胸膜活检在渗出性胸腔积液中的价值

目的探讨胸膜穿刺活检在渗出性胸腔积液中的诊断价值。方法对40例渗出性胸腔积液患者进行经皮胸膜活检术,同时取胸水送涂片查抗酸杆菌、脱落细胞检查。结果 40例胸膜活检成功率70%,特异性病理诊断21例,病理诊断阳性率52.5%。胸膜活检病理诊断为结核17例（42.5%）、肿瘤4例（10%）、慢性炎症6例（15%）、急性炎症表现1例（2.5%）骨骼肌,未获得胸膜组织12例（30%）。全部40例胸膜活检患者无1例气胸及胸膜反应发生。结论胸膜穿刺活检在渗出性胸腔积液诊断中具有重要价值,是一项安全、简单、有效的手段。     

胸膜活检在结核性胸膜炎诊断中的价值

近年来,结核病的发病率又呈上升趋势。在结核的诊断上临床上常采用多种方法联合应用,如PPD试验、胸片、痰涂片找抗酸杆菌、痰培养抗酸杆菌,对于有胸腔积液者怀疑结核性胸膜炎时,还可采用胸水检查及胸膜活检术。胸膜活检术是钩取壁层胸膜组织的方     

胸膜刷检在恶性胸腔积液诊断中的应用

目的观察胸膜刷检在恶性胸腔积液的诊断上的价值。方法15例胸腔积液患者胸腔穿刺术后行胸膜活检、抽取胸液、胸膜刷检分别留取组织及胸液送细胞学检查。结果恶性胸腔积液诊断的阳性率分别为：胸膜刷检73．3％（11／15），胸液细胞学检查53．3％（8／15），胸膜活检33．3％（5／15）。胸膜刷检的阳性率高于胸液细胞学检查及胸膜活检，比较有显著性差异。结论胸膜刷检在恶性胸腔积液的诊断有重要价值。     

胸膜活检联合微创引流酶学检测在良恶性胸腔积液中的诊断价值

目的胸膜活检联合微创引流酶学检测，能及早提高渗出性胸膜炎的病因诊断。方法微创组对所有中等量积液病人行胸膜活检后微创引流，引出的所有胸水送病理、酶学检测。胸穿组对所有中等量积液的病人仅做隔日胸穿抽液，将抽出的胸水同样送病理、酶学检测。结果微创组的胸水消失或减至极少量比胸穿组快4．3天，病因诊断率比胸穿组提高28％。结论胸膜活检联合微创引流酶学检测，不但临床症状改善快，胸水消失也快，而且能及早提高渗出性胸腔积液的病因学诊断，值得在基层医院推广应用。     

闭式胸膜刷检术对恶性胸腔积液的诊断价值

目的评价闭式胸膜刷检术对恶性胸腔积液的诊断价值。方法临床疑诊的48例恶性胸腔积液行胸膜刷检、胸膜活检和胸水细胞学检查,比较各种方法和组合对肿瘤细胞的阳性率。结果43例确诊为恶性胸腔积液,胸膜刷检阳性率为62.8%,胸水细胞学检查阳性率为55.8%,胸膜活检阳性率为37.2%,以胸膜刷检最高,明显高于胸膜活检(P<0.05),但与胸水细胞学检查比较无显著性差异(P>0.05)。联合胸膜活检和胸膜刷检,阳性率提高为76.7%,3种方法联合应用阳性率为83.7%。结论胸膜刷检是一种简单、安全、有效的检查手段,对诊断恶性胸腔积液有较大的应用价值。     

胸水三种标志物检测联合胸膜活检对结核性与癌性胸水的诊断价值

目的探讨胸水三种标志物检测联合胸膜活检在结核性与癌性胸水中的诊断价值。方法对确诊的胸腔积液（简称胸水）患者共122例进行回顾性分析,其中54例为结核性胸水（结核组）,68例为癌性胸水（癌性组）,在行胸膜活检的同时。抽取胸水测定癌胚抗原（CEA）、乳酸脱氢酶（LDH）及葡萄糖（GLU）的浓度,对结果进行分析。结果癌性组CEA、GLU明显高于结核组,LDH变化不明显;CEA、GLU与胸膜活检相比诊断阳性率分别为79．41％、75．0％和51．47％,差异有显著性;对标志物检测阳性但胸膜活检阴性者,反复多部位胸膜活检使胸膜活检诊断阳性率达72．06％。结论联合检测CEA、LDH、GLU对癌性胸水与结核性胸水有较高的临床鉴别诊断价值,胸膜活检具有确诊价值。三种标志物检测联合胸膜活检可提高胸膜活检诊断阳性率,为临床早期诊断提供依据。     

内科胸腔镜对老年疑难性胸腔积液的诊断价值

目的内科胸腔镜在诊断老年疑难性渗出性胸腔积液的价值。方法应用内科胸腔镜对56例老年疑难性渗出性胸腔积液患者进行检查,术中对可疑病变部位进行直视下多点活检,比较镜下表现与病理结果相关性,评价手术的安全性。结果56例疑难性渗出性胸腔积液患者中病理确诊51例,诊断阳性率92．9％,其中转移性腺癌16例（28．5％）,鳞癌7例（12．5％）,小细胞癌2例（3．6％）,食道癌胸膜转移1例（1．8％）,淋巴瘤2例（3．6％）,恶性胸膜问皮瘤4例（7．1％）,结核病20例（35．7％）,非特异性慢性炎症2例（3．6％）;2例（3．6％）病理为阴性,所有病例均未发生严重并发症。结论内科胸腔镜检查对老年性疑难性渗出性胸腔积液诊断阳性率高、简单、安全、并发症发生率低。     

1 例淋巴瘤误诊为结核性胸腔积液并文献复习简

结核性胸腔积液是临床常见的一类胸腔积液,而它的确诊还是相对困难的.结核性胸膜炎的确诊需要胸腔积液或胸膜活检标本中找到结核杆菌,或胸膜活检有典型结核性肉芽肿改变;然而根据病史和临床表现,以及胸腔积液ADA增高,临床上也可诊断结核性胸腔积液[1].超过一半的结核性胸腔积液患者,胸腔积液是唯一的临床表现.由于结核性胸腔积液胸膜结核分枝杆菌负荷低,胸腔积液离心沉淀后的结核菌涂片阳性率在5%以下[2],结核性胸腔积液胸水培养结果阳性率〈20%[3],而且这往往需要等待几个星期.胸膜活检病理检查作为诊断结核性胸腔积液的一种重要手段,但并非只有结核性胸腔积液的胸膜病理呈肉芽肿病变,还有如真菌性疾病、结节病、土拉菌病和类风湿胸膜炎也可有肉芽肿病变[1],有时还得抗酸染色或活检标本的培养.     

闭式胸膜活检加胸膜刷检在胸腔积液中的诊断价值

目的探讨闭式胸腔穿刺胸膜活检同时胸膜刷检在渗出性胸腔积液中的诊断价值。方法对87例渗出性胸腔积液患者,同时行闭式胸膜活检术与胸膜刷检术。结果 87例患者,胸膜活检113次,成功率92.9%(105/113),病因诊断阳性率为70.1%(61/87)。胸膜刷检112次,成功率73.2%(82/112),病因诊断阳性率为60.0%(52/87)。胸膜活检病因诊断阳性率虽高于胸膜刷检,但差异无统计学意义(P0.05)。有11例患者胸膜活检病因诊断阴性,胸膜刷检阳性;有20例患者胸膜刷检病因诊断阴性,但胸膜活检阳性。胸膜活检同时胸膜刷检,病因诊断阳性率提高至82.8%(72/87),高于单独胸膜活检及单独胸膜刷检(均P0.05)。87例患者胸膜检查时发生胸膜反应3例(2.7%),气胸4例(3.5%)。结论经皮胸膜活检与胸膜刷检均是渗出性胸腔积液病因诊断的重要手段,相对安全。胸膜活检同时胸膜刷检有更高的病因诊断阳性率,在渗出性胸腔积液的临床诊断中具有重要价值。     

MicroRNA在恶性胸腔积液中的研究进展

正胸腔积液在临床上是一种常见疾病,它是由多种病因引起人体胸膜腔内大量液体形成而导致。健康人胸膜腔内仅存在约5-10m L液体,在人体做呼吸运动时起润滑作用。胸腔积液分为良性胸腔积液和恶性胸腔积液,临床上恶性胸腔积液多由胸膜原发肿瘤或继发肿瘤转移至胸膜后引起。病理学检查是目前诊断恶性胸腔积液的金标准,但因其阳性率较低~([1-2]),目前临床上常常通过实验室检查(胸水常规、生化、肿瘤、胸水找抗酸杆菌)、影像学检查(胸     

超声引导下改良胸膜活检术对诊断原因不明胸腔积液的临床观察(附49例临床分析)

目的 观察超声引导下改良胸膜活检术对原因不明胸腔积液诊断中的价值.方法 使用改良胸膜活检术对49例不明原因胸腔积液患者进行胸膜活检术.结果 所有患者胸膜活检均成功,其中间皮瘤3例,低分化癌6例,腺癌7例,未分型4例,结核18例,慢性炎症11例(经治疗最终证实为结核),病理确诊率77.6％,仅2例出现胸膜反应,未出现局部出血及气胸.结论 超声引导下改良胸膜活检术安全、方便,对胸腔积液确诊率高、并发症少.     

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。     

结核及恶性胸腔积液患者胸膜活检次数与病理阳性率分析

目的研究结核及恶性胸腔积液胸膜活检时各次活检获得病理阳性结果的特点。方法对确诊的103例结核性胸腔积液及124例恶性胸腔积液患者行胸膜活检的临床资料进行分析。结果结核胸腔积液首次、第2次、第3次胸膜活检的病理阳性率分别为42.7%(44/103)、26.0%(12/46)、19.4%(6/31)。第3次活检的阳性率同第一次比较差异有统计学意义(χ2,P<0.05);恶性胸腔积液首次、第2次、第3次胸膜活检的病理阳性率分别为33.9%(42/124)、22.9%(16/70)、34.2%(13/38)。两者前3次活检后病理阳性者均已达到行胸膜活检阳性患者总阳性的94%以上。结论 3次胸膜活检已可达到较高阳性率,提示单次多部位活检可能提高阳性率,利于早期诊断。     

Precut technique using an injection needle: A retrospective study on a new ancillary procedure for pleural biopsy

The effectiveness of thoracoscopic biopsy as a diagnostic method for pleural diseases has been reported; however, obtaining a sufficient specimen size is sometimes difficult. Therefore, an ancillary technique, the precut technique using an injection needle, was devised to address this problem. This study aimed to evaluate the effectiveness and safety of the novel precut technique in patients with undiagnosed pleural effusion.This retrospective study included 22 patients who underwent pleural biopsy using the precut technique to examine exudative pleural effusion of unknown etiology. Thoracoscopy was performed under local anesthesia. The biopsy procedure was performed as follows: a needle was inserted into the pleura around the lesion using a semiflexible thoracoscope; the needle was positioned to make an incision in the pleura while injecting 1% lidocaine with epinephrine and lifting the pleura from the fascia; 2 or 3 precut incision lines were arranged in a triangle; and the specimen was obtained from the parietal pleura using forceps or a cryoprobe. Patient data including age, number of biopsies, biopsy specimen size, pathological and final diagnosis, and postoperative complications were examined.All patients were male with an average age of 74 years. Pleural effusion was found on the right and left sides in 16 and 6 patients, respectively. The average major axis of the biopsy specimens was 18 mm (range, 10–30 mm), which was sufficient to establish a pathological diagnosis. Only 1 patient experienced minor temporal bleeding as a complication.The precut technique enabled the procurement of specimens sufficient in size for pleural biopsy.     

Role of pleural viscosity in the differential diagnosis of exudative pleural effusion

OBJECTIVE AND BACKGROUND: Determining the aetiology of an effusion involves assessing if it is an exudate or a transudate. However, a reliable test for determining the aetiology of a pleural effusion is lacking. Pleural viscosity has a high sensitivity and specificity and a high positive and negative predictive value for discriminating exudative and transudative pleural effusions. The aim of this study was to use pleural fluid viscosity to discriminate between various aetiologies of exudative effusions, namely malignant, parapneumonic and tuberculous. METHODS: Seventy consecutive patients (24 women, 46 men, mean age = 67 years) with exudative pleural effusion due to pneumoniae in 24 patients, tuberculous pleurisy in 21 and lung cancer in 25 were studied prospectively. Measurements of pleural fluid and plasma viscosity were performed using Brookfield DV-II viscometer. RESULTS: Pleural viscosity and pleural LDH were highest in the tuberculous pleurisy patients and lowest in the lung cancer patients. Pleural viscosity > or = 1.57 was found to be indicative of tuberculous pleurisy with a sensitivity of 100% and specificity of 95%. Pleural viscosity < 1.39 was found to be indicative of lung cancer with a sensitivity of 100% and specificity of 94%. Pleural viscosity was significantly correlated with pleural albumin (r = 0.34, P = 0.004), protein (r = 0.40, P = 0.001), LDH (r = 0.70, P < 0.001) and plasma viscosity (r = 0.44, P < 0.001), having the most significant value with pleural LDH. CONCLUSION: The pleural fluid viscosity of patients with parapneumonic, tuberculous and malignant effusions are significantly different from each other. Among these groups, tuberculous effusions had the highest viscosity, and malignant effusions from lung cancer the lowest.     

以胸腔积液为首诊的肺栓塞19例临床分析

目的分析以胸腔积液为首诊的肺栓塞患者的临床特点,增强对症状不典型肺栓塞的认识,降低误诊率。方法回顾性分析19例以胸腔积液为首要临床表现的肺栓塞患者的临床特点。结果 71例肺栓塞患者中19例出现胸腔积液,占26.76%;大量胸腔积液1例,中量2例,少量16例;双侧胸腔积液2例,单侧胸腔积液17例,其中右侧8例,左侧9例;3例行胸腔穿刺胸水常规化验均为渗出性胸水。结论胸腔积液是肺栓塞的非典型、非特异性临床表现,临床上要提高警惕,及时完善D-二聚体检测,CT肺动脉造影检查,以提高确诊率。     

胸腔镜对恶性胸腔积液诊断的价值

目的探讨内科胸腔镜对恶性胸腔积液诊断价值。方法 138例恶性胸腔积液患者行内科胸腔镜,取病变组织病理检查。结果获得明确病理结果 130例。镜下表现分为以下4种:①结节120例;②胸膜增厚、纤维组织增生形成分隔或粘连带10例;③胸膜充血、水肿6例,④胸膜弥漫性肥厚、凹凸不平2例。确诊病例中肺癌110例,肺腺癌转移93例,恶性间皮瘤8例,转移癌10例,病理无法定性的恶性胸腔积液5例。所有病例无严重并发症。结论内科胸腔镜检查对恶性胸腔积液诊断是一种安全、有效的方法。