胸腔镜在不明原因胸腔积液患者中的应用价值

目的 探讨胸腔镜在不明原因胸腔积液患者中的应用价值.方法 选取2015年6月至2016年5月期间我院诊治的42例不明原因胸腔积液患者,行胸腔镜下活检送病理检查,分析结果.结果 (1)胸腔镜下30例患者表现为单发或多发结节,占71.43%,其中15例为菜花样包块、5例为葡萄串样病灶、10例弥漫性栗粒样小结节,分别占35.71%、11.90%、23.81%,7例表现为弥漫性胸膜增厚凹凸不平,5例表现分布胸膜充血水肿或纤维分割、粘连带形成,分别占16.67%、11.90%.(2)41例患者均明确病因诊断,诊断阳性率为97.62%;21例为恶性肿瘤,占50.00%;12例为结核性胸膜炎,占28.57%;4例为结缔组织伴胸腔积液,占9.52%;4例为非特异性炎症,占9.52%;1例不明原因,占2.38%.(3)22例血性积液患者中20例确诊为恶性病变、2例为良性病变;20例非血性积液患者中1例确诊为恶性病变、19例为良性病变;血性与非血性积液用于诊断恶性与良性病变的准确率分别为90.91%、95.00%.(4)患者均顺利完成手术,11例患者术后发生并发症,发生率为26.19%,其中4例发热、1例皮下气肿、8例咳嗽、8例胸痛、4例恶心,发生率分别为9.52%、2.38%、19.05%、19.05%、9.52%,部分患者同时出现多种并发症.结论 胸腔镜用于不明原因胸腔积液诊断阳性率高,并发症表现轻微,不明原因胸腔积液以恶性多见,尤其是血性积液者在常规检查不能确诊病因情况下应及时进行胸腔镜检查以尽快明确病因.

Value of medical thoracoscopy in diagnosis of pleural effusion with unknown aetiology

Objective To discuss the diagnostic value of medical thoracoscopy in pleural effusion with un-known aetiology, and to provide reference for clinical diagnosis and treatment of the disease. Methods From June 2015 to May 2016, 42 patients of pleural effusion with unknown aetiology undergoing thoracoscopy biopsy and patho-logical examination were enrolled. The results were analyzed. Results (1) thoracoscopy performance:30 cases showed single or multiple nodules (71.43%), including 15 cases for cauliflower-like mass (35.71%), 5 cases for grape-like lesion (11.90%), 10 cases of diffuse miliary nodules (23.81%);7 cases showed uneven diffuse pleural thickening (16.67%);5 cases showed pleural congestive edema or fiber segmentation and adhesion formation (11.90%). (2) 41 patients (97.62%) had clear etiological diagnosis, including 21 cases of malignant tumor (50.00%), 12 cases of tuberculous pleurisy (28.57%), 4 cases of connective tissue with pleural effusion (9.52%), 4 cases of nonspecific inflammation (9.52%); 1 case had aetiology still unexplained (2.38%). (3) Among the 22 cases of hemorrhagic effusion, 20 cases were diagnosed as malignant lesions and 2 cases as benign lesions;among the 20 cases of non-hemorrhagic effusion, 1 case was diag-nosed as malignant lesion and 19 cases as benign lesions;the accuracy of hemorrhagic effusion and non-hemorrhagic ef-fusion for diagnosis of malignant and benign lesions were 90.91%and 95.00%. (4) All the patients completed the sur-gery, and 11 patients had postoperative complications (26.19%), including 4 cases of fever (9.52%), 1 case of subcutane-ous emphysema (2.38%), 8 cases of cough (19.05%), 8 cases of chest pain (19.05%), 4 cases of nausea (9.52%), some of which had multiple complications. Conclusion Medical thoracoscopy results in higher positive rate in the diagnosis of pleural effusion with unknown aaetiology and low incidence of severe complications. Pleural effusion with unknown aae-tiology is mostly malignant, and thoracoscopy should be performed timely as routine check is not able to ascertain the aaetiology for hemorrhagic effusion.