脏层胸膜在胸膜腔液体循环中作用机制的临床研究

Clinical Investigation of the Functional Effects of Visceral Pleura on Pleural Fluid Turnover

目的 结合心力衰竭、肺淋巴管癌病和肺淋巴管平滑肌瘤病的临床和病理特征 ,探讨脏层胸膜在胸膜腔液体循环中的作用机制。方法 (1)分析 1999～ 2 0 0 1年 5 31例心力衰竭患者胸膜腔积液的发生率 ,其中冠心病等所致的左心功能 级 32 9例 ,慢性肺原性心脏病右心功能失代偿 2 0 2例 ;(2 )分析 1998～ 2 0 0 2年 6例肺内淋巴管性疾病胸膜肺组织活检的病理表现和肺内淋巴管的分布特征。结果 (1)胸腔积液的发生率左心功能 级者为14.89%;肺心病右心功能失代者为 0 %,两者差异有显著性 (p<0 .0 1) ;(2 )肺内淋巴管性疾病的胸膜肺组织病理可见肺内淋巴管起源于胸膜脏层。结论 肺内淋巴管起源于胸膜脏层 ,在胸膜腔液体的循环过程中和壁层胸膜一样发挥着重要的作用。

Objective To explore the functional effects of visceral pleurae on pleural fluid turnover by analyzing the clinical pathological characteristics of heart failure, pulmonary lymphangitic carcinomatosis and lymphangioleiomyomatosis.Methods The prevalence of pleural effusion in 531 heart failure cases admitted to the Peking Univeristy People's Hospital during January 1999 - December 2001 was retrospectively summarized. There were 329 cases with left heart failure (Grade IV) resulted from coronary heart disease and 202 cases with right heart failure (discompensation) resulted from cor pulmonale. The pathologic characteristics of 6 cases of pulmonary lymphangitic disorders (5 cases with pulmonary lymphangitic carcinomatosis and 1 case with pulmonary lymphangioleiomyomatosis) were analyzed and their pulmonary lymphangitic origination was observed through pelural-lung biopsy tissue.Results (1) The incidence of pleural effusion in left and right ventricular heart failure was 14.89% and 0%, respectively: p < .001; (2) pulmonary lymphangitic drainage originated from visceral pleura was validated in pleural-lung biopsy tissue with pulmonary lymphangitic disorders.Conclusion Pulmonary lymphangitic drainage is originated from visceral pleura. Like parietal lymphangitic drainage, it plays a pivotal role in pleural fluid turnover.