内科胸腔镜对老年疑难性胸腔积液的诊断价值

Diagnostic value of medical thoracoscopy in the treatment of senile patients with difficult exudative pleural effusions

目的内科胸腔镜在诊断老年疑难性渗出性胸腔积液的价值。方法应用内科胸腔镜对56例老年疑难性渗出性胸腔积液患者进行检查,术中对可疑病变部位进行直视下多点活检,比较镜下表现与病理结果相关性,评价手术的安全性。结果 56例疑难性渗出性胸腔积液患者中病理确诊51例,诊断阳性率92.9%,其中转移性腺癌16例(28.5%),鳞癌7例(12.5%),小细胞癌2例(3.6%),食道癌胸膜转移1例(1.8%),淋巴瘤2例(3.6%),恶性胸膜间皮瘤4例(7.1%),结核病20例(35.7%),非特异性慢性炎症2例(3.6%);2例(3.6%)病理为阴性,所有病例均未发生严重并发症。结论内科胸腔镜检查对老年性疑难性渗出性胸腔积液诊断阳性率高、简单、安全、并发症发生率低。

Objective To explore the value of medical thoracoscopy in the diagnosis of senile patients with difficult exudative pleural effusion. Methods 56 senile patients with difficult exudative pleural effusions were examined by medical thoracoscopy, and the questionable affection regions were given multiple punch biopsies under direct vision. The correlation between the thoracoscopic manifesta- tions and pathological results was investigated, and the safety of operation was evaluated. Results The pathology of 51 cases （92.9%） were finally confirmed by medical thoracoscopy, including 16 cases of metastatic adenocarcinoma （28.5%）, 7 cases of squamous cell car- cinoma （ 12. 5% ）, 2 cases of small cell carcinoma （3.6%）, 1 case of esophageal cancer pleural metastases （ 1.8% ）, 2 cases of lym- phoma （3.6%） , 4 cases of malignant pleural mesothelioma （7. 1% ） , 20 cases of tuberculosis （35.7%） , 2 cases of nonspecific chronic inflammation （3.6%）, and 2 cases with undetermined diagnosis. None of them had serious complications. Conclusion Medical thora- coscopy has a high diagnostic rate in the diagnosis of senile patients with difficult exudative pleural effusions. Besides, it＇s a simple and safe method with few complications in clinical practice.