电子支气管镜胸膜活检联合壁层胸膜冷冻活检对渗出性胸腔积液的诊断价值  

Diagnostic Efficiency of Pleura Biopsy and Partial Pleura Cryobiopsy via Electronic Bronchoscope in Exudative Pleural Effusion

作　　者：邓治平[1] 杨莹[1] 吴小玲[1] 周玲[1] 林涛[1] 

机构地区：[1]四川省自贡市第一人民医院呼吸内科,四川自贡643000

出　　处：《中国呼吸与危重监护杂志》2013年第4期390-393,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨通过电子支气管镜进行胸膜活检联合壁层胸膜冷冻活检对不明原因的渗出性胸腔积液的诊断价值和安全性。方法回顾分析单独用支气管镜进行胸膜常规活检(187例),以及用支气管镜常规胸膜活检联合壁层胸膜冷冻活检(376例)对不明原因的渗出性胸腔积液的病理学确诊率。结果对2006年至2008年187例不明原因的渗出性胸腔积液患者采用支气管镜进行常规胸膜活检,161例获得病理学确诊(86.1%),26例未取得足够的活体组织标本而无病理学诊断(13.9%)。对2009年至2012年376例不明原因的渗出性胸腔积液患者用电子支气管镜进行胸膜活检,338例用常规活检的方法即获得病理学确诊(89.9%),有16例在壁层胸膜发现病变常规钳夹活检失败后联合冷冻切除的方法获得了满意的标本。电子支气管镜常规胸膜活检联合壁层胸膜冷冻活检总体病理学确诊率达94.1%(354/376),与单独用电子支气管镜常规胸膜活检的确诊率相比有显著差异(P<0.05)。主要的并发症是局部少量出血和轻微胸痛。结论通过电子支气管镜进行胸膜活检对不明原因的渗出性胸腔积液的确诊率接近90%,如果联合应用壁层胸膜冷冻活检可以达到更高的病理学确诊率,并发症轻微且易于处理。在内科胸腔镜设备缺乏的医疗机构,通过电子支气管镜进行胸膜活检和冷冻活检诊断渗出性胸腔积液是可行的。Objective To explore the clinical value of pleura biopsy and partial pleura cryobiopsy via electronic bronchoscope in diagnosis of unknown exudative pleural effusion. Methods Diagnostic results of 563 patients with unknown exudative pleural effusion were analyzed retrospectively. Bronehoscope and routine pleura biopsy were performed in 187 patients. Bronchoscope and routine pleura biopsy plus partial pleura eryobiopsy were performed in 376 patients. Pathological positive rates of the two groups were compared. Results In the 187 patients examined by bronehoseope and routine pleura biopsy from 2006 to 2008,161 patients obtained pathological positive results （86. 1% ）. In the 376 patients examined by bronchoscope and routine pleura biopsy plus partial pleura eryobiopsy from 2009 to 2012,354 patients acquired pathological diagnosis （94. 1% ）. There was significant difference between the two groups （ P 〈 0. 05）. The main complications were bleeding and local chest pain, and they can be controlled easily. Conclusions Electronic bronchoseope and pleura biopsy can obtain high detection rate of nearly 90% in diagnosis of unknown exudative pleural effusion especially when combined with eryobiopsy of partial pleura. Electronic bronehoscope combined with pleura biopsy or cryobiopsy is an alternative in clinical settings when thoraeoseope is unavailable.

关 键 词：胸腔积液 电子支气管镜 胸腔镜 壁层胸膜 冷冻活检 

分 类 号：R561[医药卫生—呼吸系统]