评价可弯曲内科胸腔镜在不明原因胸腔积液诊断中的应用价值

Evaluation of the value of flexible medical thoracoscopy in the diagnosis of unexplained pleural effusion

目的探讨可弯曲内科胸腔镜在不明原因胸腔积液(PE)诊断中的应用价值。方法 165例不明原因胸腔积液患者,均行胸腔积液常规、生化和实验室检查未能明确病因,后行可弯曲内科胸腔镜检查,分析胸膜活检结果、内膜胸腔镜表现及术中、术后不良事件发生情况。结果胸膜活检诊断阳性率为92.12%(152/165),其中结核性胸膜炎94例(56.97%);恶性胸腔积液58例(35.15%),包括肺腺癌38例,肺鳞癌2例,其他部位肿瘤10例,类炎性胸腔积液5例,脓胸3例;诊断不明13例(7.88%)。结核性胸膜炎多以结节形成、局灶伴坏死为主,肺腺癌以异性细胞浸润、灶性黏液腺体浸润为主;3例疼痛,7例发热。结论在不明原因胸腔积液中应用可弯曲内科胸腔镜可以进一步明确胸腔积液病因,效果显著,值得应用。

Objective To discuss the value of flexible medical thoracoscopy in the diagnosis of unexplained pleural effusion(PE). Methods A total of 165 patients with unexplained pleural effusion were examined by routine, biochemical and laboratory examinations, but the etiology of pleural effusion was not clear, then flexible internal thoracoscopic examination was used to analyze pleural biopsy results, endometrial thoracoscopic findings and occurrence of intraoperative, postoperative adverse events. Results The positive rate of pleural biopsy was 92.12%(152/165), of which there were 94 cases(56.97%) of tuberculous pleurisy, 58 cases(35.15%) of malignant pleural effusion, including 38 cases of lung adenocarcinoma, 2 cases of lung squamous cell carcinoma, 10 cases of other tumors, 5 cases of inflammatory pleural effusion and 3 cases of empyema, and 13 cases(7.88%) of unknown diagnosis. Tuberculous pleurisy was characterized by nodule formation and focal necrosis. Heterosexual cell infiltration and focal mucous gland infiltration were the main manifestations of lung adenocarcinoma. There were 3 cases with pain and 7 cases with fever. Conclusion The application of flexible medical thoracoscopy shows remarkable effect in unexplained pleural effusion, and it can further clarify the etiology of pleural effusion. It is worth applying.