自制抗粘连合剂治疗结核性胸腔积液12例

由于结核性胸腔积液的常规治疗方法不能有效地控制纤维蛋白原含量 ,常导致腔内形成多处包裹分隔或机化 ,引起胸膜脏层和壁层纤维素性粘连、肥厚 ,严重者须行胸膜剥离。为此 ,我们应用自制抗粘连合剂 ,对结核性胸腔积液 12例行胸腔内注射 ,疗效满意。1　临床资料1 1　一般情况　男 8例 ,女 4例 ;年龄 17～ 68岁 ,平均 3 6岁。胸腔积液中等量 9例 ,大量 3例 ,均为单侧。纤维蛋白原平均 110ｍｇ/Ｌ。经Ｘ线胸片及Ｂ超示 :大、中量胸腔积液 ,均经实验室检查及病史证实为结核性胸腔积液 ,均无呼吸困难 ,并排除血液病及肝、肾功能障碍。1 2　治疗…     

可弯曲内科胸腔镜对不明原因胸腔积液的诊断价值

目的探讨可弯曲内科胸腔镜技术对不明原因胸腔积液的诊断价值。方法对所有经过相关影像学、血生化检查以及胸腔穿刺进行胸水常规、生化、微生物学、细胞学、胸膜病理学等检查,仍不能明确其积液原因的113例患者进行可弯曲内科胸腔镜检查。结果恶性肿瘤48例（42．5％）,结核42例（37．2％）,普通炎症20例（17．7％）,不明原因3例（2．7％）。常见的并发症主要是疼痛,这些并发症均可控制,手术无一例出现严重并发症。结论可弯曲内科胸腔镜检查对不明原因胸腔积液的诊断是一项安全、敏感性和特异性均极高的检查方法,但不应作为首选。     

胸腔积液B超与X线对比分析

胸腔积液在临床上非常多见，但原因很多，按发病机制可分为渗出性和漏出性两种，前者可以是炎性的，从稀薄的浆液性渗出液到稠厚的脓性液体；也可以是胸膜原发或转移性肿瘤所引起的血性胸腔积液，或是因淋巴管或乳糜管阻塞、破裂，使乳糜流入胸腔而形成乳糜性胸水；也可因胸膜损伤引起血胸、血气胸、乳糜胸；漏出性的常是由于心脏病伴右心衰竭、肾脏病变或血浆蛋白过低而引起。此外膈下病变如肝脓肿、原发性肝癌、膈下脓肿、急性胰腺炎等可引起反应性胸腔积液，卵巢纤维瘤时可引起胸腔积液。B超检查能准确定位，估计液体量，指导穿刺及跟踪治疗效果观察．具有简便、有效、准确、无损伤等优点，现将近3年所检查患者声像图与X线对比进行回顾性分析。     

尿激酶胸腔内注射治疗结核性胸腔包裹性积液

胸膜炎性渗出时，由于脏、壁层胸膜粘连，使积液局限于胸腔的某一部位，称为包裹性胸腔积液。一般病程长，治疗效果不甚满意。2000-01～2002—08，我院在超声引导下胸腔内注入尿激酶治疗，取得了较满意疗效。     

胆固醇性胸膜腔积液的X线特征（附6例报告并文献复习）

目的探讨胆固醇性胸腔积液的X线特征及诊断要点。方法回顾性分析经检查胸水证实为胆固醇性胸腔积液6例患者的X线胸片。结果6例均为左侧大量胸腔积液,压片检查均见典型胆固醇结晶。4例X胸片上可见胸膜呈蛋壳样钙化。1例手术见脏壁层胸膜均有钙化。结论胸膜表面蛋壳样钙化是本病的X线特征。确诊需做胸水检验。     

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.     

关于包裹性胸腔积液分型的商榷

教科书中包裹性胸腔积液的定义是 :胸膜炎时 ,特别是化脓性胸膜炎时 ,壁层胸膜和脏层胸膜发生粘连 ,将积液局限在胸腔的某个部位。但关于包裹的程度分类没有说明。本人通过对普通Ｘ线观察 ,根据包裹的程度、范围、部位 ,将包裹性胸腔积液分为 3类 :即完全性、不完全性、叶间纵隔性。这样分型能给临床医师穿刺定位提供准确的资料 ,现将分型予以说明。完全性的包裹性胸腔积液[1 ,3]工作中常遇到肺底包裹性积液、侧胸壁包裹性积液和前后壁的包裹性胸腔积液。只要在胸部透视时摆一下体位 ,如 :肺底积液时 ,横隔升高 ,最高点在外侧 1 / 3处。膈面…     

HRCT在检出恶性胸腔积液中胸膜病变的价值

目的 探讨HRCT检出恶性胸腔积液中胸膜病变的价值.方法 回顾分析恶性胸腔积液合并胸膜病变患者40例,复习恶性胸腔积液中胸膜病变的HRCT影像学表现.结果 本组40例患者CT平扫显示胸腔大量积液者12例,中等量或少量积液者28例.CT增强扫描,胸膜病变明显强化,主要表现为结节状强化.结论 HRCT主要用于肺部弥漫性病变的检出,通过本组病例发现HRCT对于检出恶性胸腔积液中的胸膜病变亦有较高价值.     

碘伏胸腔内冲洗治疗结核性胸腔积液疗效观察

目的探讨经留置导管,应用碘伏胸腔冲洗治疗结核性胸腔积液的方法、机制及疗效。方法首先通过内科胸腔镜检查,并离断胸膜粘连带及包裹分隔的胸腔积液,抽净胸水,应用0．5％碘伏冲洗,用以根除胸腔内结核菌感染,常规抗结核治疗,随诊1年,观察有无复发及胸膜肥厚情况。结果①22例常规胸穿抽液加抗结核治疗,10例病情好转,胸水消失时间25．8±6．3天（x^-±s,下同）,1年后胸膜明显肥厚,12例治疗半个月无效,转用胸腔镜治疗,胸水消失时间6．2±2．6天,1年无明显胸膜肥厚;②22例直接采用胸腔镜加抗结核治疗,胸水消失时间为4．8±2．6天,明显短于单纯胸穿组（P〈0．05）,1年后无明显胸膜肥厚。结论先经内科胸腔镜局部用药治疗,后应用碘伏胸腔内冲洗治疗结核性大量胸腔积液,疗效确切,简单方便实用,可有效避免或减轻胸膜肥厚。     

人工气胸CT检查诊断胸膜转移瘤的价值

目的　评价人工气胸CT检查在诊断胸膜转移瘤中的价值。方法　对常规CT检查除胸水外未见胸膜异常的 14例血性胸腔积液的病例采用了穿刺抽液人工气胸后CT检查的方法。结果　 14例中 6例病人在脏层和 /或壁层胸膜上发现常规CT扫描未能显示的单发或多发结节灶 ,手术和病理证实 3例为周围型肺癌胸膜转移 ,另 3例为乳腺癌胸膜转移。结论　人工气胸CT检查是发现胸膜转移瘤的一种简便易行的方法     

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。     

Malignant solitary fibrous tumor of the pleura: two cases and review of the literature

We present two cases of malignant solitary fibrous tumor of the pleura (MSFT-P) and review 29 reported cases of MSFT-P. In examining the clinical and morphological features and prognosis of MSFT-P, we found that over 90% of the patients had some symptoms and one-third showed local recurrence. Chest radiographs and CT demonstrated large broad-based masses with necrosis, hemorrhage, and pleural effusion. The maximum diameter of the tumors was greater than 10 cm. Pleural effusion was seen in more than 70% of the patients, but there was only one case of pleural dissemination. All of the cases were well demarcated, and this was the most reliable finding for differentiating MSFT-P and malignant mesothelioma.     

良、恶性胸腔积液的CT鉴别诊断

目的评价良、恶性胸腔积液的CT特征性表现.资料与方法回顾性分析38例恶性胸腔积液和56例良性胸腔积液的CT征象.结果良性积液中,双侧占41.1%,胸膜增厚占19.6%,呈弥漫均匀增厚,纵隔胸膜受累占10.7%,胸膜外脂肪层明确显示占71.4%,厚度＞3 mm占41.1%,平均厚度5.7 mm;恶性积液中,双侧占15.8%,胸膜增厚占57.9%,主要呈不规则弥漫或局限性增厚,累及纵隔胸膜占36.8%,胸膜外脂肪层显示占60.5%,＞3 mm占26.3%,平均2.9 mm.结论单侧、大量积液且张力高,胸膜不规则增厚,纵隔胸膜受累对恶性诊断有特异性;而胸膜无或轻度弥漫规则增厚,胸膜外脂肪层增厚多提示良性.     

胸膜肿瘤的X线诊断(附10例报告)

作者报告经手术病理证实的胸膜肿瘤10例,其中胸膜间皮瘤6例,纤维瘤2例,畸胎瘤1例,多发结节型转移瘤1例。文章介绍了这10例胸膜肿瘤的X线表现,并重点讨论了胸膜间皮瘤的发病率、分类、病理、临床、检查方法及X线表现。局限性胸膜间皮瘤表现为与胸膜相连的软组织肿块影;弥漫性胸膜间皮瘤表现为广泛明显的胸膜增厚,呈波浪状,凸凹不平的结节状或片状阴影。胸膜转移瘤可有两种X线表现:胸腔积液型及肿块型。     

Value of sonography in determining the nature of pleural effusion: analysis of 320 cases.

To assess the value of sonography in determining the nature of pleural effusions, we prospectively analyzed the sonographic findings in 320 patients with pleural effusion of various causes (224 with exudates and 96 with transudates). The nature of the effusions was established on the basis of chemical, bacteriologic, and cytologic examination of pleural fluid; pleural biopsy; and clinical follow-up. All patients had high-frequency, real-time sonography performed by one of three sonographers who had no clinical information concerning the patients. The sonographer evaluated the images for internal echogenicity of the effusion, thickness of the pleura, and associated parenchymal lesions of the lung. The images were also printed out and interpreted a second time by the other two sonographers to reach a consensus. Our results showed that the two types of effusions could be distinguished on the basis of sonographic findings. Transudates were anechoic, whereas an anechoic effusion could be either a transudate or an exudate. Pleural effusions with complex septated, complex nonseptated, or homogeneously echogenic patterns were always exudates (p less than .01). Sonographic findings of thickened pleura and associated parenchymal lesions in the lung also were indicative of an exudate (p less than .01). Homogenous echogenic effusions were due to hemorrhagic effusion or empyema. Sonographic evidence of a pleural nodule was a specific finding in patients with a malignant effusion. We conclude that sonography is useful in determining the nature of pleural effusion.     

胸膜原发性肿瘤的影像学诊断(附26例分析)

目的：分析胸膜原发性肿瘤的影像学特点，探讨胸膜原发性肿瘤与肺内肿块鉴别诊断的要点。方法：回顾性分析26例经手术病理证实的原发性胸膜肿瘤的影偈学资料，其中，胸膜间皮瘤20例，胸膜神经鞘瘤4例，神经纤维瘤1例及胸膜纤维脂肪瘤1例。结果：胸膜间皮瘤影偈学表现为3种类型；单发胸膜肿块型，多发胸膜肿块及结节状胸膜增厚型，胸膜积液为主型，单发肿块良，恶性均有，多发性肿块或结节状胸膜增厚伴胸腔积液时，多见于恶性弥漫型胸膜间皮瘤，胸膜神经鞘瘤，神经纤维瘤及胸膜纤维脂肪瘤均具有良性肿瘤的特征。结论：胸膜原发性肿瘤虽无特征性影像学表现，仔细综合分析各种影像学征象特点，对提高本病的诊断具有重要价值。     

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。     

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。     

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.