超声检测胸膜滑动征判定胸膜腔粘连

The study of preoperative detection of pleural adhesions by chest ultrasonography

目的评价胸部超声检测胸膜滑动征对胸腔镜手术前判定胸膜腔粘连的临床价值。方法63例病人于胸腔镜术前经胸部超声检查术侧胸腔9个位点胸膜滑动征，并与术中同样位点胸膜粘连情况做对照。结果共检测567个位点胸膜滑动征，超声下判定106个位点存在胸膜粘连，术中证实粘连位点72个；超声下判定无粘连位点461个，术中证实无粘连位点495个，其灵敏度、特异度、阴性预测值、阳性预测值及准确度分别为80．56％、90．03％、96．96％、54．72％及89．07％；受试者工作特征（Reeiver Operating Characteristic，ROC）曲线分析显示，8个点以上胸膜滑动征阳性可以作为判定胸膜无粘连的重要标准。结论经胸部超声检测胸膜滑动征有助于胸腔镜手术前判定是否存在胸膜粘连及确定粘连部位。

Objective Assess the value of pleura sliding sign with chest ultrasonogTaphy in the prediction of pleura adhesion prior to video-assisted thoracoscopic surgery （VATS）. Method 63 patients were evaluated for pleura sliding signs with chest uhrasonography at 9 points along the chest wall prior to thoracotomies and were compared with the findings of the same points during the operation. Methods Pleura sliding signs on 567 points were examined in 63 cases, and 106 points pleura adhesion were found by chest uhrasonography and 72 points were proved by operations. 461 points were no pleura adhesion under chest unhrasonography and 495 points had no pleura adhesion confirmed by operations. Results The sensitivity, specificity, negative predictive value, positive predictive value and overall accuracy were 80.56% ,90.03% ,96.96% ,54.72% and 9.07%, respectively. The Receiver Operating Characteristic （ROC） curve showed that there should be no pleura adhesion if there were more than 8 points positive pleura sliding signs. Conclusion Examination of pleura sliding sign by chest ultrasonography aphy is helpful to predict the presence and location of pleura adhesion prior to VATS.