内科胸腔镜术对不明原因胸腔积液的诊断价值

The diagnostic value of medical thoracoscopy for unexplained pleural effusion

目的观察不明原因胸腔积液在胸腔镜下的特点，以评价内科胸腔镜术对不明原因胸腔积液的诊断价值。方法回顾性分析1992—2011年山东省立医院呼吸科2380例经内科胸腔镜术确诊的胸腔积液患者，其中男1320例，女1060例，年龄15～94岁，平均（45±11）岁。结果（1）2380例患者中，癌性胸腔积液1338例（56．2％），镜下多表现为大小不等的结节，可呈葡萄状、菜花状，部分结节融合为肿块，亦可呈弥漫性小结节。癌性结节比结核性胸膜炎结节形态更具多样性。（2）结核性胸膜炎患者514例（21．6％），胸腔镜下主要表现为胸膜弥漫性充血、粟粒样改变；胸膜多发灰白色小结节；胸膜腔内纤维素苔沉积、粘连（常呈多房性）；胸膜肥厚。（3）病理诊断：2380例患者中胸膜转移肿瘤899例（37．8％）、原发性胸膜间皮瘤439例（18．4％）；结核性胸膜炎514例（21．6％），非特异性炎症226例（9．5％）、脓胸190例（8．0％）、肝源性胸腔积液36例（1．5％）、不明原因胸腔积液76例（3．2％）。胸腔镜诊断阳性率为96．8％（2304例）。无1例发生严重并发症。结论内科胸腔镜术操作简单，安全性高，埘不明原因胸腔积液的诊断有重要临床应用价值。

Objective To explore the endoscopic features of patients with unexplained pleural effusion, and to evaluate the diagnostic value of medical thoracoscopy. Methods A retrospective analysis of 2380 patients with unexplained pleural effusion （1320 males and 1060 females; age 15 -94 years） in Shandong Provincial Hospital from 1992 to 2011 were performed . The diagnosis was confirmed by medical thoracoscopy. Results The endoscopic findings of malignant pleural effusion mostly showed nodules of varying sizes. The nodules could be grape-like, cauliflower-like, fused into masses, or diffused small nodules. The appearance of cancerous nodules was more diversified compared to tuberculous nodules. Tuberculous pleurisy was manifested as diffuse pleural congestion and miliary changes, multiple small gray- white nodules, fibrin deposition and adhesion in the pleural cavity, pleural thickening and loculation . The pathological diagnosis was as follows： pleural metastases in 899 （37.8%） , primary pleural mesothelioma in 439 （ 18.4% ）, tuberculous pleurisy in 514 （ 21.6% ）, non-specific inflammation in 226 （ 9. 5% ）, empyema in 190 （8.0%） , hepatic pleural effusion in 36 （ 1.5% ） and pleural effusion of unknown causes in 76 （3.2%） cases. The diagnostic positive rate of medical thoracoscopy was 96. 8%. No serious complications were observed. Conclusion Medical thoracoscopy is a relatively safe procedure and has an important application value in the diagnosis of unexplained p]eural effusion.