三种活检方法对不明原因的渗出性胸腔积液的诊断价值

目的:比较内科胸腔镜、经CT引导穿刺活检及经皮胸膜盲穿活检在不明原因的渗出性胸腔积液中的诊断价值.方法:收集武汉市医疗救治中心收治的不明原因胸腔积液患者149例,分成CT穿刺组、内科胸腔镜组和盲穿组,比较三组胸腔积液的病理确诊率、并发症发生率及术后住院时间、疼痛评分及操作时间.结果:内科胸腔镜组在恶性间皮瘤病理确诊率(94％)上高于盲穿组(47％),差异有统计学意义(P<0.05);而与CT穿刺组(80％)比较,差异无统计学意义(P>0.05).在肺癌相关的恶性胸腔积液病理确诊率上,内科胸腔镜组病理确诊率(100％)高于盲穿组(53.3％),差异有统计学意义(P<0.05);与CT穿刺组(93％)比较,差异无统计学意义(P>0.05).三组在转移肿瘤及结核性相关的胸腔积液病理确诊率上差异无统计学意义(P>0.05);三组并发症发生率差异无统计学意义(P=0.558);内科胸腔镜组术后住院时间(9.42±1.7)d短于盲穿组(13.21±1.9)d,差异有统计学意义(P<0.05);亦短于CT穿刺组(12.65±2.7)d,差异有统计学意义(P<0.05);内科胸腔镜组术后疼痛评分(4.34±0.81)高于盲穿组(3.25±0.68)和CT穿刺组(3.21±0.72),差异均有统计学意义(P<0.05);内科胸腔镜组的操作时间(42.53±17.3)min短于盲穿组(53.27±19.3)min及CT穿刺组(80.38±27.49)min,差异均有统计学意义(P<0.05).结论:内科胸腔镜对恶性间皮瘤和肺癌相关恶性胸腔积液的病理确诊率优于CT引导下经皮胸腔病变穿刺活检和经皮胸膜穿刺活检,在结核性和肿瘤转移性胸腔积液上,三种方法无差异;三种方法并发症发生率无显著差异;但内科胸腔镜组操作时间更短、术后住院时间更短.

Diagnostic value of three methods in pleural effusion of unknown aetiology

Objective: To compare the diagnostic value of medical thoracoscopy, CT scan-guided Abrams pleural needle biopsy and percutaneous blind biopsy of pleura in pleural effusion of unknown aetiology. Methods: A total of 149 cases of pleural effusion of unknown aetiology was divided into a CT group, a medical thoracoscopy group and a blind biopsy group. The pathological diagnosis rate, complication rate, length of stay, pain score and operate time were compared among the three groups. Results: The pathological diagnosis rate of the medical thoracoscopy group(94％) was significantly higher than blind biopsy group (47％) in the diagnosis of malignant mesothelioma (P<0.05). While the difference was not significant between the medical thoracoscopy group and the CT group (80％, P>0.05). The pathological diagnosis rate of the medical thoracoscopy group was significantly higher than that in the blind biopsy group in the diagnosis of malignant pleural effusion caused by lung cancer (100％ vs 53.3％, P<0.05). While the difference was not significant between Medical thoracoscopy group and CT group (100％ vs 93％, P>0.05). There was no significantly difference between three groups in term of pleural metastasis due to other organ carcinomas and tuberculous pleurisy (P>0.05). There was no significantly difference regarding complication rate (P=0.558). The length of stay of the medical thoracoscopy group (9.42±1.7) d was significantly shorter than that in the blind biopsy group (13.21±1.9) d and the CT group (12.65±2.7) d, the differences were statistically significant (P<0.05). The postoperative pain score of the medical thoracoscopy group (4.34±0.81) was significantly higher than that in blind biopsy group (3.25±0.68) and that in CT group (3.21±0.72), the differences were statistically significant (P<0.05). The operate time of the medical thoracoscopy group (42.53±17.3) min was significantly shorter than that in the blind biopsy group (53.27±19.3) min and that in the CT group (80.38±27.49) min, the differences were statistically significant (P<0.05). Conclusion: The medical thoracoscopy is superior to CT scan-guided Abrams pleural needle biopsy and percutaneous blind biopsy of pleura in diagnosis of pleural effusion caused by malignant mesothelioma and lung cancer. While there is no significantly difference regarding pleural effusion caused by pleural metastasis due to other organ carcinomas and tuberculous pleurisy. The complication rate of three groups was no significantly different. However, the medical thoracoscopy is featured with shorter operation time and postoperative length of stay.