内科胸腔镜在不明原因胸腔积液中的诊断价值及操作方法

目的 观察内科胸腔镜在不明原因胸腔积液中的诊断价值及操作方法。方法 自2009年4月~2015年6月，共149例患者于笔者医院呼吸科行胸腔镜检查，根据病因分为肺炎旁积液、脓胸、结核性胸膜炎、恶性胸腔积液4组，观察各组的胸腔镜下胸膜表现，胸腔积液外观、常规、生化、肿瘤标志物、细胞学及结核涂片检查的特点；观察胸腔镜操作前人工气胸以及操作后置管引流的情况；并观察并发症的发生情况。结果 内科胸腔镜的确诊率为87.2%。不同病因所导致的胸腔积液，其胸腔镜下表现是不同的。粘连最重的是脓胸和结核性胸膜炎。结核性胸膜炎和恶性胸腔积液的胸膜结节表现不同。胸腔积液的各项检查有助于进一步确诊。术前通过胸腔引流管行人工气胸，注气量平均为588±276ml。术后留置细管比例为69.4%（109/157），带针粗引流管比例为21.0%（33/157）。最常见并发症为皮下气肿（38/157，24.2%），少量患者出现胸痛（24/157，15.3%）、低热（2/157，1.3%）。结论 胸腔镜检查能够明显提高不明原因胸腔积液的诊断率；在局麻镇静下即可完成操作，术前建议给予人工气胸，术后建议留置细管，并且操作过程安全，并发症少，值得临床推广。

Diagnostic Value and Operation Method of Thoracoscopy in Pleural Effusion of Unknown Causes

Objective To observe the diagnostic value and operation method of thoracoscopy in pleural effusion of unknown causes. Methods From April 2009 to June 2015, 149 patients in our department received thoracoscopy. According to the etiologies, they were divided into four groups, which were parapneumonic effusion, empyema, tuberculous and malignant pleural effusion. We observed the pleura by thoracoscopy, the appearance of pleural effusion, and the examination of pleural effusion routine, biochemical and tumor marker, cytological and tuberculosis smear. We also observed the artificial pneumothorax before operation and tube drainage after it. The complications were observed too. Results The diagnosis rate was 87.2%. The performances of different causes of pleural effusion were different under thoracoscopy. The most severe adhesion were empyema and tuberculous pleurisy. The apperence of pleural nodules were different in tuberculous pleurisy and malignant pleural effusion. The examinations of pleural effusion helped to further diagnose. Before operation, the patients were underwent artificial pneumothorax by thoracic drainage tube. The average gas injection volume was (588±276)ml. Postoperative thin needle drainage tube indwelling ratio was 69.4% (109/157), with a thick needle drainage tube indwelling ratio was 21% (33/157). One of the most common complications was subcutaneous emphysema (38/157, 24.2%) and a small number of patients which appeared chest pain (24/157, 15.3%), fever (2/157, 1.3%). Conclusion Thoracoscopy can significantly improve the rate of diagnosis of pleural effusion of unknown causes. The operation can be finished under local anesthesia sedation. Preoperative suggestion was given artificial pneumothorax. Postoperative recommendation was indwelling tube. The operation process was safe, fewer complications, and worthy of clinical promotion.