301例不明原因胸腔积液胸腔镜下表现与临床特征分析

Manifestations of medical thoracoscopy and diagnostic analysis of 301 unknown origin pleural effusion

目的分析不明原因胸腔积液在内科胸腔镜下的表现及临床、病理特征。方法回顾性分析医院301例不明原因胸腔积液行内科胸腔镜检查的镜下表现、病理特征、临床特征,并评价手术安全性。结果病理表现为恶性肺癌103例其中腺癌82例,鳞癌10例,腺鳞癌3例,小细胞癌3例,恶性间皮细胞瘤2例,印戒细胞癌转移1例,T细胞来源恶性肿瘤1例,浆细胞瘤1例;结核156例;真菌1例;非干酪样肉芽肿(结合临床考虑结缔组织疾病)4例;纤维素性炎症9例;未确诊28例,其中恶性肿瘤未能分型18例;非特异性慢性炎症10例。确诊率90.7%。恶性肿瘤镜下主要表现为血性胸水及肿块、菜花样结节、葡萄串样结节或弥漫小结节部分融合成块,质硬,触之易出血;结核主要为淡黄色胸水,胸膜粘连,胸膜充血,弥漫粟粒样结节,或部分融合成片,质地较软。发生术后疼痛需镇痛治疗89例,胸膜反应2例,复张性肺水肿3例。结论不同病理类型病变在胸腔镜下表现有差异,内科胸腔镜检查在胸膜疾病诊断中具有确诊率高、安全及创伤小的优点。

Objective To evaluate the clinical application of medical thoracoscopy for the diagnosis of unknown origin pleural effusion. Methods A retrospective review of 301 patients undergoing a thoracoscopic operation was performed. The diagnosis was confirmed by biopsy. Results Of 301 patients by histopathological examination, there were 103 malignant tumor （including 82 adenocarcinoma, 10 squamous carcinoma, 3 glands squamous carcinoma cases, 3 small cell carcinoma, 2 mesothelium cell tumor, 1 signet ring cell carcinoma case, 1 T cell malignant tumor and 1 plasma cell tumor） ,156 tuberculous pleurisy, 1 fungi infection, 4 non caseating granuloma, 9 fibrinous inflammation and 28 cases Non-confirmed. Diagnosis rate was 90.7 %. Malignant tumor displayed nodules or masses with different size like cauliflower or grape bunch, while tuberculous pleurisy always appeared as diffused pleural congestion and edema, with wide distribution of small miliary nodules and caseous necrosis. 89 cases of postoperative pain needed analgesia. 2 patients had pleurat reaction. 3 patients had reexpansion pulmonary edema. Conclusion Medical thoracoscopy with pleural biopsy is a relatively safe method with high diagnostic rate for pleural effusion of unknown origin.