支气管镜代替胸腔镜胸膜活检在诊断胸腔积液中的运用价值

The Value of Using Bronchoscopy Instead of Thoracoscopy in the Diagnosis of Pleural Effusion in Pleural Biopsy

目的:探讨支气管镜代替胸腔镜对胸腔积液诊断的价值。方法:回顾性分析2013年8月至2014年10月入院的42例胸腔积液患者经皮穿刺胸膜活检术仍不能明确诊断的胸腔积液患者进行支气管镜代替胸腔镜检查,分析检查结果并对患者的临床资料和检查结果相关性进行分析。结果:24例确诊为恶性肿瘤,其中20例为肺癌,4例为恶性胸膜间皮瘤,12例为结核性胸膜炎,6例为慢性非特异性炎症,并对6例未能明确诊断的患者进行半年随访,出院后均未出现病情恶化,亦未能找到任何恶性肿瘤及结核证据。结论:经支气管镜代替胸腔镜检查对不明原因的胸腔积液患者的诊断是一种安全、易操作的诊断方法,假阴性率低,对于同时有慢性病程、气短、吸烟、大量胸水、恶性肿瘤影像学证据的患者,均应进行胸腔镜检查。

Objective： To explore the value of diagnosing pleural effusion with bronchoscopy instead of thoracoscopy. Methods：Clinical data of 42 cases using bronchoscopy instead of thoracoscopy in patients with pleural effusion which remained unsure in pleural biopsy from August 2013 to October 2014 were analyzed retrospectively. Test results, the clinical data of patients and the correlation analysis of test results were analyzed. Results： 24 cases were diagnosed as malignant tumor, including 20 cases of lung cancer, 4 cases of malignant pleural mesothelioma, 12 cases of tuberculous pleurisy, 6 cases of chronic nonspecific inflammation. 6 cases of patients with unsure diagnosis had half a year follow-up, and there was no deterioration occurred after hospital discharge and no any evidence of malignant tumor and tuberculosis. Conclusion： Using bronchoscopy instead of thoracoscopy examination in the diagnosis of patients with pleural effusion of unknown origin is a safe and easy diagnostic method with low false negative rate. Patients with imaging evidence of a chronic course, shortness of breath, smoking, massive pleural effusion, malignant tumor should be examined by thoracoscopy.