内科胸腔镜对不明原因胸腔积液诊断价值及恶性胸腔积液镜下表型特征

Diagnostic value and morphological features for unexplained and malignant pleural effusion under medical thoracoscopy examination

目的探讨内科胸腔镜在不明原因胸腔积液诊断中的临床应用价值及恶性胸腔积液的镜下表型特征。方法回顾性分析2015年1月-2018年1月我科98例不明原因胸腔积液患者胸腔镜活检病理结果、恶性胸腔积液镜下表型特征、围手术期并发症及胸水腺苷脱氨酶(adenosine deaminase,ADA)、癌胚抗原(carcino-embryonic,CEA)和血CEA的结果。结果 98例不明原因胸腔积液中确诊89例,确诊率达90. 82%;其中恶性胸腔积液36例,确诊率为94. 74%,镜下主要表现为:正常者1例,溃疡糜烂样病变2例,孤立性结节1例,粟粒样结节2例,多发结节27例,多发结节至弥漫性白斑样病变3例;胸腔镜检查术后疼痛18例、皮下气肿5例、发热4例。结核性胸腔积液胸水ADA较高,而胸水及血CEA在恶性胸腔积液浓度较高(P均<0. 05)。结论内科电子胸腔镜具有微创、安全、高效的特点,对不明原因胸腔积液具有较高的诊断价值;恶性胸腔积液具有特征性镜下表型特征,正确识别恶性胸腔积液胸膜病变在内科胸腔镜下的表现对术中指导多点活检,尽早明确诊断具有重要意义。

Objective To investigate the clinical diagnostic value and the morphological features of malignant pleural effusion under thoracoscopy examination.Methods The results of pathological biopsy,the morphological features of malignant pleural effusion under medical thoracoscopy,the perioperative complications,CEA and ADA of 98 patients,who accepted the examination of flexi-rigid thoracoscopy in our hospital because of unknown pleural effusion from January 2015 to January 2018,were analyzed retrospectively.Results There were 89 cases definitely diagnosed(90.82%)and 36 malignant pleural effusion(94.74%)among 98 patients.The morphological features of malignant pleural effusion under thoracoscopy showed mainly 1 case of normal pleura,2 lesions of ulcerative erosion,1 single nodule,2 miliary nodules,27 multiple nodules and 3 multiple nodules to extensive leukoplakia like lesions.Complications of the patients underwent medical thoracosopy were mainly chest pain,subcutaneous emphysema and fever.The concentration of ADA was higher in tuberculous pleural effusion while CEA was higher in malignant pleural effusion and blood(P<0.05).Conclusion Medical thoracoscopy examination is a minimally invasive,safe and effective technology for diagnosis of unexplained pleural effusion with high exact diagnosis rate.It has a significant value in diagnosing unknown pleural effusion.Malignant pleural effusions have unique morphological features.The exact awareness of morphological features of malignant pleural effusions under thoracoscopy has significance for guiding precise multipoint biopsy and early diagnosis.