内科胸腔镜对胸腔积液诊断和治疗的临床价值

目的：探讨内科胸腔镜对胸腔积液的诊断价值,以及应用内科胸腔镜滑石粉胸膜固定术对恶性胸腔积液的治疗价值。方法回顾性性分析2008年1月至2014年1月在郑州市第三人民医院呼吸内科接受内科胸腔镜诊断的142例胸腔积液患者的临床资料。评价内科胸腔镜对胸腔积液的诊断阳性率和分析病因。将确诊为恶性胸腔积液的患者分为胸腔镜组和对照组。胸腔镜组给予内科胸腔镜滑石粉胸膜固定术,对照组胸给予胸腔引流管内灌注滑石粉而实现胸膜固定。对两组的疗效进行对比和分析。结果在142例胸腔积液患者中,有136例经内科胸腔镜检查及病理活检明确诊断,确诊率达95.8%。其中恶性胸腔积液(含恶性胸膜间皮瘤2例)85例(59.9%),结核性胸膜炎31例(21.8%),肺炎旁积液13例(9.2%),非特异性炎症7例(4.9%),原因不明胸腔积液6例(4.2%)。确诊的85例恶性胸腔积液患者中,胸腔镜组56例,1个月后复查有效率为91.1%,完全缓解率为82.1%；对照组29例,1个月后复查有效率为69.0%,完全缓解率为48.3%,两组有效率和完全缓解率比较,差异均有统计学意义(χ2值分别为6.786、10.555,P 值分别为0.009、0.001)。结论内科胸腔镜对胸腔积液具有较好的确诊率,内科胸腔镜滑石粉胸膜固定术可以有效地治疗恶性胸腔积液。

Clinical value of medical thoracoscopy in diagnosis and treatment of patients with pleural effusion

Objective To explore the diagnostic value of medical thoracoscopy in pleural effusion and treatment value of talc pleurodesis by medical thoracoscopy in malignant pleural effusion.Methods The clinical data of 142 patients with pleural effusion were retrospectively analyzed,who accepted medical thoracoscopic diagnosis in the department of respiratory medicine in the Third People′s Hospital of Zhengzhou from Janurary 2008 to Janurary 2014.The positive rate of pleural effusion diagnosed by medical thoracoscopy was evaluated and causes were analyzed.The patients definitely diagnosed with malignant pleural effusion were divided into thoracoscopy group and control group.Thoracoscopy group accepted talc pleurodesis by medical thoracoscopy and control group were treated with talc perfusion through routine thoracic drainage to complish pleurodesis.The curative effects were analyzed and compared between the two groups.Results 136 patients were confirmed by medical thoracoscopy and pathology,definite rate was 95.8%,including 85 cases (59.9%) of malignant pleura effusion (including two cases of pleural mesothelioma),31 cases (21.8%) of tuberculous pleuritis,13 cases (9.2%) of parapneumonic effusion,seven cases (4.9%) of non-specific inflammation and six cases (4.2%) of pleural effusion of unknown causes.After one month,the effective rate was 91.1% and the complete remission rate was 82.1% in thoracoscopy group (n = 56),the effective rate was 69.0% and the complete remission rate was 48.3% in control group (n =29),there were statistical differences between the two groups(χ2 =6.786,10.555,P =0.009,0.001,respectively).Conclusions Medical thoracoscopy has a high positive diagnostic rate on pleural effusion.Talc pleurodesis under medical thoracoscopy can effectively cure malignant pleural effusion.