胸腔镜检查在老年结核性胸膜炎患者中的诊断价值

The diagnostic value of thoracoscopy in elderly patients with tuberculous pleurisy

目的 探讨老年结核性胸膜炎(TBP)患者的临床特征及内科胸腔镜下表现.方法 回顾性分析2013年8月至2021年8月间经胸腔镜确诊的TBP患者143例,其中,老年TBP患者51例,非老年TBP患者92例,分析两组的临床特点及胸腔镜下表现、病理类型的差异.结果 两组TBP患者胸腔镜下均有充血水肿型、粟粒样结节型、大小不等结节型、胸膜黏连肥厚型表现,老年TBP组较非老年TBP组镜下表现为大小不一结节型居多;两组干酪样肉芽肿病理类型比较差异有统计学意义(P<0.05).两组病程、发热、胸闷、胸痛表现、胸水LDH、TP、CEA、葡萄糖、血清LDH、CEA等临床特征及病理结果之间有统计学差异(P<0.05).结论 对于老年不明原因胸腔积液,可以早期进行胸腔镜检查.

Objective To investigate the clinical characteristics and the medical thoracoscopy manifestations of senile tuberculous pleurisy(TBP).Methods A retrospective analysis was performed on 143 TBP patients diagnosed by medical thoracoscopy from August 2013 to August 2021,including 51 elderly TBP patients and 92 non-elderly TBP patients.The clinical characterisics,horacoscopic manifestations and pathological types of the two groups were analyzed.Results Both groups of TBP patients showed blood edema type,milary nodular type,unequal size nodular type and pleural adhesion hypertrophy type under thoracoscopy.Compared with the non-elderly tuberculous pleurisy group,the elderly tuberculous pleurisy group showed more nodular types of different sizes under the microscope.There were significant differences in the pathological types of caseous granuloma between the two groups(P<0.05).There were significant dfferences between the disease course,fever,chest tightnes,chest pain manifestations,pleural water LDH,pleural water TP,pleural water CEA,pleural water glucose,serum LDH,and serum CEA(P<0.05).Conclusion For senile patients with unexplained pleural effusion,medical thoracoscopy should be performed as soon as possible.Medical thoracoscopy can effectively and safely diagnose senile tuberculous pleurisy.