内科胸腔镜在不明原因胸腔积液中的诊断价值

目的]探讨内科胸腔镜对于不明原因胸腔积液病因的诊断价值.方法]对经内科胸腔镜诊断的20例不明原因胸腔积液患者的临床资料进行分析、总结,通过与临床常用的鉴别良恶性胸腔积液的影像学、生化指标、胸腔积液细胞学检查等比较,评估内科胸腔镜检查的优势.结果]20例患者中经胸腔镜直视下多部位取材病理活检的确诊率为85%(17/20):恶性间皮瘤5例,胸膜转移瘤5例,结核性胸膜炎6例,非特异性炎症1例;内科胸腔镜对恶性胸腔积液的敏感性为90.9%(10/11),特异性为100%(10/10).胸部CT显示胸膜厚度>1 cm,胸腔积液CEA/血清CEA>1检测的敏感性、特异性分别为45.6%(5/11)、100%(5/5)和80%(4/5)、75%(3/4),两者敏感性均低于内科胸腔镜( P <0.01);内科胸腔镜的常见并发症为活检部位出血、疼痛及发热.结论]使用内科胸腔镜对胸腔积液的病因诊断具有较高的临床实用价值,为一种安全、有效、诊断率高的检查方法.

Diagnostic Value of Medical Thoracoscopy in Pleural Effusion with Unknown Origin

Objective]To explore the value of medical thoracoscopy in the etiological diagnosis of pleural effusion with unknown origin. Methods] The clinical data of 20 cases of pleural effusion with unknown origin diagnosed by medical thoracoscopy were analyzed and summarized. The imaging, biochemical index and cyto- logical examination for differentiating benign and malignant pleural effusion were compared to evaluate the ad- vantages of medical thoracoscopy. Results]Among the 20 patients, the final diagnosis rate of multiple punch biopsy under direct vision by medical thoracoscopy was 85 % （17/20）. There were 5 cases of malignant pleural mesothelioma, 5 cases of metastatic adenocarcinoma, 6 cases of tuberculosis and a case of non-specific inflam- mation. The sensitivity and specificity of medical thoracoscopy for malignant pleural effusion were 90.9 % （10/ 11） and 100% （10/10）, respectively. The sensitivity and specificity of chest CT for malignant pleural effusion with pleura thickness more than lcm were 45.6% （5/11） and 80%（4/5）, respectively. The sensitivity and specificity of CEA for pleural effusion with serum CEA more than 1 were 100% （5/5） and 75% （3/4）, respec- tively. The sensitivity of above two methods was lower than that of medical thoracoscopy（ P〈0.01）. The common complications of medical thoracoscopy were bleeding of biopsy, pain and fever. Conclusion] Medical thoracoscopy for the etiological diagnosis of pleural effusion has higher clinical practice value, and is a safe and effective examination method with high diagnostic rate.