结核性胸膜炎超声诊断、分型及介入治疗专家共识(2022年版)

结核性胸膜炎是结核分枝杆菌侵犯胸膜腔发生高强度变态反应引起的胸膜炎症,属于肺结核的一种,临床现阶段认为是渗出性胸腔积液产生的最主要原因之一。结核性胸膜炎未经及时有效的诊断及治疗,可导致严重通气功能障碍及肺功能损害。胸部超声目前是结核性胸膜炎诊断及评估的首选影像学方法,超声引导下胸膜穿刺活检获得病原学和病理组织学阳性证据是结核性胸膜炎确诊的标准之一,依据超声不同征象对结核性胸膜炎进行分型及治疗,可有效提高治愈率,减少并发症,降低复发率。由于不同医院和检查者之间的检查方法、诊断结果及治疗方案存在一定差异,不利于结核性胸膜炎患者的综合管理。因此,本共识介绍了超声引导下胸膜穿刺活检、结核性胸膜炎超声分型及不同分型的临床介入治疗,旨在针对不同病程分期的结核性胸膜炎患者进行精准化、规范化、合理化的超声诊疗。

Expert consensus on ultrasound diagnosis,classification and interventional therapy of tuberculous pleurisy (2022 Edition)

Tuberculous pleurisy is pleural inflammation caused by delayed hypersensitivity response when Mycobacterium tuberculosis invades the pleural cavity. It is a kind of pulmonary tuberculosis, which is considered to be one of the main causes of exudative pleural effusion in clinic. Without timely and effective diagnosis or treatment, tuberculous pleurisy can lead to severe ventilatory dysfunction and pulmonary function damage. At present, chest ultrasound is the preferred imaging method for the diagnosis and evaluation of tuberculous pleurisy. One of the diagnostic criteria of tuberculous pleurisy is to obtain positive etiology or positive histopathology through ultrasound-guided pleural puncture biopsy. Classification and corresponding treatment of tuberculous pleurisy according to different ultrasound images can effectively improve the cure rate, reduce adverse complications and reduce the recurrence rate. Due to the differences in examination methods, diagnostic results and treatment between different hospitals and examiners, it is not conducive to the comprehensive management of patients with tuberculous pleurisy. Therefore, this consensus introduces ultrasound-guided pleural puncture biopsy, ultrasound classification of tuberculous pleurisy and clinical treatment of different types, aiming to provide precise, standardized and rational ultrasound diagnosis and treatment for tuberculous pleurisy patients at different stages.