经内科胸腔镜刷检对恶性胸腔积液诊断的应用价值  

The value of medical thoracoscopic pleural brushing in the diagnosis of malignant pleural effusion

作　　者：张永祥[1] 张力[1] 李月川[1] 贾玮[1] 张冬睿[1] 马晖[1] 谷松涛[1] 

机构地区：[1]天津市胸科医院呼吸与危重症医学科,300222

出　　处：《天津医药》2016年第9期1160-1163,1188,共5页Tianjin Medical Journal

摘　　要：目的探讨经内科胸腔镜直视下胸膜刷检对恶性胸腔积液诊断的阳性率、可靠性及安全性。方法对70例不明原因胸腔积液患者行胸腔镜检查:(1)对脏壁层胸膜可疑病变部位刷检行细胞学检查;(2)对壁层胸膜可疑病变部位活检行病理组织学检查;(3)比较2种方法各自及联合诊断恶性胸腔积液的诊断阳性率、病理类型确定率以及并发症发生率。结果 51例确诊为恶性胸腔积液者壁层胸膜活检阳性率88.24%(45/51),刷检阳性率90.20%(46/51),活检联合刷检诊断阳性率96.08%(49/51),2种方法各自及联合诊断恶性胸腔积液阳性率差异无统计学意义(P>0.05)。51例中刷检病理类型确定率76.47%(39/51),活检为88.24%(45/51),2种方法明确恶性胸腔积液病理类型结果差异无统计学意义(P>0.05)。活检168例次,出血较多5例次(2.98%),疼痛134例次(79.76%),多部位胸膜刷检共198例次,未见局部明显出血及疼痛。结论经胸腔镜直视下胸膜刷检安全、阳性率高、结果可靠,可作为诊断恶性胸腔积液的有效方法。Objective To evaluate the positive rate, reliability and safety of thoracoscope pleural brushing fordiagnosing malignant pleural effusion. Methods Seventy patients with unexplained pleural effusion were performed withmedical thoracoscopy： （1） Observe the visceral and parietal pleura then use disposable cell brush to obtain specimens fromsuspect areas and take cytological examination. （2） Observe the parietal pleura then use biopsy forceps to forceps specimensfrom suspect areas and take histological examination. （3） Compare the positive rate of diagnosis, coincidence rate ofpathological type and complication between two methods individual and combination in diagnosis. Results In 51 patientsdiagnosed as malignant pleural effusion, the diagnosis-positive rate of biopsy was 88.24% （45/51） and the diagnosis-positiverate of pleural brushing cytology was 90.20% （46/51）. The diagnosis-positive rate of pleural brushing combined with biopsywas 96.08% （49/51）, but there was no significant difference in diagnosis-positive rate between two methods individual andcombination for malignant pleural effusion （P〉0.05）. In 51 patients, pathological type determination rate was 76.47% （39/51）evaluated by pleural brushing, 88.24% （45/51） by biopsy, and there was no significant difference in pathological typedetermination rate between two methods （P〉0.05）. Biopsy was performed for 168 times, more bleeding was found in 5 cases（2.98%）, feeling pain in 134 cases （79.76%）. Pleural brushing examination was performed for 198 times, no significantbleeding and pain were found. Conclusion Medical thoracoscopic pleural brushing under direct vision is a safe andreliable method, which can be use as an effective diagnostic method for malignant pleural effusion.

关 键 词：胸腔积液 恶性 胸腔镜检查 胸膜肿瘤 活组织检查 胸膜刷检 

分 类 号：R561.3[医药卫生—呼吸系统]