内科胸腔镜检查结核性与恶性胸腔积液的对照研究

Comparative study on the differentiation of pleural effusions in tuberculosis and malignant patients by thoracoscopy

目的提高结核性和恶性胸腔积液患者诊断和鉴别诊断的水平。方法比较经内科胸腔镜胸膜活检确诊的结核性胸腔积液60例(结胸组)和恶性胸腔积液56例(恶胸组)患者胸腔镜检查结果和临床资料。结果 1.临床表现:患者年龄:结胸组较恶胸组年轻(t=5.77,P<0.01)。胸腔积液量:结胸组大量者较少(χ2=13.75,P<0.01);中量者较多(χ2=13.92,P<0.01)。胸水性质:结胸组黄色胸水较多见(χ2=21.47,P<0.01),恶胸组血性胸水较多见(χ2=23.88,P<0.01)。2.内科胸腔镜下表现:结胸组胸膜粘连、增厚、干酪样坏死和粟粒结节较多见;恶胸组胸膜多发息肉和斑片状白苔较多见。3.胸水ADA结胸组较恶胸组为高(P<0.05);而胸水和血清CEA水平恶胸组比结胸组为高(P<0.05)。结论内科胸腔镜检查联合胸水ADA、胸水和血清CEA等检测,提高了结核性和恶性胸腔积液诊断、鉴别诊断的特异性和敏感性。

Aim To comprative differentiate pleural effusions from tuberculous and malignant effusion. Methods The 60 patients with tuberculous pleural effusions （TPE）confirmed by thoracoscopy and 56 patients with malignant pleural effusions（MPE） were analyzed. Results Age of the patients with TPE were more lighter than those with MPE（t=5.77, P〈0.01）. The amount of pleural effusions in the patients with TPE were less than those with MPE （χ2=13.75,P〈0.01）. The amount of yellow pleural effusions in the patients with TPE were more than those with MPE（χ2=21.47,P〈0.01 ）. Blood pleural effusions in the patients with riPE were less than those with MPE （χ2=23.88,P〈O.O1）. Pleura adhesion and fleshy,cheesy spoils and grain s^ape tubercle under thoracoseope in the patients with TPE were common than those with MPE. The ADA level in pleural effusions of the patients with TPE was higher than those with MPE （P〈0.05）, The CEA levels in pleurat effusions and serum of the patients with MPE was higher than those with TPE h （P〈0.05）. Conclusion Thoracoseopy combined with detection of ADA in pleural effusions, CEA in pleural effusions and serum can enhance the the Specificity and sensitivity of differentiating tuberculous and malignant pleural effusions.