内科胸腔镜对淋巴瘤所致胸腔积液的诊断价值

Diagnostic value of thoracoscopy for pleural effusion caused by lymphoma

目的评价内科胸腔镜对淋巴瘤所致胸腔积液的诊断价值。方法回顾性分析2013-2018年陆军军医大学第二附属医院呼吸内科胸腔镜确诊的6例淋巴瘤患者的内科胸腔镜镜下特征及临床表现并复习相关文献。结果 6例淋巴瘤患者的胸腔镜下表现及临床特征缺乏特异性,其主要表现为胸膜多发小结节(n=5),或伴有胸膜粘连(n=3)、分隔(n=1)、胸膜肥厚(n=1)或色素沉着(n=1)等多种特征;所有患者均伴有肺部病灶及渗出性胸腔积液,其中单侧或双侧胸腔积液各3例,血性胸腔积液4例,非血性胸腔积液2例;6例患者最终诊断均为非霍奇金淋巴瘤。结论淋巴瘤在临床上表现具有多样性,伴有胸腔积液的淋巴瘤患者,多为非霍奇金淋巴瘤;此类患者的胸腔镜下表现不尽相同,但其内科胸腔镜下胸膜活检阳性率高,是不可替代的诊断方法。

Objective To evaluate the diagnostic value of thoracoscopy in pleural effusion caused by lymphoma.Methods The endoscopic characteristics and clinical manifestations of 6 patients with lymphoma diagnosed by thoracoscopy in the Second Affiliated Hospital of Army Medical University from 2013 to 2018 were retrospectively analyzed,and the related literature was reviewed.Results The thoracoscopic findings and clinical features of the 6 patients were lack of specificity,which were mainly characterized as pleural multiple nodules(n=5),and/or accompanied by pleural adhesion(n=3),partition(n=1),pleural hypertrophy(n=1)or pigmentation(n=1).All patients were accompanied with pulmonary lesions and exudative pleural effusion,including 3 cases of unilateral and 3 cases of bilateral pleural effusion,4 cases of hemorrhagic pleural effusion and 2 of non-hemorrhagic pleural effusion.All the 6 patients were diagnosed as non-Hodgkin's lymphoma.Conclusion Lymphoma has diverse clinical manifestations.Most of the lymphoma patients with pleural effusion are non-Hodgkin's lymphoma.Since the thoracoscopic findings are quite different and positive rate of thoracoscopic pleural biopsy is quite high,this procedure is irreplaceable for diagnosis.