内科腔镜直视下胸膜刷检涂片对结核性胸膜炎确诊的价值  

The Value of Endoscopic Surgery of Pleural Brushing Smear on the Diagnosis of Tuberculous Pleurisy

作　　者：杜春鲜 郝光旭 郝萌 

机构地区：[1]湖北省宜昌市兴山县人民医院呼吸内科,湖北宜昌443700 [2]湖北省宜昌市秭归县人民医院内科,湖北宜昌443600

出　　处：《中国继续医学教育》2017年第2期106-108,共3页China Continuing Medical Education

摘　　要：目的探讨内科胸腔镜直视下胸膜刷检抗酸杆菌涂片对二级医院结核性胸膜炎患者的确诊价值,评价内科胸腔镜对不明原因胸腔积液患者的诊断价值,总结二级医院开展经内科胸腔镜检查的安全性。方法分步回顾总结笔者在我院和进修时共完成66例胸腔积液,其中原因不明的胸腔积液56例,接受内科胸腔镜检查患者的临床资料。结果 66例患者均成功实施了内科胸腔镜检查,胸腔镜下病理组织活检确诊恶性肿瘤20例、结核性胸膜炎27例、慢性炎症9例、乳糜胸2例,脓胸5例,未见异常3例。肿瘤和结核病理结果确诊率为83.9%(47/56),总诊断有效率为94.6%(53/56)。我院14例结核性胸膜炎患者内科胸腔镜检查:结核病理诊断阳性符合率100.0%,腔镜直视下胸膜多点刷检抗酸杆菌涂片阳性率42.9%,胸水抗酸杆菌培养阳性率28.6%,抗酸杆菌总阳性率57.1%,而支持诊断的胸水ADA阳性率14.3%。66例胸腔镜检查3例出现粘连带撕裂出血,1例术中血压下降,经处理均恢复正常,恶心3例,3例存在胸膜反应,有部分患者出现胸痛和自限性发热,分别为24.2%,13.6%;所有接受内科胸腔镜检查的患者无严重并发症。结论本研究揭示出结核性胸膜炎患者内科胸腔镜直视下胸膜刷检抗酸杆菌阳性率比其他标本病原阳性率高,联合多种方法病原菌检测阳性率更高,且无需长时间等待结核杆菌培养,对结核性胸膜炎有较高确诊价值;内科胸腔镜对不明原因胸腔积液患者的诊断价值较高;不良反应少而轻,安全性好,二级医院同样适合应用。Objective To explore the medical thoracoscopy surgery under the pleural brushing smear of acid fast bacilli value in the diagnosis of tuberculous pleurisy patients of two hospitals, and the diagnosis of patients with unexplained pleural effusion thoracoscopy and summarize the evaluation value of two hospitals to carry out safety by medical thoracoscopy. Methods Review of the step by step in our hospital the study and completed a total of 66 cases of pleural effusion, 56 cases of unexplained pleural effusion, accepted clinical data of medical thoracoscopy in patients. Results 66 patients were performed successfully by medical thoracoscopy, 20 cases of thoracoscopic biopsy confirmed the diagnosis of malignant tumor, 27 cases of tuberculous pleurisy, 9 cases of chronic inflammation, 2 cases of chylothorax, 5 empyema cases, 3 cases were abnormal. The pathological results of tumor and tuberculosis diagnosis rate was 83.9%（47/56）, the total diagnostic efficiency of 94.6%（53/56） in our hospital 14 cases of tuberculosis. Pleurisy patients with medical thoracoscopy： tuberculosis diagnostic coincidence rate was 100.0%, endoscopic surgery under multiple pleural brushing smear positive rate of acid fast bacilli in 42.9%, pleural fluid acid fast bacilli culture positive rate was 28.6%, the total positive rate of acid fast bacilli in 57.1%, and support the positive rate of diagnosis of pleural ADA 14.3%. 66 cases of thoracoscopy in 3 cases the adhesion with hemorrhage, 1 cases of intraoperative blood pressure decreased after treatment were normal, 3 cases of nausea, 3 cases with pleural reaction, some patients had chest pain and self limiting fever, were 24.2%, 13.6%; all underwent medical thoracoscopy in patients without severe complications. Conclusion This study revealed tuberculosis pleurisy patients with thoracoscopic surgery under the pleural brushing positive rate of acid fast bacilli than other pathogenic high positive rate, positive rate of pathogen detection method combined with a variety of higher, and the

关 键 词：二级医院 内科胸腔镜 抗酸杆菌刷检阳性率 结核性胸膜炎 确诊价值 

分 类 号：R521.7[医药卫生—内科学]