内科胸腔镜对不明原因胸腔积液的诊治价值

The value of diagnosis and treatment of medical thoracoscopy for unexplained pleural effusion

目的探讨内科胸腔镜对不明原因胸腔积液中的诊断价值以及经内科胸腔镜胸膜固定术对恶性胸腔积液的治疗价值及安全性。方法回顾性分析了2004年4月—2013年12月在广州市第一人民医院482例不明原因胸腔积液患者接受内科胸腔镜诊断或治疗的临床资料。其中男298例（61.8%）,女184例（38.2%）,平均年龄64.74±14.76岁（21～89岁）。结果在482例不明原因胸腔积液患者中,有457例经内科胸腔镜检查及病理活检最终获得明确的诊断,确诊率达94.8%。其中恶性胸腔积液278例（57.7%）,结核性胸膜炎109例（22.6%）,肺炎旁积液46例（5.2%）,结缔组织病伴胸腔积液11例（2.3%）,非特异性炎症13例（2.7%）,原因不明胸腔积液25例（5.2%）。203例患者接受内科胸腔镜下滑石粉喷洒的胸膜固定术,复发率为19.2%。内科胸腔镜并发症轻微,最常见为胸痛（56.2%）和发热（23.6%）。结论在不明原因的胸腔积液中内科胸腔镜具有较好的诊断价值;镜下喷洒滑石粉的胸膜固定术是治疗恶性胸腔积液的有效手段,安全性好,具有重要的临床应用价值。

Objective To evaluate the diagnostic value of medical thoracoscopy and therapeutic value and safety of pleurodesis via medical thoracoscopy in malignant pleural effusions.Methods A retrospective study was performed between April 2004 and December 2013 in Guangzhou First People＇s Hospital.482 patients,298 men（61.8%） and 184 women（38.2%） and mean age 64.7 ＋/-14.8 years,with effusion of unknown origin underwent medical pleuroscopy.Results For the 482 patients,457 patients（94.8%） were definitely dignosed by Medical thoracoscopy.The pathogenic factors were as follows：malignant pleural effusion in 278（57.7%）,tuberculous pleuritis in 109（22.6%）,parapneumonic effusion in 46（5.2%）,connective tissue disease in 11（2.3%）,non-specific inflammation in 13（2.7%） and pleural effusion of unknown causes in 25（5.2%） cases.The recurrence rate was 19.2% in 203 patients with malignant pleural effusion who underwent pleurodesis by pleuroscopy.No serious complications were observed.The common complications were thoracalgia（56.2%） and self-limited fever（23.6%）.Conclusion Medical thoracoscopy or pleurodesis by talc poudrage under medical thoracoscopy is a relatively safe,effective and less harmful procedure and has an important application value in unexplained pleural effusion.