内科胸腔镜检查对不明原因胸腔积液的诊断价值

目的探讨内科胸腔镜技术在不明原因胸腔积液中的诊断价值。方法对2010年2月至2015年11月110例原因不明胸腔积液患者进行可弯曲电子内科胸腔镜（LTF-240型）检查，并对临床资料进行回顾性分析。结果102例患者胸膜病理被确诊，诊断阳性率92．7％，其中结核性胸膜炎55例（50％）；恶性肿瘤39例（35．5％），两者共94例（85．5％）；39例恶性肿瘤中肺癌35例（31．8％），包括腺癌32例（29．1％），鳞癌2例（1．8％），小细胞肺癌1例（0．9％）；原发胸膜间皮瘤1例（0．9％），大B细胞淋巴瘤胸膜转移1例（0．9％），乳腺癌胸膜转移1例（0．9％），结肠癌胸膜转移1例（0．9％）；16例良性病变中发现肺吸虫2例，结节病胸膜病变1例。结论内科胸腔镜术是一种微创、安全、高诊断率的检查方法，是不明原因胸腔积液病因诊断的最可靠的检查手段。

Objective To evaluate the role of medical thorascopy in diagnosis of the pleural effusion of unknown etioiogy. Methods Between February 2010 and November 2015, 110 patients with pleural effusions of unknown etiologies underwent medical thoracoscopy in The Affiliated Hospital of Hangzhou Normal University, and the results of those patients were retrospectively analyzed. Results In 110 cases, 102 patients were diagnosed by pathological evidence, the positive diagnostic rate of medical thoracoscopy was 92.7%; 55 cases of tuberculous pleurisy （ 50% ） for the first; 39 cases of malignant tumor （ 35.5% ） , the total of 94 cases accounted for 85.5%. Among malignant lesions, lung cancer 36 cases （ adenocarcinoma 32 cases, squamous cell lung cancer 2 cases, small cell lung cancer 1 case ） , large B cell lymphoma pleural metastasis 1 case and pleural mesothelioma 1 case, pleural metastasis from breast cancer 1 case, from colon cancer lcases. Benign lesions in 16 cases found 2 cases of paragonimiasis, and pleural sarcoidosis 1 case. Conclusion Medical thoracoscopy combined with biopsy is a simple procedure with high diagnostic yield and excellent safety for the diagnosis of unknown etioiogy pleural effusion, and is also the most reliable inspection method.