内科胸腔镜对结核性胸膜炎的诊断价值

Diagnostic value of thoracoscopic pleural biopsy for tuberculous pleurisy under local anesthesia

目的观察结核性胸膜炎患者胸腔镜下的表现,提高对其特点的认识,并评价胸腔镜检查的诊断价值。方法回顾性分析28例经内科电子胸腔镜确诊的结核性胸膜炎患者的临床资料。结果结核性胸膜炎患者胸腔镜下主要有4种形态:胸膜弥漫性充血、粟粒样改变2例(7.14%)、胸膜多发白色结节影13例(46.43%)、胸膜腔内纤维苔素沉积及粘连带12例(42.86%),胸膜肥厚、呈多房性1例(3.57%)。14例患者胸膜病理为肉芽肿性炎伴干酪性坏死,11例患者为肉芽肿性炎,3例患者为黏膜慢性炎症。无1例发生严重并发症。结论电子胸腔镜检查安全,在结核性胸腔积液的诊断中具有重要的应用价值。

【Objective】To improve the cognition of the character of tuberculous pleurisy and assess the value of thoracoscopy in the diagnosis of tuberculous pleurisy【Methods】Twenty-eight tuberculous pleurisy patients diagnosed through flexi-rigid thoracoscopic pleural biopsy were retrospectively studied on its clinical characteristics.【Results】They are pleural congestion and white military diffused nodes in 2 cases（7.14%）,multi white nodes in 13 cases（46.43%）,fibrin deposition and adhesion between the parietal and visceral pleura in 12 cases（42.86%）,pleural thickness and many of the separation in 1 cases（3.57%）.Twenty-five patients（89.29%） were successfully diagnosed by pleural biopsy with pathological examination.There were 14 cases with epithelioid granuloma with necrosis,11 cases with epithelioid cell granuloma,3 cases with chronic inflammation.There was no serious complication.【Conclusion】Electronic-assisted thoracoscopic pleural biopsy is relatively safe and has very important value in diagnosis of tuberculous pleurisy.