内科胸腔镜检查在良恶性胸腔积液的诊治应用分析  

Analysis of the medical thoracoscopy in benign and malignant pleural effusion

作　　者：达春和[1] 边雨田[1] 张衡中[1] 李倩[1] 杜世霞[1] 张小惠[1] 

机构地区：[1]白银市第一人民医院呼吸科,甘肃730900

出　　处：《临床肺科杂志》2009年第11期1432-1434,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的认识内科胸腔镜检查在良恶性胸腔积液的病因学诊断价值。方法对34例胸腔积液患者实施胸腔镜检查,对恶性胸腔积液的患者采取多部位钳夹(8～10个部位),闭式引流管保留1～3天。结果34例患者经病理确诊32例,确诊率为91.4%。结核性胸膜炎41.2%(14/34);非典型炎性病变5.9%(2/34);恶性肿瘤52.9%(18/34)。14例结核性胸膜炎患者术后均在1周内完全缓解(CR);18例恶性胸腔积液检查后完全缓解(CR)率66.7%(12/18),总有效率83.3%(15/18),无效(PD)3例均有严重低蛋白血症。12例完全缓解(CR)患者,10例未出现胸水复发,2例出现胸水复发,复发率16.7%。结论内科胸腔镜检查能准确诊断胸膜疾病的病因,而且对结核性胸膜炎和恶性胸腔积液均有很好的治疗效果。Objective To explore the etiology, therapeutics and therapeutic effects of medical thoracoscopy in benign or malignant pleural effusion. Methods 34 patients with pleural effusion were examined by medical thoracoscopy. Patients with benign pleural effusion were adopted by adhering zone solution and douching. Biopsy of multi-situs （ 8 - 10 situs） was used for malignant pleural effusion. After the examination, closed drainage remaining for 1 to 2 days in the benign pleural effusion, and for 3 days in the malignant pleural effussion. Results Results showed that the diagnostic rate of thoracoscopy was 91.4% （32/34）. Tuberculous pleurisy was 41.2% （ 14/ 34 ） ; atypical inflammation was 5.9 % （2/34） ; and malignant tumor was 52.9% （ 18/34 ）. There were 14 patients with tuberculous pleurisy recovered completely within 1 week after the operation; and 18 patients with malignant tumor recovered completely （CR）. The rate of complete recovery was 66. 7% （12/18）, and the total effective rate was 83.3 % （ 15/18 ）. 3 cases suffered seriously hypoproteinemia. Pleural fluid didn＇t recur in 10 patients with malignant tumor, and in 2 patients it recurred. The relapse rate was 16.7%. Conclusion Medical thoracoscopy is an accurate method for the identification etiolgy of pleural diseases. Furthermore, it is an effective treatment for patients with tuberculous pleurisy or malignant pleural effusion.

关 键 词：内科胸腔镜 胸腔积液 

分 类 号：R561[医药卫生—呼吸系统] R730.4[医药卫生—内科学]