内科胸腔镜在原因不明胸腔积液诊断中的价值及安全性评价

Evaluation of safety and value by using medical thoracoscopy to diagnose pleural effusion in unknown origin

目的探讨内科胸腔镜在原因不明胸腔积液诊断中的价值并进行安全性评价。方法 285例原因不明胸腔积液患者在局麻下进行内科胸腔镜检查,观察胸膜的异常表现,并在直视下钳取病变进行病理检查。结果镜下的异常表现主要有:①孤立性、弥漫性大小不等菜花样、乳头状、桑葚状结节或肿块;②广泛分布的大小不等的球形结节或肿块,呈葡萄状、卵石状或铺路石样改变;③广泛性分布的粟粒样或麻疹样小结节影;④乳白色厚薄不一的纤维素沉积和网状分布的粘连带等。活检确诊275例,确诊率为96.5%(275/285)。确诊病例中最常见病因为恶性肿瘤(占67.0%,191/285)和结核性胸膜病变(占20.4%,58/285)等。恶性肿瘤最常见的病因为肺癌并胸膜转移(占58.1%,111/191)和弥漫性胸膜间皮瘤(占17.8%,34/191)等。结论内科胸腔镜检查对原因不明胸腔积液是一种操作简便、安全可行、确诊率高的诊断方法,值得临床推广应用。

Objective To evaluate safety and value of medical thoracoscopy in the diagnosis of pleural effusion of unknown origin. Methods 258 patients with pleural effllsion of unknown origin were examined via medical thoraeoscopy under local anesthesia, and the abnormal appearance of pleu- ra were observed and taken for biopsy under direct vision. Results Main appearances under medical thoracoscopy were：（1） solitary/diffusion nodules or masses with different size appearing cauliflower- like, papillary or mulberry; （2） Ball-shaped nodules or masses with wide distribution and inequality size representing grape-like, gravel-or cobblestone-shaped; （3） Small nodules with wide distribution appearing miliary or morbilliform; （4） Fibrin deposition with different thickness appearing milk white and adhesion band displaying retieular distribution. 275 eases were made definite diagnosis by biop- sy, with diagnosis rate of 96.5% （275/285）. Among the eases, malignant tumor and tuberculous pleural disease were the most common etiology, comprising 67.0% （191/285） and 20.4% （58/285） respectively. Among the malignant tumor, lung cancer with pleural metastasis and diffuse mesothelioma of pleura were the most leading cause, eomprising 58.1% （ 111/191 ） and 17.8% （34/191） respectively. Conclusion Medical thoraeoscopy was a simple, safe and feasible method with high diagnostie rate for pleural effusion of unknown origin. It worthed extending elinical application.