摘要
目的评价内科胸腔镜在提高胸腔积液病因诊断中的价值及内科胸腔镜的检查时机。方法连续收集渗出性胸腔积液患者311例,其中男性194例,女性117例;年龄17～90岁,平均年龄58.3岁。评估胸腔积液细胞学对恶性胸水的诊断率。对27例经胸水细胞学未能诊断的患者和2例胸水细胞学恶性胸腔积液但未准确分型的患者进行了内科胸腔镜检查,评估胸腔镜检查联合胸水细胞学检查对胸腔积液诊断率及恶性胸水的准确诊断率的影响。结合不同次数的胸腔积液细胞学的阳性率及相关支出,评估内科胸腔镜的检查时机。结果311例渗出性胸腔积液患者经胸水细胞学诊断恶性胸腔积液的患者为80例;231例胸水细胞学未确诊的患者结合各自情况,经过内科胸腔镜检查和/或支气管镜、或肺动脉CT造影等检查,并结合临床资料系统分析后,诊断如下:恶性胸腔积液106例,良性胸腔积液91例,未确诊病例34例。胸水细胞学检查的确诊率为28.9%(80/277)。29例接受了内科胸腔镜检查患者中,25例患者直接确诊,诊断率为86.2%。内科胸腔镜检查使该组病例的确诊率提高到37.9%(105/277),与单纯胸腔积液细胞学检查结果比较差异有统计学意义(P=0.024)。3次及以上的胸腔积液细胞学检查不能较2次胸腔积液细胞学检查提高更多的诊断率(P=0.156),且其支出超过内科胸腔镜的支出。结论内科胸腔镜不仅较胸腔积液细胞学检查能提高恶性胸腔积液的诊断率,更能提高胸腔积液总体诊断率。对2次胸腔积液细胞学检查无结果者,如无禁忌证,应积极进行内科胸腔镜检查。
Objective To evaluate the efficacy and safety of medical thoracoscopy and the appropriate time for medical thoracoscopy. Methods A total of 311 patients with excudative pleural effusion were enrolled, male 194, female 117, aged 17 - 90 years old, mean age 58.3 years old. The diagnosis rate of cytological examinations of pleural effusion was evaluated. Twenty- seven patients whose diagnosis were not obtained by thoracocentesis and cellular examinations, and 2 cases of malignant pleural effusion without pathologically determined diagnosis received medical thoracoscopy. The combination of medical thoracoscopy and the method of thoracocentesis and cellular examinations were compared. Results Among the 311 patients, 80 cases were diagnosed as malignant pleural effusion; the other 231 cases had not diagnosed by cytological examinations, but finally confirmed by the methods of individual conditions, medical thoracoscopy and/or bronchoscopy, pulmonary artery CT scan and clinical information. The diagnosis of 231 cases were as follows： 106 cases of malignant pleural effusion, 91 cases of benign pleural effusion, 34 cases were undetermined. The positive diagnosis rate of pleural effusion by cytological examinations only was 28.9 % （80/277）. Among twenty-nine cases received medical thoracoscopy, 25 cases got the definite diagnosis with positive diagnosis rate as 86.2 %. The total positive diagnosis rate was improved by the combination of medical thoracoscopy and the method of thoracocentesis and cellular examinations by 37.9 % （105/277）, which was significantly higher than that of simple cellular examination（P = 0.024）. The diagnosis rate was not improved in pleural effusion cytology of more than 3 times than 2 times, but the expense was higher than that of medical thoracoscopy. Conclusion It is demonstrated that medical thoracoscopy is a safe and effective method to diagnose the pleural effusion of unknown origin with relative high positive diagnostic rate. When twice thoracentesis and cytological examinations have not produced positive diagnosis, medical thoracoscopy should be performed if there is no contraindications exist.
出处
《生物医学工程与临床》
CAS
2012年第4期365-369,共5页
Biomedical Engineering and Clinical Medicine
关键词
内科胸腔镜
诊断试验
胸腔积液
细胞学检查
medical thoracoscope
diagnosis test
pleural effusion
cytological examination
作者简介
侯刚（1978-），男，辽宁沈阳市人，博士研究生，主治医师，讲师．主要从事COPD防治的基础与临床研究及介人肺脏病学技术研究。E-mail：hougangcmu@yahoo．com．cn。
