老年结核性胸膜炎临床及胸腔镜下表现分析

Analysis on clinical features and manifestations under thoracoscopy in elderly patients with tubercular pleurisy

目的总结老年结核性胸膜炎临床特点和胸腔镜下表现特征,提高胸腔镜检查对老年结核性胸膜炎诊断价值的认识。方法回顾性分析41例通过内科可弯曲胸腔镜检查和组织活检确诊的老年结核性胸膜炎临床资料和胸腔镜下表现特征。结果老年结核性胸膜炎临床表现不典型,以咳嗽(75.6%)和胸闷、气促(87.8%)出现比例最高,并存病多(85.4%),误诊率高(68.3%)。镜下表现小点状结节41.5%,单发、多发结节26.8%,胸膜充血、水肿19.5%,胸膜肥厚、粘连12.2%,病变部位分布于后胸壁壁层胸膜46.3%,前胸壁壁层胸膜12.2%,侧胸壁壁层胸膜7.3%,膈胸膜7.3%,弥漫型19.5%,脏层胸膜7.3%,无1例发生严重并发症。结论老年结核性胸膜炎临床表现缺乏特异性,应尽早行内科胸腔镜检查明确诊断。

Objective To summarize the clinical features and manifestations under thoracoscopy of 41 elderly patients with tubercular pleurisy, and to discuss the importance of medical thoracoscopy for the diagnosis of tubercular pleurisy in the elderly. Methods The clinical features and manifestations under thoracoscopy of 41 patients with tubercular pleurisy in the elderly diagnosed by flexible electron-assisted thoracoscopy and biopsy were retrospectively analyzed. Results The clinical presentations of tubercular pleurisy were atypical in the elderly. Cough（75.6% ） and chest tightness and dyspnea（87.8% ） were the most common, and the coexistence proportion of both disease（85.4% ） and misdiagnosis rate （68. 3% ） were high. Based on observation of thoracoscopy there were small punctual sarcoidosis （41.5%）, one or more sarcoidosis （26. 8% ）, pleural congestion and edema （ 19.5% ） and pleural thickening and fibrinous adhesion （ 12. 2% ） in 41 elderly patients. Distribution of the focus lesion was as follows： 46. 3% on parietal pleura with posterior, 12. 2% on anterior, 7.3% on lateral, 7.3% on diaphragmatic pleura, 19.5% diffusively distributed and 7.3% on visceral pleura. There was no serious complication. Conclusions The clinical profiles of tubercular pleurisy are nonspecific in the elderly. To make a definite diagnosis, medical thoracoscopic surgery should be carried out as early as possible.