可弯曲内科胸腔镜在渗出性胸腔积液诊断中的应用

Application of flexible medical thoracoscopy in the diagnosis of exudative pleural effusion

目的研究可弯曲内科胸腔镜在渗出性胸腔积液诊断中的临床价值。方法对180例渗出性胸腔积液患者进行可弯曲内科胸腔镜检查,分析其诊断结果、胸膜病变形态、胸水颜色及并发症。结果 180例患者成功接受局麻下可弯曲内科胸腔镜检查,明确诊断165例,诊断率为91.7%(165/180)。良性胸腔积液患者112例,占62.2%(112/180),其中结核性胸膜炎109例,肺吸虫感染胸水3例;恶性胸腔积液患者53例,占29.4%(53/180),其中肺癌胸膜转移50例(肺腺癌47例),胸膜间皮瘤2例,淋巴瘤1例;未能明确病理诊断15例(8.3%)。165例确诊患者胸水颜色:血性胸水42例(恶性胸水38例、结核性胸膜炎4例),草黄色胸水123例(结核性胸膜炎105例、肺吸虫感染3例、恶性胸水15例)。恶性胸水组血性胸水比例与良性胸水组比较差异有统计学意义(χ2=85.93,P<0.01)。胸膜病变形态:胸膜充血水肿52例,胸膜多发结节68例,胸膜肿块18例,胸膜粘连56例,胸膜瓷片状增厚12例。良性胸水组胸膜充血水肿、胸膜粘连、胸膜肿块、胸膜瓷片状增厚比例与恶性胸水组比较差异有统计学意义(P<0.01),良性胸水组胸膜结节比例与恶性胸水组比较差异无统计学意义(P>0.05)。并发症:术前皮下气肿4例,检查后发热4例,术后皮下气肿16例,术中活检时胸痛6例,术后切口疼痛13例,术后交通性气胸1例。结论应用可弯曲内科胸腔镜检查渗出性胸腔积液具有微创、操作简单、诊断率高的优点,可作为渗出性胸腔积液的临床诊断方法。

Objective To study the clinical value of the application flexible medical thoracoscopy check for diagnosing exudative pleural effusion. Methods 180 patients with exudative pleural effusion finished flexible medical thoracoscopy check,analyzed the diagnostic results, pleural lesion morphology, pleural effusion color and complications. Results All 180 patients finished flexible medical thoracoscopy examination,165 cases were diagnosed, the diagnostic rate was 91.7%. 112 pa-tients with benign pleural effusion accounted for 62.2%（112/180）, in which 109 cases of tuberculous pleurisy, lung fluke infection in 3 cases. 53 cases of malignant pleural effusions （29.4%）：pleural metastasis of lung cancer in 50 cases （47 cases of lung adenocarcinoma）, 2 cases of pleural mesothelioma, 1 case of lymphoma. Indefinitive pathological diagnosis occured in 15 cases （8.3%）. Pleural effusion of 42 cases were hemorrhagic （malignant pleural effusion in 38 cases, 4 cases of tuberculous pleurisy）, pleural effusion of 123 cases were straw yellow （105 cases with tuberculous pleurisy, lung fluke infection in 3 cases, 15 cases of malignant pleural effusion）. The ratio of hemorrhagic effusion in malignant pleural effusion group was higher than that of benign pleural effusion group, the difference was statistically significant （χ2=85.93, P〈0.01）. The pleural lesions included pleural congestion and edema in 52 cases,pleural nodules in 68 cases,pleural mass in 18 cases, 56 cases with pleural adhe-sions,12 cases of pleural thickening and tiles. There was significant difference in the ratio of hydrothorax pleural congestion and edema, pleural adhesions,pleural lesions,pleural thickening and tile between the benign pleural effusion group and the malig-nant pleural effusion group （P〈0.01）. There was no significant difference in pleural nodules between benign group and malignant group（P〉0.05）. The complications included preoperative subcutaneous emphysema in 4 cases,4 cases of fever after examination,＆amp;nbsp;16 cases of subcutaneous emphysema, 6 cases of chest pain,13 cases of incision pain after operation and postoperative pneu-mothorax in 1 case. Conclusion Flexible medical thoracoscopy check for exudative pleural effusion has advantages of mini-mally invasive,simple operation,high rate of diagnosis, it can be used as a clinical diagnosis method of exudative pleural effu-sion.