纤支镜替代胸腔镜对诊断原因不明胸水的价值

目的：探讨纤维支气管镜代替胸腔镜对原因不明胸腔积液（胸水）病因的诊断价值。方法：在局麻下用纤支镜行开放式胸腔检查术，可全面检查胸膜腔和肺，并取活检。结果：25例病因诊断不明的胸水中，23例确诊，确诊率为92%。其中胸膜间皮瘤2例，肺癌胸膜转移16例，乳腺癌胸膜转移3例，胸膜结核2例。结论：局麻下用纤支镜代替胸腔镜检查创伤小，诊断率高，操作简便、安全，并发症少，值得临床推广应用。     

278例胸腔积液患者行胸腔镜手术后的观察与护理

胸腔积液的病因最多见为结核和肿瘤引起,胸水细胞学检查和针刺胸膜活检一直是诊断胸腔积液的主要手段,但阳性率很低.我科对278例原因不明的胸腔积液患者,在局麻下行胸腔镜手术,在胸腔镜下取活检,且无严重并发症发生,取得满意效果.     

结核性胸腔积液54例胸腔镜检查及临床分析

报告结核性胸腔积液54例的临床表现、胸腔镜所见及病理检查结果。胸腔镜直视下胸膜病变可分为3型：（A）结核结节型34例，组织学全部阳性；（B）炎症型14例，组织学阳性率78．5％（11／14）；（C）胸膜肥厚粘连型6例，组织学阳性率4／6例。总阳性率90．7％（49／54）。对结核性胸腔积液的诊断和发病机理进行了讨论，根据多数病例胸膜上有特征性结核结节以及组织学检查的特异性发现，认为可能结核菌直接侵及胸膜比过敏反应在发病机理中起更重要的作用。     

胸膜活检术在胸腔积液中的诊断价值

目的：观察胸膜活检术在胸腔积液诊断中的价值。方法：对135例胸腔积液患者行胸膜活检，同时取胸水及痰送检抗酸杆菌及癌细胞。结果：135例胸膜活检第一次活检成功率96．3％，特异性病理诊断92例，病理诊断阳性率68．1％、恶性胸腔积液胸膜活检阳性率65．3％，胸水细胞学捡查阳性率13．3％，痰找癌细胞阳性率6．7％。结核性胸腔积液胸膜活检阳性率71．7％，胸水找抗酸杆菌阳性率1．7％，痰找抗酸杆菌阳性率3．3％。结论：胸膜活检术是一项安全、简单、有效的明确胸膜疾病的手段，对不明原因的胸腔积液，可提高在恶性胸腔积液中的诊断阳性率，是结核性胸膜炎重要的确诊手段.     

胸部外伤328例治疗体会

目的．分析胸部外伤患者的临床特点和治疗。方法对328例胸部外伤患者的致伤原因、损伤类型及治疗方法进行回顾性分析。结果致伤原因以交通事故、锐器伤及高处坠落伤为主（86．6％）;损伤类型主要表现肋骨骨折（69．2％）,合并肺挫伤及血气胸;全组以非手术及胸腔闭式引流治疗为主（79．3％）,治愈319例（97．3％）,死亡9例（2．7％）。结论大部分胸部外伤经非手术及胸腔闭式引流治疗可治愈;电视胸腔镜（VATS）手术创伤小并可及时明确诊断,应早期选用;及早有效治疗多脏器复合伤、连枷胸、肺挫伤以及急性呼吸窘迫综合征等严重并发症,能提高严重胸部外伤患者的生存几率。     

56例胸腔积液病因误诊分析

目的探讨胸腔积液误诊原因。方法随机对327例胸腔积液病人中56例病因不明者行误诊原因分析。结果56例中,结核性胸膜炎37例,恶性胸腔积液16例,待诊3例;其中右侧胸腔积液25例,左侧胸腔积液22例,双侧胸腔积液9例。结论在仔细询问病史的基础上,除对胸水做常规检查外,同时应做生化免疫、细胞病理学及病原学检查,结合胸部影像学特征进行综合分析,判明胸水病因。     

两种引流方法辅助治疗结核性胸腔积液疗效观察

目的：观察比较闭式引流和常规胸腔穿刺引流辅助治疗结核性胸腔积液的疗效。方法：选择结核性渗出性胸膜炎中等量以上胸腔积液200例,随机分为闭式引流组102例与胸腔穿刺引流组98例。两组均采用同一短程化疗方案。闭式引流组采用中心静脉导管接延长管及负压引流袋,使胸腔积液自然流出,经超声检查证实积液消失后拔管;胸腔穿刺引流组采用常规穿刺方法,反复穿刺抽液,超声证实胸腔积液深度〈2．0cm时停止抽液。观察两组有效率,并比较并发症发生情况、胸腔积液消失时间、住院时间及排液相关费用等情况。结果：闭式引流组总有效率86．3％,非常显著高于胸腔穿刺组的64．3％（P〈0．01）。闭式引流组胸膜肥厚粘连发生率及总并发症发生率均非常显著低于胸腔穿刺组（P〈0．01）;闭式引流组穿刺次数、胸腔积液消失时间、平均住院时间及排液相关费用均显著或非常显著少（短）于胸腔穿刺组（P〈0．05,P〈0．01）。结论：闭式引流辅助治疗结核性胸腔积液疗效优于常规胸腔穿刺引流。     

118例恶性肿瘤胸腔积液细胞学检查结果分析

目的：为探讨对胸腔积液细胞学检查结果，提高阳性检出率，及时做出正确的诊断。方法：对我院病因不明的439例胸腔积液进行了细胞学检查。结果：共查出恶性肿瘤118例，阳性检出率为：26．88％。     

118例恶性肿瘤胸腔积液细胞学检查结果分析

目的：为探讨对胸腔积液细胞学检查结果，提高阳性检出率，及时做出正确的诊断。方法：对我院病因不明的439例胸腔积液进行了细胞学检查。结果：共查出恶性肿瘤118例，阳性检出率为：26．88％。     

不伴肝硬化的病毒性肝炎相关性胸腔积液的临床特点

 目的 探讨不伴肝硬化的病毒性肝炎相关胸腔积液的临床特点。方法 回顾性分析2003-01至2018-03在北京积水潭医院收治的不伴肝硬化的病毒性肝炎合并胸腔积液患者的临床资料,包括生命体征、血生化及微生物学检查,胸部影像学检查,胸腔积液的生化、常规、微生物学检查,行胸腔镜检查的患者,以及病理学检查结果。结果 共有132例病毒性肝炎合并胸腔积液病例入选,排除因心、肺、肾等脏器病变,以及肝硬化、结核、肿瘤、风湿等引起的胸腔积液后,剩余6例。胸腔积液为渗出液,单侧或双侧,少量至中量。其中2例行胸腔镜检查,壁层胸膜纤维素性渗出、局部充血,少量粘连。壁层胸膜病理检查发现:纤维细胞和纤维母细胞增生,被覆纤维素性渗出及坏死;有散在的淋巴细胞浸润;大片新鲜和陈旧性出血。结论 未出现肝硬化和低蛋白血症的病毒性肝炎也可引起胸腔积液。病毒性肝炎治愈或好转后,胸腔积液可以吸收或好转。     

Diagnostic thoracoscopy

Diagnostic thoracoscopy in patients with pleural effusion of unclear origin mostly provides the correct diagnosis. Results from published reports of previous researches are not uniform. In 47 male and 20 female patients with pleural effusion of unknown etiology, after receiving negative results obtained from cytological finding of pleural effusion and percutaneous needle biopsy, thoracoscopy with biopsy of one or both pleurae was performed. Procedure was done in local anesthesia using Stortz rigid thoracoscope. In 37 patients with malignant disease (primary or metastatic) diagnosis was confirmed histopathologically in 31 patient (81.12%). In 27 patients with inflammatory pleural disease diagnosis was confirmed histopathologically in 22 patients (81.4%). Among 11 patients with specific pleural effusions, tuberculosis was confirmed in 10 (90.91%). Normal finding in cases of spontaneous pneumothorax and pulmonary embolism was taken as a positive result. Total number of positive findings was 55 (82.10%). In one patient, the third spontaneous pneumothorax was the indication for thoracoscopy, and after numerous bullae were seen during the procedure, talcum powder pleurodesis was done. In four patients low intensity subcutaneous emphysema occurred one day after thoracoscopy. It can be concluded that thoracoscopy in local anesthesia out of the operating room is good and practical method for solving the unclear pleural effusions, with neglectable rate of complications.     

血管内皮生长因子、癌胚抗原及端粒酶联合检测对良恶性胸腔积液的鉴别诊断价值

目的 探索胸腔积液中血管内皮生长因子（vascular endothelial growth factor,VEGF）、癌胚抗原（carcinoembryonic antigen,CEA）及端粒酶单项和联合检测在良恶性胸腔积液中的诊断价值.方法 选取70例胸腔积液患者,包括恶性胸腔积液34例,良性胸腔积液36例.采用ELISA法检测VEGF和CEA在两组病例胸腔积液中的表达,端粒酶的表达采用PCR-ELISA法检测.结果 VEGF、CEA及端粒酶在恶性胸腔积液患者组中的表达明显高于良性组（P＜0.05）;在单项检测中,VEGF的敏感性最高73.53％,其阳性预测值最高83.33％;CEA的特异性最高88.88％;联合检测中VEGF＋ CEA的敏感性最高91.17％,CEA＋端粒酶的特异性低于VEGF＋CEA和VEGF＋端粒酶.结论 VEGF、CEA及端粒酶在良恶性胸腔积液的鉴别诊断中具有较高价值,联合检测可提高诊断的敏感性.     

Thoracic computed tomography in patients with suspected malignant pleural effusions

AIM: To assess the role of contrast-enhanced computed tomography (CT) prospectively in patients with suspected malignant pleural effusions.MATERIALS AND METHODS: Forty consecutive patients referred for the investigation of a suspected malignant pleural effusion had contrast-enhanced thoracic CT, thoracoscopy, thoraco-centesis and pleural biopsy, either percutaneously or at thoracoscopy. Final diagnoses were based on histopathological or cytological analysis (n = 30), autopsy findings (n = 3) or clinical follow-up (n = 7). The pleural surfaces were classified at contrast-enhanced CT as normal or abnormal and, if abnormal, as benign or malignant in appearance using previously established CT criteria for malignant pleural thickening by two observers unaware of the pathological diagnosis.RESULTS: Pleural effusions were malignant in 32 patients and benign in eight patients. Pleural surfaces assessed at CT showed features of malignancy in 27 out of 32 patients with a malignant effusion (sensitivity 84%, specificity 100%). Overall, CT appearances indicated the presence of malignancy in 28 of 32 (87%) patients. All eight patients with benign pleural disease were correctly diagnosed by CT.CONCLUSION: Contrast-enhanced CT is of value in patients with suspected malignant pleural effusions. The previously established criteria for malignant pleural thickening of nodularity, irregularity and pleural thickness >1 cm are reliable in the presence of a pleural effusion.     

Feasibility of CT-Guided Percutaneous Needle Biopsy in Early Diagnosis of BOOP

Bronchiolitis obliterans organizing pneumonia (BOOP) is a nonneoplastic, noninfectious lung disease with a diverse spectrum of imaging abnormalities and nonspecific symptoms diagnosed by open lung biopsy, transbroncial biopsy, and/or video-assisted thoracoscopy. The objective of this study was to retrospectively assess the role of percutaneous computed tomography (CT)-guided biopsy in early diagnosis of the disorder. Fourteen BOOP cases diagnosed by CT-guided biopsy were analyzed in terms of imaging abnormalities and complication rate. All had previously undergone a nondiagnostic procedure (bronchoscopy, transbronchial biopsy, bronchoalveolar lavage) to exclude infection or lung cancer. The most common imaging abnormalities in descending order were bilateral consolidations (5/14), unilateral tumor-like lesions (5/14), unilateral consolidations (3/14), and diffuse reticular pattern (1/14). Coexistent abnormalities (pleural effusions, nodules, ground-glass opacities) were observed in five patients. The complication rate was 4 of 14 (28.6%), including 2 cases of subclinical pneumothorax and 1 case of minor hemoptysis and local lung injury. None required intervention. We conclude that transthoracic CT-guided biopsy may be used in the diagnosis of BOOP in selected patients with mild complications. For the focal consolidation nodule/mass imaging pattern, CT-guided biopsy may prove to be a reasonable alternative to more invasive procedures.     

联合检测胸水ADA、CEA、CA125、CA153在结核性与恶性胸水中的鉴别诊断价值

目的探讨联合检测胸水ADA、CEA、CA125、CA153对结核性与恶性胸水的鉴别诊断价值。方法收集114例已确诊胸腔积液患者的胸水,其中恶性组胸水64例,结核性胸水50例,检测两组患者胸水ADA、CEA、CA125、CA153水平。结果恶性组ADA明显低于结核组,而CEA、CA125、CA153水平明显高于结核组,两者差异显著。具有统计学意义。CEA、CA125、CA153对恶性胸水诊断的敏感性分别为73-4％、81．2％、43．8％,特异性分别为84．0％、46．0％、88．0％．准确性分别为79．8％、63．2％、66．7％,三项联合检测可显著提高诊断敏感性（93．4％）。ADA对结核性胸水的敏感性、特异性、准确性分别为83．4％、91．5％、87．6％。结论联合检测胸水ADA、CEA、CA125、CA153有助于结核性与恶性胸水的鉴别诊断。     

电视胸腔镜治疗恶性胸腔积液（附26例分析）

目的：总结电视胸腔镜治疗恶性胸腔积液的临床经验。方法：纳入电视胸腔镜治疗恶性胸腔积液26例,全麻下通过胸腔镜吸除积液,后喷洒无菌滑石粉形成胸膜固定。结果：电视胸腔镜术后患者生活质量明显改善,有效率100%。26例患者除1例术后2个月因肿瘤脑转移死亡外,余25例患者生存期均超过6个月。获得了良好的治疗效果。结论：电视胸腔镜治疗恶性胸腔积液是一种微创、有效、实用的治疗方法。     

超声导引下艾迪注射液及顺铂联合应用治疗恶性胸腔积液

目的:比较艾迪注射液和顺铂及两者联用对恶性胸腔积液的治疗作用。方法:自2003年10月~2008年5月我院肿瘤科收治恶性胸腔积液患者149例,随机分为A、B、C 3组,3组均超声引导下介入穿刺置入中心静脉导管,充分引流后,A组51例,胸腔注入艾迪注射液和顺铂;B组49例,胸腔内注入顺铂;C组49例胸腔内注入艾迪注射液。均每周1次,治疗1~4次不等。结果:有效率(RR),A、B、C 3组分别为:82.4%、49%、55%,A组高于C组和B组,差异具有统计学意义(P<0.05)。生存质量KPS评分有效率:A组高于C组和B组(P<0.05)。毒性评价(Ⅱ级以上):B组>A组>C组。三组两两比较差异有统计学意义(P<0.05)。结论:艾迪注射液联合顺铂疗效优于单用顺铂或艾迪注射液,艾迪注射液优于顺铂。     

胸膜结核瘤的CT诊断

目的 探讨胸膜结核瘤的CT特征,提高该病的影像诊断水平.方法 回顾性分析经病理及临床证实的8例胸膜结核瘤的CT资料.结果 8例均有或曾有过胸膜炎病史,单发胸膜结核瘤4例,多发4例,共16枚病灶,多数(10/16)位于右下胸腔;CT表现为自胸膜凸向肺野的“D”字形、椭圆形、乳头状、圆形软组织密度影,与胸膜多呈宽基底相交,边缘光滑,多数密度均匀;增强后多数(10/16)呈环形强化,部分(3/16)呈脏层胸膜缘弧线状强化,少数(2/16)均匀强化,病灶基底部胸膜移行性增厚强化,形成“胸膜尾征”;6例伴有肺内结核,3例伴有胸腔积液,4例伴有胸膜钙化.结论 胸膜结核瘤的CT表现具有一定的特征,结合临床病史,多可作出明确诊断.     

Pleural effusions associated with acute pancreatitis: Incidence and appearance based on computed tomography

Recognition of pleural effusions in acute pancreatitis is important since it carries prognostic implications. This study evaluates the incidence and characteristics of pleural effusions on computed tomography (CT) of patients with mainly an alcohol ingestion etiology of acute pancreatitis. A review of medical records and abdominal CT scans in 50 patients with clinical and laboratory evidence of acute pancreatitis was carried out. All patients were referred for abdominal CT scanning based on an initial clinical presentation consistent with acute pancreatitis and had confirmatory elevation of the corresponding serum enzyme levels. The presence, laterality, and size of any pleural effusions were recorded from the initial sections through the lung bases.Based on a review of medical records, 36 patients (72%) had an alcohol-related etiology of acute pancreatitis.Overall, 10 patients (20%) with acute pancreatitis had pleural effusions on abdominal CT imaging. Five of the effusions were bilateral, three were unilateral right sided, and two were unilateral left sided. Nine of the effusions were small (<1 cm in maximal height) or medium (1–2 cm) in size.Small and medium-sized pleural effusions are not uncommon in acute pancreatitis. The higher incidence in this study compared to that in earlier reports likely represents the increased sensitivity of cross-sectional imaging for small amounts of pleural fluid. The absence of left-sided effusion predominance in our study group is contrary to much of the earlier literature and may reflect demographic factors, such as etiology and previous history of pancreatitis, although statistical variability must also be considered.     

ANCA阳性小血管炎的胸部高分辨率CT表现

目的：探讨ANCA阳性小血管炎（ANCA-associated small vessel vasculitis,AASV）的肺部高分辨率CT（HRCT）的影像学表现。方法：搜集26例经临床证实的ANCA阳性小血管炎的胸部HRCT资料,对其HRCT表现进行回顾性分析。结果：AASV的主要表现包括：①间质性改变：主要为网状改变,不规则网状改变17例（65.4%）、结节状网状改变3例（11.5%）,在不规则网状改变中,树冠征阳性较具特点,共7例;其它有小叶间隔增厚22例（84.6%）、磨玻璃影22例（84.6%）、支气管扩张9例（34.6%）、胸膜下线7例（26.9%）。囊状改变：葡萄串样2例（7.7%）、串珠样13例（50%）、蜂窝样9例（34.6%）,囊内小叶核心征阳性较具特点,共13例（50%）;②肺泡改变：其中弥漫渗出较具特点,共8例（30.8%）,局部渗出1例（3.8%）、空气捕捉征3例（11.5%）、树芽征1例（3.8%）、实变灶3例（11.5%）;③结节改变：均为散发,共10例（38.5%）;④其它影像学改变：包括条索影22例（84.6%）,斑片影12例（46.1%）、钙化灶（近胸膜下）3例（11.5%）、胸膜增厚17例（65.4%）,结节状叶间胸膜增厚较具特点,共5例（19.2%）,肺不张4例（15.4%）、纵隔、腋下淋巴结显示25例（96.2%）;肿大4例（15.4%）、胸腔积液7例（26.9%）、心包积液4例（15.4%）、肺动脉高压3例（11.5%）;⑤10位患者随访结果：无变化3例、加重5例,减轻2例。结论：HRCT可提供ANCA阳性小血管炎胸部病变的众多信息,对ANCA阳性小血管炎诊疗有重要参考价值。