内科胸腔镜在老年胸腔积液患者68例中的应用

目的：探讨内科胸腔镜在诊断老年不明原因胸腔积液中的价值和安全性研究，对老年不明胸腔积液患者最终病因进行分析。方法采用德国STORZ内科电子胸腔镜对68例老年不明原因胸腔积液患者进行胸腔镜检查，术中对可疑病变部位进行直视下多点活检，明确胸腔积液成因，观察术中术后患者病情变化。结果68例不明原因胸腔积液患者中病理确诊63例，诊断阳性率92．6％，其中结核病26例（38．2％）；恶性肿瘤31例（45．6％）；慢性脓胸3例（4．4％），曲霉菌感染1例（1．5％），活检组织中可见大量曲霉菌菌丝。非特异性炎性改变7例（10．3％），其中2例最终诊断肺血吸虫病伴胸腔积液，另5例原因不明。所有病例均未发生严重并发症。结论老年不明原因胸腔积液患者经内科胸腔镜检查诊断阳性率高、安全、微创、有效，可作为临床常规诊断手段进行推广。老年不明原因胸腔积液患者其首要病因是恶性肿瘤，次要病因为结核。

Application of Medical thoracoscopy on 68 cases of elderly patients with pleural effusions

Objective To evaluate the value and security of the use of medical thoracoscopy in the diagnosis of elderly patients with un‐known pleural effusion and to analyze the finally pathological results .Methods STORZ medical thoracoscopy was used to retrospectively study the 68 patients with unknown pleural effusion .Multiple punch biopsy was taken in the questionable diseased regions under direct vi‐sion .The changes of patients′condition in intraoperative and postoperative ,and the causes of pleural effusion were observed .Results Sixty‐three cases were confirmed in 68 cases of patients with unexplained pleural effusion ,the diagnostic rate was 92 .6% .In all cases ,26 cases (38 .2% ) were tuberculosis ,31 cases (45 .6% ) were malignant tumor ,3 cases (4 .4% ) were chronic pus chest and Aspergillus infection in 1 case(1 .5% ) ,a large number of aspergillus hyphae were found in biopsy tissue .Non‐specific inflammatory changed in 7 cases (10 .3% ) ,in which 2 patients were eventually diagnosed with pleural effusion caused by pulmonary schistosomiasis ,and the rest cases were still un‐known .All cases had no serious complications .Conclusion Medical thoracoscopy have a good effect in diagnosing elderly patients with un‐explained pleural effusion ,which could be easily and safely performed .The primary cause of unexplained pleural effusion in elder patients may be malignant tumor ,followed by tuberculosis .