内科胸腔镜对不同病因胸腔积液的鉴别诊断价值

Clinical value of internal medicine thoracoscopy in differential diagnosis of pleural effusion of different causes

目的探讨内科胸腔镜对不同病因胸腔积液的鉴别诊断价值。方法抽取2018年1月至2019年12月于周口市中心医院接受内科胸腔镜检查的不同病因胸腔积液患者118例。对胸腔镜检查结果进行分析,包括检查结果和不同类型胸腔积液在胸腔镜下表现,并以病理检查为金标准,对其诊断率以及临床价值进行分析。结果118例接受内科胸腔镜检查的患者中,116例明确诊断。其中结核性胸膜炎57例(占50.00%);恶性肿瘤33例(占28.94%),其中肺腺癌10例、肺小细胞癌5例、肺鳞癌3例、恶性胸膜间皮瘤5例、子宫内膜癌转移4例、乳腺癌转移6例;炎性胸腔积液26例(占22.80%)。另2例胸腔镜检查阴性的患者经后续病理学检查确诊为1例恶性肿瘤,1例结核性胸膜炎。胸腔镜下,结核性胸膜炎多表现为充血肿胀、胸膜粘连、结节样性生物以及弥漫性结节;恶性肿瘤多表现为充血肿胀、粘连、结节样新生物以及坏死;炎性胸腔多表现为充血肿胀、粘连和坏死。与病理诊断对照,内科胸腔镜阳性符合率为98.30%,内科胸腔镜对于不同病因胸腔积液的准确率和灵敏度均较高。结论胸腔镜检查对于不同病因胸腔积液诊断的灵敏度、特异度以及阳性符合率均较高。

Objective To study the clinical value of internal medicine thoracoscopy in differential diagnosis of pleural effusion of different causes.Methods One hundred and eighteen patients with pleural effusion of different etiologies who underwent medical thoracoscopy in Zhoukou Central Hospital from January 2018 to December 2019 were retrospectively selected.The results of thoracoscopy were analyzed,including the examination results and the performance of different types of pleural effusion under thoracoscopy.The pathological examination was set as the gold standard to analyze its diagnostic rate and clinical value.Results In 118 patients undergoing medical thoracoscopy,116 cases were clearly diagnosed,including 57 cases(50.00%)of tuberculous pleurisy;33 cases(28.94%)of malignant tumors,including 10 cases of lung adenocarcinoma and 5 cases of lung small cell carcinoma,3 cases of lung squamous cell carcinoma,5 cases of malignant pleural mesothelioma,4 cases of endometrial cancer metastasis,6 cases of breast cancer metastasis;26 cases(22.80%)of inflammatory pleural effusion.The other two patients with negative thoracoscopy were confirmed as malignant tumor in one case and tuberculous pleurisy in another by subsequent pathological examination.Under video-assisted thoracoscopy,tuberculous pleurisy showed hyperemia,swelling,pleural adhesion,nodular organisms and diffuse nodules;malignant tumors showed hyperemia,swelling,adhesion,nodular new organisms and necrosis;inflammatory chest showed hyperemia,swelling,adhesion and necrosis.Compared with pathological examination,the positive rate of medical thoracoscopy was 98.30%.The accuracy and sensitivity of medical thoracoscopy for different causes of pleural effusion were high.Conclusions The sensitivity,specificity and positive coincidence rate of internal medicine thoracoscopy for pleural effusion of different causes are high.