内科胸腔镜在不明原因胸腔积液中的临床诊断价值

Clinical diagnostic value of medical thoracoscopy in pleural effusion of unknown causes

目的评价内科胸腔镜在不明原因胸腔积液患者中的临床诊断价值,分析不同病因胸腔积液的胸腔镜下表现,并评估手术安全性。方法回顾性总结经内科胸腔镜诊断的30例不明原因胸腔积液患者的临床资料,并进行统计分析。结果 30例患者均成功接受内科胸腔镜检查及多部位病理活检;最后诊断:恶性间皮瘤4例,胸膜转移瘤14例,结核性胸膜炎10例,非特异性炎症2例。全部患者手术顺利,术中术后无严重并发症发生。根据最终病理结果,比照内科胸腔镜下表现,发现肿瘤多为血性胸水,镜下常表现为单个或多个大小不等的结节,呈灰白色多见;结核性胸膜炎的特征性表现为胸膜弥漫分布的大小均匀的粟粒样灰白色或粉红色结节伴有胸膜粘连。结论内科胸腔镜对不明原因胸腔积液诊断有较高的临床价值,手术创伤小,安全性高,且操作相对简单,是一项有效、诊断率高的检查方法,值得临床借鉴和推广。

Objective To evaluate the diagnostic value of medical thoracoscopy in clinical patients with pleural effusion of unknown causes, and analyze the different causes of pleural effusion thoracoscopy performance and to assess the safety of surgery. Methods A retrospective clinical data by medical thoracoscopy diagnosis of 30 cases of patients with pleural effusion of unknown cause were statistically analyzed. Results 30 patients were successfully accepted medical thoracoscopy and multi-site biopsy; final diagnosis： four cases of malignant mesothelioma; pleural metastases in 14 cases; 10 cases of tuberculous pleurisy; nonspecific inflammation in 2 cases. All patients with successful surgery, intraoperatire and postoperative no serious complications occurred. And according to the final pathology results, combined with the medical endoscopic thoracoscopic found tumors were bloody pleural effusion, usually microscopic single or multiple nodules of varying sizes, pale common; tuberculous pleurisy characteristic performance of diffuse pleural uniform size distribution of miliary white or pink nodules with pleural adhesions. Conclusion The medical thoracoscopy pleural effusion of unknown causes has high clinical value, surgical trauma, safety, and the operation is relatively simple, is an effective, high rate of diagnostic methods, is worthy of learning and promotion.