内科胸腔镜在不明原因胸腔积液诊断中的应用价值

Value of medical thoracoscopy in the diagnosis of pleural effusion of unknown origin

目的了解内科胸腔镜对不明原因胸腔积液患者进行病因诊断的临床应用价值。方法回顾性分析50例不明原因胸腔积液患者的临床及病理资料,包括内科胸腔镜下活检病理结果、不同类型的胸腔积液其镜下的表现特征。结果50例不明原因胸腔积液患者中通过内科胸腔镜检查后最终确诊48例,诊断率达96.0%;其中恶性肿瘤性胸腔积液13例(26.0%),结核性胸腔积液20例(38.0%),炎症性胸腔积液15例(30.0%),未能确诊2例(4.0%)。内科胸腔镜检查术后并发症中,术后切口疼痛14例,皮下气肿4例,发热2例,无恶性心律失常、大出血、复张性肺水肿等严重并发症。结论内科胸腔镜对不明原因胸腔积液的诊断及良恶性胸腔积液的鉴别具有操作简单、创伤小、安全、诊断率高的特点。

Objective To explore the clinical value of medical thoracoscopy in etiological diagnosis of patients with pleural effusion of unknown origin.Methods The clinical and pathological data of 50 patients with pleural effusion of unknown origin were retrospectively analyzed,including pathological results of thoracoscopic biopsy and thoracoscopic manifestations of different types of pleural effusion.Results Among the 50 patients with pleural effusion of unknown origin,48 were finally diagnosed in thoracoscopy,with a diagnosis rate of 96.0%;and there were 13 cases(26.0%)with malignant pleural effusion,20 cases(38.0%)with tuberculosis pleural effusion,15 cases(30.0%)with inflammatory pleural effusion,and 2 cases(4.0%)undiagnosed.For the complications after thoracoscopy,14 cases had postoperative incision pain,4 cases had subcutaneous emphysema and 2 cases had fever.There were no serious complications such as malignant arrhythmia,massive hemorrhage and recurrent pulmonary edema identified.Conclusion For the diagnosis of pleural effusion of unknown origin and the differentiation between benign and malignant pleural effusion,medical thoracoscopy is characterized by simple operation,small wound,safety and high diagnostic rate.