285例原因不明胸腔积液可弯曲电子胸腔镜检查结果分析

Flexible electron-assisted thoracoscopy for diagnosis of 285 patients with pleural effusions of unknown causes

目的评价可弯曲电子胸腔镜对不明原因胸腔积液的诊断价值。方法回顾性分析285例不明原因胸腔积液患者可弯曲电子胸腔镜检查结果。结果该组经胸腔镜和胸膜活检确诊269例,确诊率为94.39%,青年组中以结核为主,占89.66%,中老年组中以肿瘤为主,占63.44%,胸膜转移肿瘤以壁层及膈胸膜散在结节及肿块为特征,纤维粘连少见;胸膜间皮瘤表现为壁层胸膜弥漫性充血、增厚,散在结节和肿块;结核性胸膜炎在壁层及膈胸膜弥漫性充血、增厚的基础上有粟粒样小结节,部分可见干酪坏死物,纤维粘连常见,以下后壁层胸膜及肋膈角部最明显;非特异性炎症表现为壁层胸膜弥漫性充血、水肿、增厚。结论可弯曲电子胸腔镜检查操作简单、安全,在不明原因胸腔积液诊断中具有重要价值。

[ Objective ] To evaluate the value of flexible electron-assisted thoracoscopy for the diagnosis of pleural effusions of unknown causes and to analyze the etiopathogenesis. [Methods] The results of flexible electron-assisted thoraeoscopy in 285 patients with the pleural effusions of unknown causes and biopsy were retrospectively analyzed. [ Results ] The diagnoses were determined in 269 of the 285 patients by flexible electron-assisted thoracoscopy and pathological biopsy with positive rate of 94.39%. Tuberculosis （89.66%） was more common in youth group; pleural tumors （63.44%） were frequent in middle and old-aged groups. Metastatic pleural tumors were charaeterized by scattered sarcoidosis and mass on parietal pleura and diaphragmatic pleura, but fibrinous adhesion was very rare. pleural mesothelioma manifested as diffused pleural congestion and thickening, and scattered sarcoidosis and mass on the parietal pleura. Tuberculous pleuritis presented miliary tubercles on the basis of diffused congestive and thickening parietal pleura and diaphragmatic pleura, in some parts cheesy necrosis could be found, fibrinous adhesion was common, the loci the most significantly distributed on posterior and lower parietal pleura and costophrenic angle. Non-specific inflammation included diffuse congestion, edema and thickening of parietal pleura. [ Conclusion ] Flexible electron-assisted thoraeoscopy plays an important role in diagnosing pleural effusions of unknown causes, its operation is very easy without serious complications, patients＇ compliance is very well.