内科胸腔镜下胸膜冷冻活检对不明原因胸腔积液的诊断价值  

Diagnostic Value of Thoracoscopic Frozen Pleural Biopsy in Patients with Unexplained Pleural Effusion

作　　者：陈碧玉 唐以军[1] 金阳[2] 王梅芳[1] 罗国仕[1] 王汉生 魏娜[1] CHEN Bi-yu;TANG Yi-jun;JIN Yang;WANG Mei-fang;LUO Guo-shi;WANG Han-sheng;WEI Na(Department of Respiratory Medicine,Taihe Hospital,Shiyan,Hubei 442000;Department of Respiratory Medicine,Xiehe Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430000,China)

机构地区：[1]湖北医药学院附属太和医院呼吸与危重症医学科,湖北十堰442000 [2]华中科技大学同济医学院附属协和医院呼吸内科,湖北武汉430000

出　　处：《湖北医药学院学报》2021年第3期250-252,258,共4页Journal of Hubei University of Medicine

基　　金：湖北省医学领军人才项目;湖北医药学院创新团队项目(FDFR201801)。

摘　　要：目的:探讨内科胸腔镜下胸膜冷冻活检对不明原因胸腔积液的诊断可行性和安全性。方法:对在我院呼吸内科接受内科胸腔镜检查的160例不明原因胸腔积液患者的临床资料进行回顾性分析,比较常规活检和联合冷冻活检在标本大小、病理阳性率以及并发症等方面的差异。结果:160例行胸腔镜检查的患者中,143例通过常规活检得到确诊,阳性率89.4%;160例中有21例常规钳夹未取得满意组织标本,联合冷冻活检后获得满意标本,且冷冻活检均获得阳性结果,阳性率100%;常规活检联合冷冻活检的总阳性率为98.7%,显著高于单纯常规活检阳性率(P<0.01)。常规活检有59例出现组织挤压现象,而冷冻活检未见;二者活检出血量都很少,无需止血处理;二者活检疼痛程度评分亦无差异。结论:内科胸腔镜常规胸膜活检联合冷冻活检可以获得更高的病理阳性率,且无组织挤压现象,并发症轻微,操作简单安全,值得临床推广。Objective To explore the feasibility and safety of the cryobiopsy of pleura under the internal chest microscope in the diagnosis of unexplained pleural effusion.Methods The clinical data of 160 patients with unexplained pleural effusion who underwent thoracoscopic examination in respiratory department of our hospital were retrospectively analyzed.The differ⁃ences of specimen size,pathological positive rate and complications between routine biopsy and combined frozen biopsy were compared.Results Among 160 patients who underwent thoracoscopic examination,143 cases were confirmed by rou⁃tine biopsy,the positive rate was 89.4%,and 21 cases of routine clamps failed to obtain satisfactory tissue specimens.Combined with frozen biopsy obtained satisfactory samples,21 cases of frozen biopsy obtained positive results,and the posi⁃tive rate was 100%.The total positive rate of routine biopsy combined with frozen biopsy was 98.7%,which was significant⁃ly higher than that of routine biopsy(P<0.01).In routine biopsy,59 cases had tissue extrusion,but not in frozen biopsy.There was no need to stop bleeding,and there was no difference in the pain score between the two groups.Conclusion Routine pleural biopsy combined with frozen biopsy under medical thoracoscopy can obtain higher pathological positive rate,no tissue extrusion phenomenon,mild complications,simple and safe operation,which is worthy of clinical promotion.

关 键 词：胸腔积液 内科胸腔镜 冷冻活检 

分 类 号：R561.3[医药卫生—呼吸系统]