内科胸腔镜联合闭式胸膜活检术在不明原因胸腔积液中的临床诊断价值  

Clinical diagnostic value of medical thoracoscopy combined with closed pleural biopsy in unexplained pleural effusion

作　　者：耿立惠 GENG Lihui(Department of Respiration,Suqian First People′s Hospital in Jiangsu Province,Suqian223800,China)

机构地区：[1]江苏省宿迁市第一人民医院呼吸科,江苏宿迁223800

出　　处：《中国现代医生》2022年第1期25-28,F0003,共5页China Modern Doctor

摘　　要：目的 观察内科胸腔镜联合闭式胸膜活检术在不明原因胸腔积液中的诊断价值。方法 对2016年6月至2019年6月江苏省宿迁市第一人民医院的150例胸腔积液患者行闭式胸膜活检术和胸腔积液细胞学等检查,不能明确诊断者内科胸腔镜检查。结果 150例胸腔积液患者有44例找到肿瘤细胞,其中3例细胞数太少无法明确病理类型,胸腔积液细胞学阳性率27.3%(41/150)。150例胸腔积液患者均行闭式胸膜活检术,其中33例结核性胸膜炎,38例恶性肿瘤,闭式胸膜活检术阳性率47.3%(71/150)。闭式胸膜活检术联合胸腔积液细胞学阳性率66.0%(99/150)。51例患者内科胸腔镜检查,其中21例结核性胸膜炎,28例恶性胸腔积液,1例炎性胸腔积液,1例未明确诊断,内科胸腔镜阳性率98.0%(50/51)。恶性胸腔积液组外周血CEA、胸腔积液CEA、胸腔积液CEA/血CEA比值高于结核性胸腔积液组,差异有统计学意义(P<0.001);结核性胸腔积液组ADA高于恶性胸腔积液组,差异有统计学意义(P<0.001)。闭式胸膜活检术和内科胸腔镜检查均未发生严重并发症。结论 对于原因不明的渗出性胸腔积液,胸腔积液细胞学和胸膜活检应作为常规诊断手段;内科胸腔镜作为补充,提高诊断阳性率。Objective To observe the diagnostic value of medical thoracoscopy combined with closed pleural biopsy in unexplained pleural effusion.Methods From June 2016 to June 2019,150 patients with pleural effusion underwent closed pleural biopsy in Suqian First People′s Hospital in Jiangsu Province,cytological examination of pleural effusion,and those who could not be diagnosed definitely underwent medical thoracoscopy.Results Tumor cells were found in 44 of 150 patients with pleural effusion,among which the number of cancer cells in 3 patients was too small to identify the pathological type.The positive rate of cytology in pleural effusion was 27.3%(41/150).All 150 patients with pleural effusion underwent closed pleural biopsy,of which 33 were tuberculous pleuritis and 38 were malignant tumors.The positive rate of closed pleural biopsy was 47.3%(71/150).The positive rate of closed pleural biopsy combined with pleural effusion cytology was 66.0%(99/150).51 patients underwent medical thoracoscopy,among which 21 were tuberculous pleurisy,28 were malignant pleural effusion,1 was inflammatory pleural effusion and 1 was not diagnosed definitely.The positive rate of medical thoracoscopy was 98.0%(50/51).The ratio of Peripheral blood CEA,pleural effusion CEA and pleural effusion CEA/blood CEA in malignant pleural effusion group was higher than that in tuberculous pleural effusion group,and the difference was statistically significant(P<0.001).ADA in tuberculous pleural effusion group was higher than that in malignant group,the difference was statistically significant(P<0.001).No serious complications occurred in closed pleural biopsy and medical thoracoscopy.Conclusion For exudative pleural effusion of unknown cause,pleural effusion cytology and pleural biopsy should be routine diagnostic methods.Medical thoracoscopy as a supplement to improve the positive rate of diagnosis.

关 键 词：内科胸腔镜 闭式胸膜活检术 胸腔积液细胞学 不明原因胸腔积液 

分 类 号：R561.3[医药卫生—呼吸系统]