可弯曲电子内科胸腔镜在不明原因胸腔积液诊断中的应用价值

Application of flexi-rigid thoracoscopy under local anesthesia to diagnosing difficult pleural effusion

目的探讨可弯曲电子内科胸腔镜在不明原因胸腔积液诊断中的应用价值。方法采用尖端可弯曲电子内科胸腔镜（LTF-240型）对92例不明原因的胸腔积液患者进行检查，并回顾性分析其临床资料。结果92例患者均成功实施了胸腔镜检查，胸腔镜下病理组织活检确诊恶性肿瘤30例、结核性胸膜炎57例、慢性炎症5例。肿瘤和结核病理结果确诊率为94．6％。恶性胸腔积液主要表现为结节样改变，部分病灶融合成肿块。而结核性胸膜炎主要为胸膜弥漫性充血肿胀，结节病灶细小呈卵石样改变，可见坏死物覆盖。92例胸腔镜检查仅1例出现胸膜反应，无严重并发症发生。结论可弯曲电子内科胸腔镜检查安全、有效、易操作。

Objective To evaluate the use of flexi-rigid pleuroscope for diagnosing difficult pleural effusion. Methods Retrospective study of 92 patients referred for thoraeoseopy in our hospital between October 2007 and June 2008. All patients were clinical diagnosed with difficult pleural effusion. Results All patients finished fiexirigid thoracoscopy examination, thirty malignant tumor and fifty-sevent tuberculous pleurisy were diagnosed by pathological, only five chronic inflammation. Under thoracoscopy： malignant pleural effusion display one or more sarcoidosis, even some sarcoidosis fused into mass. and tuberculous pleurisy showed as small sarcoidosis with diffused pleural congestive and edema, sphacelus might be seen coveting the pleura. No severe complications occurred during the examination, only pleural response was seen in one patient. Conclusion Medical thoracoscopy has a high diagnostic rate, and can be easily and safely performed.