical thoracoscopy, biopsy were used of in the pleural under medical thoracoscopy. Results Of all 60 cases, 57 were diagnosed definitely by pathology, the diagnostic accuracy rate was 95% ,among which 6 were malignant tumors（5 adenocarcinoma, 1 squamous cell cancer）, 1 pleural metastasis of rectum,2 pleural mesothelioma, 1 lymphocytic lymphoma; 46 cases were diagnosed definitely as tuberculous pleurisy （76.66%） ,3 acidophily granulomatous inflammation,2 nonspecific inflammation, 1 empyema, 1 showed no abnormalities in pleura. Of 7 bilateral pleural effusion,3 were related with liver flukes, 1 with rheumatoid arthritis, 1 with systemic lupus erythematosus （SLE）, 1 were normal without biopsying. Conclusion Medical thoracoscopy is an optimum diagnosis method for unknown pleural effusion.