癌性胸腔积液的病理细胞学、免疫学诊断的对比性研究

目的对癌性胸腔积液（胸液）病理细胞学和免疫学诊断方法进行对比研究.方法比较分析76例癌性胸液的临床表现、影像学表现、胸液找癌细胞、胸膜活检、胸腔镜检查、血清及胸液癌胚抗原（CEA）测定结果.结果 70.0%癌性胸液为血性.诊断符合率分别为：胸腔镜为90.0%，胸膜活检为72.0%，胸液找癌细胞为46.0%，纤维支气管镜为27.0%，恶性胸液CEA比其血清 CEA 明显升高，两者间差异有显著性（p<0.05）.结论病理细胞学检查可确诊癌性胸液，CEA检测可以提高该病的检出率.纤维支气管镜代替胸腔镜对疑难性胸液是一种创伤少、安全、诊断率极高的检查手段.

Study of Diagnosis of Malignant Pleural Effusion with Cytopathology and Immunology

Objective　To evaluate the ways of cytopathology and immunology in diagnosing malignant pleural effusion.Methods 76 cases diagnosed as malignant pleural effusion were reviewed by clinical history and physical examination,chest X-Ray and CT,cytopathology,needle biopsy of pleural,fibrobronchoscopy,thoracoscopy,level of carcinoembryonic(CEA) in pleural effusion and serum.Results　70.0% of malignant pleural effusion were hemorrhagic effusion.Diagnostic accuracy for malignant pleural effusion: thoracoscopy 90.0%,needle biopsy of pleura 72.0% ,cytopathology 46.0% ,fibrobronchoscopy 27.0%.The level of CEA in malignant pleural effusion was signifcantly higher than those in serum (p<0.05).Conclusions　Cytopathology makes a determinate diagnosis of malignant pleural effusion.CEA is helpful for the diagnosis.Thoracoscopy is a way of safe and the highest diagnostic rate in malignant pleural effusion.