不同病因胸腔积液在胸腔镜下的表现特征分析

Clinical characteristics of pleural effusion in different etiology under thoracoscopy

回顾性分析2011年1月至2017年2月沈阳市第十人民医院胸膜炎病房128例经内科胸腔镜活检病理确诊患者的临床资料，观察胸腔镜下表现。其中非特异性胸腔积液患者9例（7．。3％），胸腔镜下表现特征为脏、壁两层胸膜均光滑、无结节。结核性胸膜炎患者78例（60．94％），其中，充血水肿型（病程1-2周）II例，表现为胸膜弥漫性充血、水肿，表面有均匀分布的白色或红色小结节；粘连型（病程3-4周）34例，表现为胸膜腔内大量粘连带，呈丝状、网状、片状，胸膜表面有黄白色纤维素沉积；包裹型（病程5-8周）27例，表现为胸膜增厚、厚薄不均，粘连带增粗、僵硬而不易钳取，胸腔积液包裹，可有多房多隔；坏死型（病程8周以上）6例，表现为脓性胸腔积液，胸膜表面有脓性物沉积，胸膜糜烂。肿瘤患者41例（32．03％），其中，转移性胸膜肿瘤（腺癌）21例，胸腔镜下表现为菜花样瘤体，多个结节，触之易出血，部分患者胸膜大片增厚，表面凹凸不平，质地较韧，不易钳取；转移性胸膜肿瘤（鳞癌）5例，表现为胸膜表面覆盖白苔，可见多个白色结节，不易钳取，未见粘连带；胸膜间皮瘤12例，表现为瘤体在胸膜上似卵石，呈单个或多个，质地硬，触之易出血，有的胸膜呈大片状增厚，不易钳取，如牛板筋；恶性小圆细胞肿瘤3例，表现为壁层及横膈胸膜见多发巨大结节，触之极易出血。笔者认为，不同病因胸腔积液在胸腔镜下的表现各异，通过内科胸腔镜检查，能够直视下评价胸膜、肺部病变情况，可以初步判断病因，为最终确立诊断提供参考依据。

This is a retrospective analysis. From January 2011 to February 2017, 128 cases were diagnosed pathologically by thoracoscopy and then admitted to the pleurisy ward of the Tenth People＇s Hospital of Shenyang. The clinical data, especially the thoracoscopic findings, were collected. There were 9 （7.03%） cases with nonspe- cific pleural effusion, which were characterized by smooth pleura in either parietal and visceral layer without nodules. Seventy-eight （60. 94%） cases were tuberculous pleurisy. Among them, 11 cases with congestive edema （1-2 weeks） were characterized by diffuse congestion and edema in the pleura, and white or red nodules on the surface, 34 cases of adhesion type （3-4 weeks） were characterized by a large amount of filamentous, reticulate, or flaky pleural adhesions, and yellowish white cellulose deposition on the pleural surface, 27 cases of inclusion type （5- 8 weeks） were characterized by pleural thickening, uneven thickness, thickened pleural adhesions that were stiff and difficult to clamp, and encapsulated pleural effusion, 6 cases of necrosis type （more than 8 weeks） were characteris- tic with pyothorax, purulent deposits on the pleural surface, and pleural erosion. In addition, lung cancer was de- tected in 41 （32.03-/00） cases. Among them, 21 cases with metastatic carcinoma of the pleural （adenocarcinoma） were characterized by cauliflower-like mass and multiple nodules that were easy bleeding by touch. In some cases, pleural was largely thickened with rugged surface, and the quality was tough and not easy to take away. Metastatic carcinoma of the pleural （squamous cell carcinoma） was found in 5 cases. The surface of the pleural was covered with whitish fur, multiple white nodules that were not easy to clamp away were observed, but no adhesion was found. In the 12 cases with pleural mesothelioma, the tumor was like a pebble on the pleura, presented as a single or more, and were hard texture and easy bleeding by touch. Some of the pleural was thickened in large areas, and not easy to take away, just like bovine tendons. Three cases of malignant small round cell tumor were characterized by many huge nodules in parietal and diaphragmatic pleura that were easy to bleed when touching. In conclusion, we found that the clinical characteristics of pleural effusion varied based on different etiology under thoracoscopy. By medical thoracoscopy, it is able to directly assess the pathological changes in pleural and lung, which could be used to initially determine the cause of the disease and provide a basis {or diagnosis.