可弯曲电子胸腔镜在不明原因胸膜疾病中的应用  

Application of flexirigid thoracoscopy in the diagnosis of pleural disease with unknown etiology

作　　者：黄国华[1] 程远雄[1] 苏瑾[1] 刘爱华[1] 郁伟伟[1] 吴月仙[1] 罗雅玲[1] 蔡绍曦[1] 

机构地区：[1]南方医科大学南方医院呼吸科,广东广州510515

出　　处：《南方医科大学学报》2011年第4期669-673,共5页Journal of Southern Medical University

基　　金：广东省重大科技计划基金资助项目(2008A060202013)

摘　　要：目的探讨局麻下可弯曲电子胸腔镜检查能否提高胸膜疾病的诊断准确性和患者的耐受性。方法对47例不明原因胸膜疾病(胸腔积液或胸膜增厚)患者进行内科胸腔镜肉眼观察和病理检查,统计诊断准确性、患者的耐受性。结果胸腔镜下肉眼观:42例患者胸壁或(和)膈肌发现病变,5例未见明显异常。47例患者中胸膜恶性肿瘤为21例(44.7%),胸膜结核17例(36.2%),特发性嗜酸细胞增多性胸水1例(2.1%),奴卡菌感染1例(2.1%),缩窄性心包炎1例(2.1%),慢性脓胸2例(4.3%),脾动脉栓塞1例(2.1%),病因未明3例(6.4%),诊断准确性达93.6%。所有患者术中、术后生命体征稳定,仅1例术中出现轻度胸膜反应,1例术后伤口疼痛,5例出现轻度皮下气肿,未见其他并发症。结论可弯曲电子胸腔镜检查及胸膜活检术是一项操作简单、安全、有效的检查方法,有助进一步明确胸膜疾病的病因;改良后的人工气胸针可进一步扩展内科胸腔镜的适应症。Objective To investigate the diagnostic accuracy of flexirigid thoracoscopy for pleural diseases and the patients＇ compliance.Methods Forty-seven patients with pleural effusion and thickening of unknown etiology underwent examinations with flexirigid thoracoscopy with subsequent pathological examination,and the diagnostic accuracy and the patients＇ compliance were observed.Results Thoracoscopy identified lesions in the pleural and/or diaphragm in 42 patients and no lesions in 5 patients.Malignancy was confirmed in 21（44.7%）,tuberculosis in 17（36.2%）,idiopathic hypereosinophilic syndrome in 1（2.1%）,nocardiasis in 1（2.1%）,constrictive pericarditis in 1（2.1%）,chronic empyema in 2（4.3%）,splenic artery embolization in 1（2.1%）,and negative result in 3（6.4%） of the cases.The diagnostic accuracy rate of flexirigid thoracoscopy reached 93.6%,and no serious complications in relation to the examination was found.Conclusion Flexirigid thoracoscopy is efficient and relatively safe for diagnosis of pleural diseases with or without hydrothorax.

关 键 词：改良人工气胸针 内科胸腔镜 胸膜疾病 

分 类 号：R561[医药卫生—呼吸系统]