有创技术在胸腔积液诊断中的应用价值

Clinical application and evaluation of invasive techniques in diagnosis of pleural effusion

胸腔积液病因复杂,相当一部分临床诊断困难,有创性技术在其病因诊断中有重要地位。本文详述了有创技术包括胸腔穿刺术、胸膜活检以及内科胸腔镜等在胸腔积液诊断的应用价值。胸腔穿刺术、胸膜活检术常作为最初步的诊疗手段,胸腔穿刺术操作简单、方便、安全、并发症少,临床广泛开展。胸膜活检可以直接提供病理组织学标本,对诊断具有确诊的价值,优于常规的检查方法,但是其阳性率不高,经超声或CT引导下进行胸膜活检术可以提高活检阳性率,尤其在尚未开展胸腔镜的基层医院有很大的应用价值。内科胸腔镜可以直观、清晰地观察几乎包括全部壁层胸膜及大部分肺脏表面和横膈,能够发现早期较小的病灶,并且可以选择可疑部位,钳取组织进行活检,阳性率可高达90.0%以上,提高了胸腔积液确诊率,是一项安全性和诊断率均较高、并发症尤其严重并发症发生率较低的一项检查手段,值得临床推广应用。

Pleural effusion (PE)is a complex etiology and affects the life quality life of patients. Invasive techniques play an important role in the diagnosis of PE.We mainly focus on the clinical application and evaluation of invasive techniques such as thoracocentesis,pleural biopsy and medical thoracoscopy in diagnosis of PE.Thoracocentesis is a simple,convenient and relatively safe technique with less complications which is often used as the initial diagnostic procedure.As pleural biopsy can provide pathological and histological specimens,its confirmed value is superior to conventional methods for diagnosis of PE.However, the positive rate is not satisfied and it can be improved when pleural biopsy is guided by ultrasound or computed tomography (CT).Pleural biopsy has great value in basic-level hospitals.Medical thoracoscopy can visually and clearly display almost whole of the pleura and lungs.Minor lesions and suspicious site can be showed for biopsy with medical thoracoscopy.As a result,the positive rate increases greatly and accordingly. In a word,medical thoracoscopy is a valuable and safe tool with a higher diagnostic rate and lower incidence of complications in clinic.