可弯曲电子内科胸腔镜在不明原因胸腔积液诊断中的应用价值

目的探讨可弯曲电子内科胸腔镜在不明原因胸腔积液诊断中的应用价值。方法采用尖端可弯曲电子内科胸腔镜（LTF-240型）对92例不明原因的胸腔积液患者进行检查,并回顾性分析其临床资料。结果92例患者均成功实施了胸腔镜检查,胸腔镜下病理组织活检确诊恶性肿瘤30例、结核性胸膜炎57例、慢性炎症5例。肿瘤和结核病理结果确诊率为94．6％。恶性胸腔积液主要表现为结节样改变,部分病灶融合成肿块。而结核性胸膜炎主要为胸膜弥漫性充血肿胀,结节病灶细小呈卵石样改变,可见坏死物覆盖。92例胸腔镜检查仅1例出现胸膜反应,无严重并发症发生。结论可弯曲电子内科胸腔镜检查安全、有效、易操作。     

电子支气管镜代内科胸腔镜检查在疑难性胸腔积液诊断中的应用

目的 探讨电子支气管镜代内科胸腔镜检查在疑难性胸腔积液诊断中的应用.方法 回顾性分析52例原因不明胸腔积液患者电子支气管镜代替胸腔镜检查诊断结果及并发症,观察在支气管镜下的胸膜改变,并对可疑组织行病理检查.结果 52例原因不明胸腔积液患者,通过电子支气管镜代内科胸腔镜检查明确诊断48例,未能确诊4例,确诊率为92.31％.结论 电子支气管镜代替胸腔镜检查对不明原因的胸腔积液的病因诊断是一种操作简单、诊断率高、并发症少的检查方法,其具有较高临床应用价值,值得进一步推广使用.     

135例胸腔积液患者内科胸腔镜检查及临床意义

目的探讨内科胸腔镜检查对不明原因胸腔积液患者的临床意义。方法分析内科胸腔镜检查135例患者的临床资料。结果135例中,经胸腔镜胸膜活检确诊104例（77．0％）,其中病理为恶性肿瘤和结核性胸膜炎各51例（49．0％）,脓胸2例（1．9％）。135例胸腔积液患者经胸腔镜检查病因诊断阳性率85．9％。恶性肿瘤和结核性胸膜炎患者经胸腔镜胸膜活检阳性率分别为79．7％和91．1％。结论内科胸腔镜检查对不明原因胸腔积液患者有获得病理诊断、病因诊断及准确肺癌分期等临床意义。     

可弯曲内科胸腔镜术对胸膜疾病的诊治价值

目的探索可弯曲内科电子胸腔镜诊治胸膜疾病的价值及可行性。方法采用Olympus LTF-240型可弯曲内科胸腔镜对114例胸膜疾病患者在局麻下行开放式胸腔镜术，包括诊断组（含不明原因胸腔积液者及肺癌分期诊断者）、气胸组、胸膜固定术组及脓胸组。结果72例不明原因胸腔积液中确诊58例（80．1％），包括胸膜转移癌39例（肺癌胸膜转移38例、食管癌胸膜转移1例），胸膜间皮瘤3例，结核性胸膜炎15例，矽肺累及胸膜1例；未确诊的病例包括12例病理示非特异性炎症、2例胸腔镜检查未见异常。6例肺癌分期诊断者2例证实胸膜转移。13例气胸治愈7例（53，8％），胸膜固定术28例胸水均得到控制，脓胸6例均得到治愈。无1例出现严重并发症。结论可弯曲内科电子胸腔镜术容易耐受、安全、微创、费用低，是诊断疑难胸膜疾病及治疗难治性胸腔积液、脓胸的有效而实用的方法。     

可弯曲式内科胸腔镜在胸腔积液鉴别诊断中的应用

目的探讨可弯盐式内科胸腔镜检查术对良恶性胸腔积液鉴别诊断中的应用价值。方法92例不明原因的胸腔积液患者在局麻下用可弯曲内科胸腔镜检查术,取病变胸膜作病理检查。结果92例中取得病理确诊87例,确诊率94．5％（87／92）。确诊病例中恶性肿瘤46．7％（43／92）,肺癌转移42．4％（39／92）其中腺癌28例,胸膜间皮瘤1．1％（1／92）其他转移癌3．3％（3／92）;良性疾病47．8％（44／92）,结核性胸膜炎40．2％（37／92）,炎症6．5％（6／92）,肝硬化1．1％（1／92）。胸膜无明确病理结果5．4％（5／92）。转移癌、结核性胸膜炎,胸腔镜下形态各异。所有受检病例无严重不良事件发生。结论可弯曲式内科胸腔镜检查术对不明原因胸腔积液鉴别诊断是一种安全、简单、确诊率高的重要诊断方法。     

胸腔镜检查诊断不明原因的胸腔积液临床分析

目的探讨胸腔镜检查对不明原因胸腔积液的诊断价值。方法25例不明原因的胸腔积液患者行胸腔镜检,直视下取病变组织行病理检查。结果镜下表现灰白色粟粒样结节,多发结节状突起,胸膜局灶不规则增厚,胸膜充血、水肿,纤维粘连。胸腔镜检查确诊率92％。确诊病例中恶性肿瘤15例（60％）,其中肺癌转移11例,恶性胸膜间皮瘤4例,良性疾病共8例（32％）,其中结核性胸膜炎7例,慢性炎症1例,无严重并发症。结论胸腔镜检查对不明原因的胸腔积液是一种安全、确诊率高的诊断方法。     

内科胸腔镜对不明原因胸腔积液的诊断价值分析

目的分析内科胸腔镜对不明原因胸腔积液的诊断价值。方法对2012年3月至2015年10月在我院就诊的不明原因胸腔积液患者253例进行内科胸腔镜检查,观察镜下改变,结合病理检查结果进行诊断,观察记录患者并发症发生情况。结果以病理检查结果为准,不明原因胸腔积液患者253例中,经内科胸腔镜检查确诊236例,确诊率为93.28%;其中恶性肿瘤124例,结核性胸膜炎74例,结缔组织疾病伴胸腔积液9例,肺炎旁胸腔积液9例,脓胸3例,乳糜胸1例,非特异炎症16例,未能确诊17例。检查过程中,出现胸腔穿刺出血18例;行病理活检患者均少量出血、出现痛感,但均可以忍受而无需处理;术后23例患者发热38℃左右,对症处理后均在3 d内缓解。结论针对不明原因的胸腔积液患者采用内科胸腔镜检查诊断,确诊率高、安全性好,具有较高的临床应用价值。     

内科胸腔镜对老年患者渗出性胸腔积液的诊断价值及安全性

目的评价局麻下内科胸腔镜对老年患者不明原因渗出性胸腔积液的诊断价值及安全性。方法回顾性分析179例不明原因老年患者渗出性胸腔积液经内科胸腔镜检查的诊断结果及不良反应。结果167例患者明确诊断,诊断率93.3%。恶性胸腔积液99例(55.3%),结核性胸膜炎58例(32.4%);恶性患者年龄大、病程长,胸水多为血性,癌胚抗原水平较高;结核性患者年龄偏小、病程短,胸水多为浅黄色,腺苷脱氨酶水平较高。患者耐受性好,主要不良反应为胸痛。结论老年患者不明原因渗出性胸腔积液多为恶性肿瘤及结核所致,内科胸腔镜检查诊断率高,不良反应少。     

内科胸腔镜在不明原因胸腔积液诊断中的应用

目的 分析内科胸腔镜在不明原因胸腔积液诊断中的价值及其安全性.方法 对我院呼吸内科及重症医学科2010年4月至2013年4月收治的92例不明原因胸腔积液患者行内科胸腔镜检查,观察胸膜病变,直视下病变处多部位活检并行病理检查.结果 92例胸腔积液患者确诊84例,诊断阳性率为91.3％,其中恶性胸腔积液48例,结核性胸腔积液29例,非特异性炎症4例,化脓性胸膜炎2例,结节病1例,病因不明8例,术后疼痛11例,发热3例,出血1例.结论 内科胸腔镜检查有助于进一步明确不明原因胸腔积液的病因,且患者耐受性好、安全、有效,值得临床推广应用.     

可弯曲内科胸腔镜诊断胸腔积液临床应用

目的 探讨可弯曲内科胸腔镜检查术对不明原因胸腔积液的诊断价值.方法 选择天津市海河医院2007年5月至12月行胸腔镜检查术的20例胸腔积液患者,16例胸腔镜直视下取病变组织行病理检查,4例术前已明确诊断.结果 胸腔镜检查术确诊率93.75%(15/16).转移性腺癌8例,转移性鳞癌1例,转移性腺鳞癌1例,恶性胸腔积液来分型1例,结核病4例,恶性胸膜间皮瘤3例,化脓性炎症1例,未确诊1例.镜下表现弥漫性粟粒样结节10例(50%),多发肿块7例(35%),纤维分隔或粘连带形成9例(45%),无严重并发症.结论 可弯曲内科胸腔镜检查术对胸腔积液是一种安全、确诊率高的诊断方法.     

Evolution of semi-rigid thoracoscopy

Pleural effusions despite being so common, there is no much literature available regarding definite diagnosis for pleural effusions. Application of Light's criteria changed the approach to pleural effusion and till date remains a very useful step in the diagnosis of pleural effusions. Pleural fluid biochemistry and adenosine deaminase (ADA) enzyme levels play a significant role in the diagnosis of tubercular effusion. Studies have shown that levels of ADA are more often higher in tubercular effusion than in any other cause for it. But ADA levels can also be elevated in other types of parapneumonic effusions (PPEs), especially complicated PPEs. Hence it is difficult to distinguish a tubercular pleural effusion (TPE) from other PPEs based on pleural fluid ADA levels alone. LDH/ADA ratio as an indicator for ruling out tuberculosis was analyzed in few studies with high sensitivity and specificity. The pleural fluid cytology has a varying sensitivity, with a maximum of only 60% and it may increase with subsequent tapping. Closed pleural biopsy using a Cope or Abrams needle has a sensitivity up to 80% in cases of tuberculous effusion and 40%–73% in cases of Malignancies.Semi-rigid thoracoscopy not only allows for visualization of the pleura but also helps in procuring the biopsies under direct visualization from the abnormal looking areas. In cases of primary pleural malignancies like mesothelioma, pleurodesis can also be done in the same setting after taking the biopsy, hence reducing the number of procedures. Limitation of the semi-rigid thoracoscopy is smaller sample size and more superficial sampling of the pleura. Cryobiopsy and Electrocautery guided pleural biopsy using the IT knife are the modifications in the semi-rigid thoracoscopy to overcome the drawback of smaller sample size. While navigation band image guided pleuroscopy helps in better visualization of the vasculature of pleura during the biopsy.Management of pleural effusions has evolved over a period of time. Starting with a single criterion based on pleural fluid proteins to semi-rigid thoracoscopy. The inexhaustible research in this field suggests the desperate need for a gold standard procedure with cost effectiveness in the management of undiagnosed pleural effusions. Semi-rigid thoracoscopy has revolutionized the management of undiagnosed pleural effusions, but it has its own limitations. Various modifications have been proposed and tried to overcome the limitations to make it a cost-effective procedure.     

Investigation of pleural effusion: comparison between fibreoptic thoracoscopy, needle biopsy and cytology

Twenty-eight patients with exudative pleural effusion have been investigated by fibreoptic thoracoscopy, Abrams needle biopsy and pleural fluid cytology. Sixteen patients had previously had negative pleural biopsies and cytology. Twenty effusions were malignant (16 mesothelioma, four metastatic carcinoma), seven were due to nonspecific inflammation and in one case no abnormality was found. The diagnostic yield for all three techniques combined was 85%, for thoracoscopy alone 65%, Abrams biopsy 60% and cytology 45%. In 12 patients presenting without previous investigation all eight malignant effusions were correctly diagnosed by at least one of the techniques with individual sensitivities of 75% for thoracoscopy, 63% for Abrams and 38% for cytology. Of the 16 patients who had previously had negative investigations 12 had malignant effusions, nine (75%) of which were diagnosed by a combination of the techniques. In this group, the individual sensitivities were 58% for both thoracoscopy and Abrams and 50% for cytology. A correct diagnosis of malignancy was made by a combination of needle biopsy and cytology in 75% of patients with previous investigations and 88% of those without. Fibreoptic thoracoscopy added only two diagnoses of malignancy to those obtained by Abrams and cytology. The limitations of the technique render it unsuitable for routine investigation of pleural effusions.     

Role of medical thoracoscopy in the diagnosis of pleural effusions

BackgroundMedical thoracoscopy (semi-rigid and rigid thoracoscopy) have revolutionized the management of undiagnosed pleural effusions. Though semi-rigid thoracoscopy has a good diagnostic yield in malignant and tubercular effusions, its role in the management of a complicated pleural effusions is debatable. Hence, rigid thoracoscopy becomes handy in these cases. The present study looked into the role of medical thoracoscopy in the diagnosis of pleural effusions in different conditions.MethodsThis study included all patients who underwent medical thoracoscopy at our center between May-2010 and March-2020. Basic demographics data, type of medical thoracoscopy used, and histopathology details were collected and analyzed.ResultsA total of 373 patients were subjected to medical thoracoscopy (202 semi-rigid thoracoscopy and 171 rigid thoracoscopy). Out of whom 246 (66%) were males, the mean age was 51.9 ± 13.2 years. Diagnosis was achieved in 370 patients with a yield of 99.2%. The diagnostic yield in semi-rigid thoracoscopy was 99.5% with lung malignancy being the most common diagnosis (41%; n = 81), followed by tuberculosis (31%; n = 61). The diagnostic yield in rigid thoracoscopy was 100% in our study. Along with high diagnostic yield, complete drainage and lung expansion was seen in 93.5% (160 out of 171 patients) without requiring a second procedure.ConclusionsSemi-rigid thoracoscopy and rigid thoracoscopy should complement each other in the diagnosis of pleural effusions. Rigid thoracoscopy should be considered as the procedure of choice in a complicated pleural effusion.     

Malignant pleural mesothelioma in the southwestern part of The Netherlands

This report is the result of an analysis of the medical records of 124 patients presenting with a malignant pleural mesothelioma. Information about asbestos exposure was available in 104 of them, which appeared to be positive in 95 (91%). The median duration of exposure was 34 yrs. The median latent period was 41 yrs. The median survival was 11 months while different ways of treatment could not prolong survival. The most common radiologic findings were pleural effusions, while in some patients contralateral effusions or pleural thickening was found. Pleural plaques or asbestosis were seen in a minority of the patients. In this series a relatively high percentage of mixed type mesotheliomas was found (56%). Large biopsies will often show both epithelial and connective tissue type elements. Concerning diagnostic procedures we recommend beginning with cytology of pleural fluid, which can easily be obtained together with an Abrams biopsy. If this does not give a definite diagnosis thoracoscopy or thoracotomy will be indicated.     

内科胸腔镜对老年人原因不明胸腔积液的诊断价值

目的 研究内科胸腔镜在老年人原因不明胸腔积液诊断方面的价值,评估其安全性.方法 筛选通过胸水检查及其他临床情况综合判断,不能明确病因的渗出性胸腔积液且年龄≥65岁的患者,对其行内科胸腔镜检查.结果 49例患者中男性33例,女性16例,年龄65～82岁,平均70.5岁.单侧胸腔积液41例(83.7%),双侧胸腔积液8例(16.3%).病理确诊结核性胸膜炎14例(28.6%),恶性肿瘤8例(16.3%),未明确诊断者包括病理报告非特异性炎症12例(24.5%)、间皮细胞及组织细胞增生4例(8.2%)、另外11例(22.4%)包括镜下脏壁层胸膜正常未取活检及未成功手术者.结合临床资料,在这27例中8例(16.3%)明确为感染性,19例(38.8%)原因不明.胸腔镜检查对临床原因不明胸腔积液诊断率为61.2%.本组胸腔镜检查术后出现发热8例(16.3%),大面积皮下气肿7例(14.3%),1例(2.0%)包裹性胸腔积液在人造气胸过程中出现严重胸膜反应.上述并发症经治疗后均痊愈.结论 内科胸腔镜检查对老年人原因不明胸腔积液明确诊断有较大的临床价值.并发症发生率较既往未按年龄分组的研究所报道的数据略高.     

内科胸腔镜对老年人原因不明胸腔积液的诊断价值

目的 研究内科胸腔镜在老年人原因不明胸腔积液诊断方面的价值,评估其安全性.方法 筛选通过胸水检查及其他临床情况综合判断,不能明确病因的渗出性胸腔积液且年龄≥65岁的患者,对其行内科胸腔镜检查.结果 49例患者中男性33例,女性16例,年龄65～82岁,平均70.5岁.单侧胸腔积液41例(83.7%),双侧胸腔积液8例(16.3%).病理确诊结核性胸膜炎14例(28.6%),恶性肿瘤8例(16.3%),未明确诊断者包括病理报告非特异性炎症12例(24.5%)、间皮细胞及组织细胞增生4例(8.2%)、另外11例(22.4%)包括镜下脏壁层胸膜正常未取活检及未成功手术者.结合临床资料,在这27例中8例(16.3%)明确为感染性,19例(38.8%)原因不明.胸腔镜检查对临床原因不明胸腔积液诊断率为61.2%.本组胸腔镜检查术后出现发热8例(16.3%),大面积皮下气肿7例(14.3%),1例(2.0%)包裹性胸腔积液在人造气胸过程中出现严重胸膜反应.上述并发症经治疗后均痊愈.结论 内科胸腔镜检查对老年人原因不明胸腔积液明确诊断有较大的临床价值.并发症发生率较既往未按年龄分组的研究所报道的数据略高.     

内科胸腔镜对老年人原因不明胸腔积液的诊断价值

目的 研究内科胸腔镜在老年人原因不明胸腔积液诊断方面的价值,评估其安全性.方法 筛选通过胸水检查及其他临床情况综合判断,不能明确病因的渗出性胸腔积液且年龄≥65岁的患者,对其行内科胸腔镜检查.结果 49例患者中男性33例,女性16例,年龄65～82岁,平均70.5岁.单侧胸腔积液41例(83.7%),双侧胸腔积液8例(16.3%).病理确诊结核性胸膜炎14例(28.6%),恶性肿瘤8例(16.3%),未明确诊断者包括病理报告非特异性炎症12例(24.5%)、间皮细胞及组织细胞增生4例(8.2%)、另外11例(22.4%)包括镜下脏壁层胸膜正常未取活检及未成功手术者.结合临床资料,在这27例中8例(16.3%)明确为感染性,19例(38.8%)原因不明.胸腔镜检查对临床原因不明胸腔积液诊断率为61.2%.本组胸腔镜检查术后出现发热8例(16.3%),大面积皮下气肿7例(14.3%),1例(2.0%)包裹性胸腔积液在人造气胸过程中出现严重胸膜反应.上述并发症经治疗后均痊愈.结论 内科胸腔镜检查对老年人原因不明胸腔积液明确诊断有较大的临床价值.并发症发生率较既往未按年龄分组的研究所报道的数据略高.

Abstract：

Objective To investigate the value of medical thoracoscopy in diagnosis of pleural effusion of unknown aetiology in aged people.Methods The patients aged 65 years and over,with exudative pleural effusion of unknown aetiology,were enrolled in this study.And they underwent medical thoracoscopy for diagnosis.Results The 49 patients,33 males and 16 females,aged 65-82years (at average age of 70.5 yeas),were enrolled.The 83.7% (41 cases) of pleural effusion was unilateral,and 16.3% (8 cases) was bilateral.The 28.6% (14 cases) of them suffered from tuberculosis,16.3 % (8 cases) malignant tumor.The pathology results of 16 cases showed nonspecific inflammation and normal pleural tissue.The other 10 patients showed a normal pleuracy or abnormal pleuracy undergoing a failure biopsy.Considering the clinical data of the 27 cases,8 cases (16.3 %)had infectious disease,18 cases (38.8%) remained unknown.Diagnostic accuracy of medical thoracoscopy was 61.2%.Complications of these patients undergoing medical thoracoscopy were fever (n=8,16.3%) and subcutaneous emphysema (n=7,14.3%).Conclusions Medical thoracoscopy is a standard option for diagnosing pleural effusion.It could be easily managed by physicians.The complications appear more often in aged people.     

Prevalence and characteristics of pleural effusions in superior vena cava syndrome

OBJECTIVE AND BACKGROUND: The prevalence and characteristics of pleural effusions occurring in adults with the superior vena cava (SVC) syndrome are unknown. The purpose of the present study was to characterize these pleural effusions. METHODS: Charts of patients diagnosed with SVC syndrome at a tertiary care referral centre were reviewed. Radiographs were evaluated for the presence and size of pleural effusions, presence and location of masses and mediastinal width. If a pleural effusion was present, the patient's chart and a pre-existing database on pleural effusions were searched to determine whether the effusion was sampled and the results of any laboratory investigations on the fluid. RESULTS: The SVC syndrome occurred in 78 patients. Malignancy was the aetiology in 60% of the cases and bronchogenic carcinoma was the most common malignancy. An intravascular device was the aetiology in the majority of benign cases. Pleural effusion was found in 70% of patients with a malignant aetiology and 58% of those with a benign cause (P=0.345). The mean size of the effusions was larger in malignant cases (P=0.012). Of the 44 effusions 22 were sampled (17 in malignancy and five with benign processes); none was transudates, 20 (91%) were exudative (four of these were chylous) and the remaining two were reported as exudates but did not have pleural chemistries documented. CONCLUSIONS: More than half of patients with SVC syndrome have pleural effusions, regardless of the aetiology. However, the effusions are larger when associated with malignancy. The majority of these effusions are exudative and occasionally chylous. None was transudates.     

Medical thoracoscopy in the diagnosis of unexplained pleural effusion

Abstract Approximately 20% of pleural effusions remain without an established aetiology after evaluation. Thoracoscopy has a very high sensitivity for the diagnosis of both benign and malignant diseases and greatly increases the diagnostic yield for pleural effusion. We sought to evaluate the diagnostic yield and safety of medical thoracoscopy at this institution. The records of all patients undergoing medical thoracoscopy for the evaluation of undiagnosed pleural effusion between 1990 and 1996 were reviewed. The procedure was performed under local anaesthesia with sedation using a Stortz rigid thoracoscope. Fifty-eight patients had thoracoscopy, most having had two (range: 1–6) non-diagnostic pleural aspirations and biopsies of the pleura. Nineteen patients were found to have mesothelioma and nine metastatic malignancy. Three patients were considered likely to have tuberculous pleural disease, six had asbestos related benign pleural fibrosis and three post-cardiotomy syndrome. There was one chylous effusion of uncertain aetiology, one post-traumatic and two other benign effusions, both of which resolved without clear aetiology. On seven occasions the pleural space could not be adequately accessed, but none of these patients had prior computerized tomography (CT) or ultrasound of the pleural space. There were five false negative diagnoses of malignancy, but no false positives. The diagnostic sensitivity for pleural malignancy was 85% and specificity 100%. There were no major complications, but four patients had late tumour seeding at the thoracoscopy site. Medical thoracoscopy is a safe procedure with a high diagnostic yield. Pre-operative evaluation of the pleural collection using ultrasound or CT increases the likelihood of successful access to the pleural space and may increase diagnostic yield.