胸腔内注射尿激酶后胸腔积液细胞块对原发性肺癌的诊断价值

Diagnostic value of intrapleural urokinase by cell block method in primary lung cancer patients with malignant pleural effusion

目的探讨胸腔内注射尿激酶后胸腔积液脱落细胞块对原发性肺癌的诊断价值。方法 28例病理确诊的原发性肺癌并恶性胸腔积液患者,采用随机数字表法分为试验组及对照组各14例。两组均在B超定位下采用一次性中心静脉导管行胸腔闭式引流。对照组收集200m L胸腔积液立即离心后弃去上清,取部分沉淀物直接涂片行细胞学检查,余沉淀物制作成细胞块行组织学检查。试验组胸腔内注入稀释后的尿激酶20万IU,保留24小时后再收集胸腔积液,余处理方法同对照组。结果试验组送检标本细胞涂片阳性率57.14%(8/14),组织块技术阳性率78.57%(11/14),总阳性率达85.71%,且明确病理类型8例(vs对照组2例),较对照组均明显提高(P<0.05)。同时胸腔积液总引流量明显增多,未发现明显相关并发症。结论胸腔内注射尿激酶可能有助于提高原发性肺癌合并恶性胸腔积液的阳性检出。

Objective To investigate the value of intrapleural urokinase for the diagnosis of malignant pleural effusion（ MPEs） in primary lung cancer patients. Methods 28 primary lung cancer patients with MPEs were randomly divided into the fibrinolytic group and the control group. All patients underwent closed intercostal drainage using a disposable central venous catheter inserted into the largest locule noted under ultrasound guidance. 200 mililiters of fresh pleural fluid gathered were centrifuged and the supernatants were discarded. The sediment samples gathered were divided to two parts,one for conventional cytological smear and the other for analysis with the cell block technique. Urokinase was instilled through the catheter at a dose of 200,000 IU diluted in 20 mililiters of normal saline in the fibrinolytic group. The catheter was clamped for 24 hours after the instillation of the drug completed,then reopened to suction. The other measures were same in the two groups. Results In the fibrinolytic group,the positive detective rate was 57. 14%（ 8/14） with malignant cell by the conventional cytological analysis,and the positive rate was 78. 57%（ 11/14） with the cell block method. The total positive rate was 85. 71%. There was 8 cases with definitively histologic types in the fibrinolytic group and 2 cases in the control group 2 cases（ P〈0. 05）. They also had a significantly increased drainage after intrapleural urokinase without any complications. Conclusion The results suggest that the intrapleural urokinase method can increase the diagnostic yield with exudative pleural effusions accompanying primary lung cancer.