可弯曲式内科胸腔镜在胸腔积液鉴别诊断中的应用

Differential value of flexirigid thorascopy in pleural effusions

目的探讨可弯曲式内科胸腔镜检查术对良恶性胸腔积液鉴别诊断中的应用价值。方法92例不明原因的胸腔积液患者在局麻下用可弯曲内科胸腔镜检查术,取病变胸膜作病理检查。结果92例中取得病理确诊87例,确诊率94.5%(87/92)。确诊病例中恶性肿瘤46.7%(43/92),肺癌转移42.4%(39/92)其中腺癌28例,胸膜间皮瘤1.1%(1/92)其他转移癌3.3%(3/92);良性疾病47.8%(44/92),结核性胸膜炎40.2%(37/92),炎症6.5%(6/92),肝硬化1.1%(1/92)。胸膜无明确病理结果5.4%(5/92)。转移癌、结核性胸膜炎,胸腔镜下形态各异。所有受检病例无严重不良事件发生。结论可弯曲式内科胸腔镜检查术对不明原因胸腔积液鉴别诊断是一种安全、简单、确诊率高的重要诊断方法。

Objective To evaluate the use of flexirigid thorascopy for benign and malignant pleural effusion. Methods 92 patients with difficult pleural effusion were diagnosed through flexirigid thorascopy pleural biopsy under local anesthesia. Results 87 patients were diagnosed by pathological analysis, and the positive rate was 94. 5 % （87/92）. The diagnosis of 87 cases were malignant pleura effusions in 46.7% （43/92） , pleura metastasis lung cancer in 39 cases, adenocarcinoma in 28 cases, pleura mesothelioma in 1 case, another metastasis carcinoma in 3 cases and 47.8 % （44.92） of benign pleural effusion, tuberculosis pleurisy in 37 cases, chronic inflammation in 6 cases and hepatic hydrothorax in 1 case, only 5.4% （5/92） cases had no problem to be found. Thorascopy of metastasis carcinoma showed differential diagnosis from tuberculosis pleurisy. No serious complication occurred in all cases. Conclusion Medical thorascopy is safe, simple, and has high positive rate and has very important value in the diagnosis of differential pleural effusion.