结核性胸膜炎经胸腔镜胸膜活检诊断66例临床病理分析  

Diagnosis of tuberculous pleuritis by thoracoscopical biopsy: a clinicopathological analysis of sixty-six cases

作　　者：刁小莉[1] 金木兰[1] 曹勍[1] 刘洋[1] 王臻[2] 

机构地区：[1]首都医科大学附属北京朝阳医院病理科,北京100020 [2]首都医科大学附属北京朝阳医院呼吸科,北京100020

出　　处：《诊断病理学杂志》2016年第5期349-352,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨经胸腔镜下胸膜活检诊断结核性胸膜炎的组织病理学表现。方法对66例胸腔镜下胸膜活检组织常规石蜡切片后,行HE染色、抗酸染色、网织纤维染色,镜下观察,并对临床信息进行分析。结果 66例结核性胸膜炎中,男性48例,女性18例,平均年龄50.4岁。组织学表现为胸膜内大量淋巴细胞浸润,绝大部分胸膜表面可见炎性渗出物(64/66),大多数病例可见朗格汉斯上皮样细胞构成的肉芽肿结构(47/66),肉芽肿中心多见干酪样坏死(31/47);少数病例只见干酪样坏死和炎性渗出物(4/66),或仅见炎性渗出物(4/66)。50例胸膜组织抗酸杆菌阳性,占全部病例数的75.8%(50/66)。结论胸腔镜胸膜活检诊断结核性胸膜炎的确诊率高,结核杆菌阳性检出率高,对于组织学单纯表现为干酪样坏死和/或炎性渗出的病例病理诊断不应漏诊。Objective To discuss how to make the pathologic diagnosis of tuberculous pleuritis obtained by thoracoscopic biopsy. Methods Sixty-six patients with tuberculous pleuritis underwent biopsy at thoracoscopy. Pleural tissue was examined histologically on paraffin sections stained with hematoxylin and eosin,AFB and reticulum. The pathologic and clinical features were analyzed. Results Sixty-six cases consisted of 48 men and 18 women ranging from sixteen to ninty-three years old（ mean = 50. 4）. All cases showed lymphocytic pleuritis, most of them had the surrounding fibroinflammatory exudation（ 64 /66）. The pleural tissues showed granulomas made of epithelial Langhans cell in 47 cases and those combined with caseous necrosis in 31 cases. In few cases there were only fibroinflammatory exudation and / or caseous necrosis（ 4 /4）. The AFB stain of the biopsy was positive in 50（ 75. 8%）. Conclusions If the patients do have tuberculous pleuritis,pleural biopsy obtained by thoracoscopy will establish the diagnosis effectively and prove that tuberculous pleuritis suffers from mycobacterium tuberculosis because the AFB stain is positive frequently. Even when the granulomas are not visualized, the biopsy specimen should always be examined for AFB when there are only fibroinflammatory exudation and / or caseous necrosis.

关 键 词：结核性胸膜炎 抗酸杆菌 胸腔镜 

分 类 号：R521.7[医药卫生—内科学]