可弯曲内科胸腔镜对结核性胸腔积液与恶性胸腔积液的诊断价值及其表现特征分析  

Application value of flexible medical thoracoscopy in the treatment of unexplained pleural effusion and analysis of the characteristics of malignant pleural effusion under endoscopy

作　　者：朱俞俊 黎萍 梁秋红 ZHU Yujun;LI Ping;LIANG Qiuhong(Department of Respiratory and Critical Care Medicine,Yichun People′s Hospital,Jiangxi Province,Yichun 336000,China)

机构地区：[1]江西省宜春市人民医院呼吸与危重症医学科,江西宜春336000

出　　处：《中国当代医药》2022年第17期44-47,F0003,共5页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(SKJP220219194);江西省宜春市科技计划项目(JXYC2019KSC015)。

摘　　要：目的探讨可弯曲内科胸腔镜对结核性胸腔积液与恶性胸腔积液的诊断价值及其表现特征。方法选取2017年6月至2020年6月宜春市人民医院收治的58例胸腔积液患者为研究对象,均行可弯曲内科胸腔镜检查。以最终临床诊断结果为“金标准”,分析可弯曲内科胸腔镜诊断胸腔积液价值,对比结核性胸腔积液、恶性胸腔积液镜下表现及安全性。结果58例患者经可弯曲内科胸腔镜检查确诊57例,误诊1例,结核性胸腔积液37例,恶性胸腔积液20例;经最终临床诊断显示,恶性胸腔积液20例,结核性胸腔积液38例。可弯曲内科胸腔镜诊断标准胸腔积液的敏感度为100.00%(20/20),特异度为97.37%(37/38),准确率为98.28%(57/58),阳性预测值为95.24%(20/21),阴性预测值为100.00%(37/37);胸腔镜下结核性胸腔积液主要表现为血性胸水多发大结节、胸膜充血水肿、结节样新生物、纤维素样粘连、干酪样坏死改变、包裹性积液;恶性胸腔积液主要表现为血性胸水多发大结节、胸膜充血水肿、纤维素样粘连、结节样新生物。结核性胸腔积液组血性胸水多发大结节、胸膜充血水肿、纤维素样粘连、包裹性积液、干酪样坏死改变、大小一致小结节比例高于恶性胸腔积液组,结节样新生物、增生增厚、大小不等结节、白斑样改变、肿块比例低于恶性胸腔积液组,差异有统计学意义(P<0.05)。58例患者术中出现剧烈胸痛1例(1.67%),呼吸困难1例(1.67%),一过性心动过速6例(10.00%),给予心理疏导后症状均获得缓解,继续完成检查。术后出现皮下气肿3例(5.00%),切口疼痛12例(20.00%),低热3例(5.00%),术后为给予特殊处理均自行缓解。结论可弯曲内科胸腔镜可准确鉴别胸腔积液病因,恶性胸腔积液、结核性胸腔积液镜下表现特征差异明显,且安全性较高。Objective To investigate the effect of flexible medical thoracoscopy in the diagnosis of unexplained pleural effusion and the characteristics of malignant pleural effusion.Methods From June 2017 to June 2020,58 patients with unexplained pleural effusion in Yichun People′s Hospital were selected as the research objects,and all patients underwent flexible medical thoracoscopy.The results of thoracoscopic examination were analyzed,and the differences between tuberculous pleural effusion and malignant pleural effusion were compared.Results A total of 57 cases of 58 patients were diagnosed by flexible medical thoracoscopy,1 case was misdiagnosed,there were 20 cases of malignant pleural effusion,37 cases of tuberculous pleurisy.The sensitivity of the standard pleural effusion was 100.00%(20/20),specificity of 97.37%(37/38),accuracy of 98.28%(57/58),positive predictive value of 95.24%(20/21)and negative predictive value of 100.00%(37/37).The main manifestations of tuberculous pleural effusion under thoracoscopy were white miliary nodules,pleural congestion and edema,nodular neobiotics,cellulose like adhesion,caseous necrosis and encapsulation;the main manifestations of malignant pleural effusion were white miliary nodules,pleural congestion and edema,cellulose like adhesions and nodular new organisms.The proportions of white miliary nodules,pleural congestion and edema,cellulose like adhesion,encapsulated effusion and caseous necrosis in tuberculous pleural effusion group were higher than those in malignant pleural effusion group,and the proportions of nodular neoplasms,hyper plasia and thickening,nodules of different sizes,leukoplakia-like changes,and masses were lower than those in malignant pleural effusion group,the differences were statistically significant(P<0.05).Among the 58 patients,1 patient(1.67%)had severe chest pain,1 patient(1.67%)had dyspnea,and 6 patients(10.00%)had transient tachycardia during the operation.All the symptoms were relieved after psychological counseling,and the examination was continued

关 键 词：胸腔积液 可弯曲内科胸腔镜 结核性胸腔积液 诊断 

分 类 号：R561[医药卫生—呼吸系统]