可弯曲电子内科胸腔镜在恶性胸腔积液诊断中的应用  

Application of flexi-rigid thoracoscopy under local anesthesia to diagnosing malignant pleural effusion

作　　者：王臻[1] 童朝辉[1] 李红杰[1] 赵婷婷[1] 李绪言[1] 徐莉莉[1] 王晓娟[1] 张隽[1] 罗静[1] 金木兰[1] 王辰[1] 

机构地区：[1]首都医科大学附属北京朝阳医院北京呼吸疾病研究所,北京100020

出　　处：《中国实用内科杂志》2008年第2期107-109,共3页Chinese Journal of Practical Internal Medicine

基　　金：首都医学发展科研基金(首都ZD199901)

摘　　要：目的探讨可弯曲电子内科胸腔镜在恶性胸腔积液诊断中的应用时机和指征。方法2005年7月至2007年7月,对首都医科大学附属北京朝阳医院应用尖端可弯曲电子内科胸腔镜(LTF-240型)检查并确诊的37例恶性胸腔积液患者临床资料进行回顾性分析,所有患者经胸腔积液细胞学、痰细胞学、支气管镜检查等仍不能确诊胸腔积液性质,临床上高度疑诊恶性胸腔积液者,行内科胸腔镜治疗。结果37例患者最终诊断:肺癌20例,其中肺鳞癌5例(其中1例经手术证实,而胸腔镜检查为阴性),肺腺癌12例,肺腺鳞癌1例,小细胞癌2例;胸膜转移癌14例,其中乳腺癌转移4例,卵巢癌转移1例,肾透明细胞癌并胸膜转移1例,恶性胸腺瘤转移1例,其他部位转移癌7例;恶性胸膜间皮瘤2例;非霍奇金淋巴瘤1例。主要并发症为术后伤口疼痛(21例),对症治疗可缓解,无肺水肿、感染、出血等并发症。结论可弯曲电子内科胸腔镜检查是一项安全、有效、易操作的检查方法,对有肿瘤病史、大量胸腔积液、胸部CT提示肿块影或胸膜病变者可早期积极进行内科胸腔镜检查。Objective To investigate when and in which patients with pleural effusion thoracoscopy are indicated. Methods Retrospective study of 37 patients referred for thoracoscopy in our hospital between July 2005 and July 2007. The patients consisted of 22 males and 15 females,ranging in age from 42 to 82 years, with a mean age of 63. All patients were undiagnosed with negative cytology after examinations of thoracentesis and bronchoscopy. Results The final diagnosis was squamous-cell carcinoma in 5 cases, adenocarcinoma in 12 cases,adenosquamous carcinoma in 1 case,lung small-cell carcinoma in 2 cases, lymphoma in 1 case, malignant mesothelioma in 2 cases, metastatic breast cancer in 4 cases, metastatic ovarian cancer in 1 case, metastatic suprarenal epithelioma in 1 case, malignant thymoma in 1 case and unknown primary disease in 7 cases. The main complication of the procedure was pain after examination;no severe complications occurred during the examination. Conclusion Medical thoracoscopy has a high diagnostic rate, and can be easily and safely performed. In patients with a history of malignant disease, massive pleural effusions and nodule or pleural lesions in lung, thoracoscopic pleural biopsy under local anesthesia should be actively performed.

关 键 词：胸腔镜 可弯曲 活检 胸腔积液 诊断 

分 类 号：R5[医药卫生—内科学]