应用套管式胸膜活检钳进行脏层胸膜活检效果和安全性评价

The Efficacy and Safety Evaluation of Trocar-style Pleural Biopsy Forceps for Visceral Pleural Biopsy

目的:评价套管式胸膜活检钳在胸膜增厚或胸膜粘连、胸水分隔包裹性胸膜疾病诊断应用中的价值和安全性。方法:对80例病因不明、伴有胸膜增厚或胸膜粘连、胸水分隔包裹性胸腔积液患者,应用套管式胸膜活检钳,经胸壁插入胸腔进行脏层胸膜活检。结果:活检成功率为96.2%(77/80);咬检成功率为93.3%(224/240),钳咬空1.3%(3/240),咬检物为纤维素5.4%(13/240);病理阳性诊断率为81.2%(65/80),其中胸膜转移癌占31.2%(25/80),结核性胸膜炎22.5%(18/80),恶性胸膜间皮瘤13.7%(11/80),化脓性胸膜炎10%(8/80),恶性淋巴瘤3.7%(3/80),病理未见肌肉组织和脂肪组织;活检组织块2.5～27mm3,平均(8.1±1.2)mm3。气胸8例,肺出血4例,发热2例,无胸痛、气短和咯血患者。结论:具有胸膜增厚或胸膜粘连、胸水分隔包襄性胸腔积液患者,应用套管式胸膜活检钳进行脏层胸膜活检是一种简单、安全和有效的方法。

Objective： To evaluate the efficacy and safety of trocar-style pleural biopsy forceps for visceral pleural biopsy when chest water seRaration, encystment and pleural thickening, adhesion happening in exudativ pleurisy. Methods： A total of 80 cases with pleural effusion who had unclear cause of disease and various degrees of pleural thickening, pleural adhesion and separation encystment have had visceral pleural biopsy with trocar-style pleural biopsy forceps. Results： The biopsy success rate was 96.2% （77/80）, the bite success rate 93.3% （224/240）, the forceps bite empty rate 1.3% （3/240） and the bite material fibrin rate 5.4% （13/240）. The pathological positive rate was 81.2%（65/80）, among them the pleural secondary carcinoma accounting for 31.2 （25/80）, the tuberculous pleurisy 22.5% （18/80）, the malignent mesothelioma 13.7% （11/80）, the suppurative pleurisy 10% （10/80）, the malignent lymphoma 3.7%（3/80） and pathologically without myoideum and adipose tissue. The size of biopsy material was 2.5-27mm^3, with an average of （8.1 ±1.2） mm^3. Eight cases had pneumothorax, 4 cases had hemorrhage, 2 cases had fever. Chest pain, short breath or hemoptysis was observerd. Conclusion： The method of the viseral pleural biopsy with trocar-style pleural biopsy forceps is sim- ple, safe and effective for patients with chest fluid separation, encystment and pleural thickening or adhesion in exudative pleurisy.