心源性胸腔积液的X线分析

胸腔积液在临床上较常见，可由多种疾病引起。而各种心血管疾病所致充血性心力衰竭引起的胸腔积液是漏出性胸腔积液最常见的原因［１］。临床上心源性胸腔积液易被误诊为结核性甚至恶性胸腔积液。因此认识心源性胸腔积液的Ｘ线特点对鉴别胸腔积液的病因减少误诊具有重要临...     

80岁以上老年人肺部感染伴胸腔积液临床分析

胸腔积液是临床常见的病理状态，病因是多方面的，老年人胸腔积液最常见的病因是肿瘤，其次是结核,≥80岁老年人肺部感染并发胸腔积液常常是多因素的结果，治疗相对困难，从而影响疾病转归。本文回顾性分析了我院老年病科确诊的≥80岁老人肺部感染并发胸腔积液的临床资料，以加深认识。     

胸腔积液和血清中脯氨酸肽酶检测对结核性和恶性胸腔积液的诊断价值

胸腔积液是一种临床常见的胸膜病变,其发生原因很多,常见的有胸膜炎、胸膜肿瘤,或继发于全身其他系统的疾病.良性疾病以感染性胸腔积液多见,其中又以结核性胸腔积液最为常见,恶性胸腔积液的病因以肺癌最为常见.因良、恶性胸腔积液的治疗和预后截然不同,及时准确地鉴别其性质有重要的临床指导意义.     

胸水肿瘤标记物在胸腔积液性质鉴别中的应用

胸腔积液（pleural effusion）是肺部及全身多种疾病的常见并发症,也是验证疾病病因、判断其良恶性的重要媒介^[1]。胸腔积液治疗效果和预后关键在于其病因的判断,故对于胸腔积液到底是良性或恶性的鉴别是非常重要的。临床上引起胸腔积液的主要是结核性胸膜炎与恶性胸膜疾病,占所有胸水患者的95％以上^[2],其中恶性胸膜疾病常见原发部位是肺、乳腺、淋巴瘤、胃和卵巢。     

良恶性胸腔积液诊断的临床进展

正胸腔积液是呼吸科的常见、多发病之一,临床上多种疾病都可引起胸腔积液。随着全球环境污染的日益严重,恶性肿瘤的发病率呈现逐年上升趋势,所有胸腔积液中大约20%是肿瘤发展造成[1]。一些患者中,胸腔积液可以是肿瘤首先出现的临床表现。因此胸腔积液病因的诊断对疾病的治疗及预后至关重要。目前,较为常用的鉴别良恶性胸腔积液的检查方法包括肿瘤细胞学、生化学和分子生物学等,肿瘤细胞学检查被认为是诊断恶性胸腔积液的"金标     

力尔凡治疗恶性胸腔积液88例

胸部恶性肿瘤常见的并发症之一是恶性胸腔积液.胸腔积液常压迫心脏和肺脏,产生胸闷、呼吸困难、憋气等临床症状,还引起低蛋白血症、电解质紊乱、严重脱水等并发症,若不及时处理,会严重影响患者的生活质量及生命健康.临床上常见的治疗恶性胸腔积液的措施是局部使用相关药物减少积液产生、促进积液的排出.目前治疗恶性胸腔积液的药物主要包括化疗药物、生物制剂、免疫药物及中药.顺铂是临床上治疗肺癌常见的药物,而力尔凡是常见的治疗胸腔积液的一种生物制剂.为探讨力尔凡治疗恶性胸腔积液的临床效果和不良反应,本研究总结并分析了2012年1月至2014年2月来我院采用力尔凡联合顺铂治疗恶性胸腔积液患者的临床资料及,报道如下.     

老年人以胸腔积液为主要表现的慢性心力衰竭15例报告

老年人以胸腔积液为主要表现的慢性心力衰竭１５例报告黄继华，温晓红（浙江省湖州市第一医院，湖州３１３０００）慢性心力衰竭常产生大量或中等量、双侧或单侧胸腔积液，往往容易误诊为呼吸系统或其他系统的疾病，应引起临床工作上的足够重视。笔者对１５例以胸腔积液为...     

脂多糖和维甲酸相关孤儿受体α在胸腔积液中的含量及临床意义

<正>结核性胸腔积液是肺结核的常见症状之一~([1]),往往由结核性胸膜炎引起,对结核病患者危害较大。恶性胸腔积液也是临床上恶性肿瘤常见的并发症状,往往是远处转移的征象之一,通常恶性胸腔积液患者的预期寿命为3个月～12个月~([2-3])。因此,临床上两者的早期鉴别对于患者获得及时有效的治疗非常重要,我们对南通市第六人民医院54例患者体内胸腔积液中的脂多糖(lipopolysaccharide,LPS)和维甲酸相关孤儿受体α(Retinoid-related orphan receptor-alpha,RORα)含量进行了测定,并进行了分析,现报道如下。     

消化系统疾病引起的胸腔积液

胸腔积液（pleural effusion，简称胸液或胸水）是肺、胸膜或其他许多全身疾病的常见临床表现之一。胸腔积液的病因有100多种，除常见的肺、胸膜疾患外，还可有心脏、肾脏、结缔组织病和消化系统疾病等多系统疾病引起。消化系统疾病中有肝硬化、胰腺炎、消化道恶性肿瘤、食管穿孔、腹腔内脓肿和腹部手术后等，常可累及胸膜出现胸腔积液而产生呼吸困难、咳嗽、胸痛等相应的呼吸系统症状。认识这些疾病所致的胸腔积液并发症，有助于对疾病整体的判断，关系到明确胸腔积液的病因及拟定针对性的治疗措施。本文主要详细介绍肝硬化、胰腺炎、消化道恶性肿瘤所引起的胸腔积液的诊治。     

论老年人胸腔积液的诊断

胸腔积液可以原发于胸膜疾患，也可以继发于全身其他系统的疾病．临床上老年人胸腔积液最多见的是漏出液，至于渗出性胸膜积液也较常见。近年来，老年人结核性和癌性渗出性胸膜炎的发病率呈上升的趋势．因此，必需重视和认识老年人胸腔积液的重要性。     

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。     

Radiographic visualization of pleural space under negative pleural pressure

Although many imaging modalities have developed in the area of pulmonary medicine, information about the condition of pleural surface is limited. In this study, we carried out contrast pleurography under negative pleural pressure in dogs and humans to evaluate the condition of the pleural space including adhesion between the two pleural layers, incomplete fissure and features of the pleural surface. After insertion of a flower-type catheter into the pleural space under ultrasonic guidance, contrast material (60% Meglumine iotalamate, Conray 60, 0.5-1.0 ml/kg) was injected into the pleural space through the catheter. In dogs with intact pleura, contrast material distributed to the pulmonary surface, including interlobar spaces, rapidly. In dogs with pleural adhesion which was induced artificially with talc, affected areas were visualized as defects of contrast material. In humans, this contrast pleurography provided information about pleural adhesion, pulmonary lobulation, extent of cancer to neighbouring lobes, irregular pleural surface due to bullae formation and pleural indentation by cancerous lesion. There was no serious complication in dogs and human studies. This contrast pleurography is unique because it is possible to evaluate the pleural space physiologically under negative pressure condition. It may be concluded that this method of pleurography is useful for the clinical evaluation of the condition of the pleura in various lung diseases.     

A case of multiple pleural cryptococcosis without pleural effusion

Pulmonary cryptococcosis is most likely to occur in immunocompromised patients. The radiological manifestations generally include pulmonary parenchymal lesions, namely, pulmonary nodules, cavitary lesions, and consolidation; thus, multiple pleural nodules are unusual presentation. Here, we report a woman who presented with multiple pleural cryptococcosis without pleural effusion. The patient had previously undergone surgery for stage II rectal cancer. In addition, she received 6 cycles of chemotherapy for follicular lymphoma. Computed tomography (CT) revealed multiple small nodules involving the pleura without pleural effusion, which suggested possible recurrence of rectal cancer or malignant lymphoma as pleural dissemination. Thoracoscopic examination was performed, and pleural cryptococcosis was diagnosed. Although pleural cryptococcosis without pleural effusion is extremely rare presentation, clinicians should consider it when an immunocompromised patient presents with multiple pleural nodules. Thoracoscopic exploration should be the best procedure for the definitive diagnosis of multiple pleural nodules.     

Use of indwelling pleural catheters for chronic pleural infection

Recurrent, chronic pleural infection creates difficult management issues. Surgical drainage is currently recommended for patients who have failed initial "medical treatment" (ie, tube thoracostomy and antibiotic therapy), but the options for patients not fit for surgery are limited. Prolonged closed tube drainage may be an option in this group, although concerns exist regarding the efficacy and risk of catheter blockage. Long-term indwelling pleural catheters are increasingly used for the treatment of recurrent malignant pleural effusion. Pleural infection is recognized as a complication and is cited as a contraindication to insertion of an indwelling pleural drain within the product literature. We report two patients with empyema in a fixed pleural space in whom the insertion of an ambulatory catheter produced successful drainage. Long-term indwelling pleural catheters may have a role in maintaining the drainage of a chronically infected pleural space that is not readily treated in other ways.     

IFN-γ、 CRP与结核性胸膜炎胸膜黏连的相关性

结核性渗出性胸膜炎的常见并发症为胸膜黏连,近年来有关结核性胸膜炎所致胸膜黏连的影响因素报道较多,胸腔积液存在的时间,胸水白蛋白及纤维蛋白原含量,胸腔积液是否抽液治疗等均与胸膜黏连有相关性,但免疫因素及炎症反应在结核性胸腔积液发生胸膜黏连,研究报道较少.临床证实以辅助性T淋巴细胞（Th细胞）免疫为代表的机体免疫功能与结核病的发病、病情转归等关系密切.Thl免疫在外周血减弱而在病灶处增强,且随病程动态变化,这是结核病的基本免疫学特征.