电子支气管镜代替胸腔镜在不明原因胸腔积液诊断中的应用  

The application of electronic bronchoscope replacing thoracoscope to diagnose unclear causes of pleural effusion

作　　者：刘志光[1] 吴怀球[1] 张卫东[1] 邓红英[1] 李建民[1] 刘念[1] 陶寅[1] 江刚[1] 

机构地区：[1]湖南省人民医院呼吸内科,湖南长沙410005

出　　处：《中国内镜杂志》2012年第1期85-88,共4页China Journal of Endoscopy

摘　　要：目的探讨电子支气管镜代替胸腔镜在不明原因胸腔积液中的诊断价值。方法选择133例不明原因胸腔积液患者采用电子支气管镜代替胸腔镜检查,观察镜下病变形态和病理结果。结果 133例患者中115例明确诊断,诊断总阳性率为86.4%。66例恶性胸腔积液,确诊65例,恶性胸腔积液的确诊率为98.4%。56例结核性胸腔积液,确诊45例,结核性胸腔积液的确诊率为80.3%;7例结核性胸腔积液病检表现为炎症细胞浸润及纤维组织增生,结合临床抗结核治疗后被证实;4例因胸膜腔严重粘连检查失败。2例病理诊断胸膜嗜酸性粒细胞肉芽肿组织。1例诊断肺炎旁性胸腔积液。2例诊断脓胸。6例漏出液未获得诊断。并发症少且轻微,无1例因不能耐受而终止。结论结果表明电子支气管镜代替胸腔镜对不明原因的胸腔积液尤其是恶性胸腔积液有较高的临床应用价值,具有诊断阳性率高、损伤小、操作简单安全等优点。[Objective] To evaluate the application of electronic bronchoscope replacing thoracoscopy to diagnose the unclear causes of pleural effusion.[Methods] 133 patients with pleural effusion,whose causes were still unknown,were selected to be diagnosed by the electronic bronchoscope replacing thoracoscope,and the appearances of pathological changes underscope were described and the pathological results were defined.[Results] Of these 133 patients,115 cases had definite diagnosis（the positive rate was 86.4%）.Of these 66 cases with malignant pleural fluid,65 cases had defined diagnosis（the positive rate was 98.4%）.of these 56 tuberculosis cases,45 cases had defined diagnosis（the positive rate was 80.3%）;7cases with the pathological changes of inflamation cells infiltration and fiberosis were diagnosed by the effective anti-tuberculosis treatment;4 failed cases because of extensive pleura adhesions.2 cases with eosinophlia granuloma,1 parapneumonic effusion case and 2 empyema cases were diagnosed.6 cases with the transudative effusion weren＇t diagnosed.There were few complications and no patients failed to finish this examine.[Conclusions] The electronic bronchoscope replacing the thoracoscope possesses high positive diagnostic rate and safety.It has preferable value in clinical application for those unclear causes of pleural effusion.

关 键 词：支气管镜 胸腔镜 胸腔积液 诊断 

分 类 号：R655[医药卫生—外科学]