内科胸腔镜对不明原因胸腔积液诊断价值及恶性胸腔积液镜下表型特征
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摘要
目的探讨内科胸腔镜在不明原因胸腔积液诊断中的临床应用价值及恶性胸腔积液的镜下表型特征。方法回顾性分析2015年1月-2018年1月我科98例不明原因胸腔积液患者胸腔镜活检病理结果、恶性胸腔积液镜下表型特征、围手术期并发症及胸水腺苷脱氨酶(adenosine deaminase,ADA)、癌胚抗原(carcino-embryonic,CEA)和血CEA的结果。结果 98例不明原因胸腔积液中确诊89例,确诊率达90. 82%;其中恶性胸腔积液36例,确诊率为94. 74%,镜下主要表现为:正常者1例,溃疡糜烂样病变2例,孤立性结节1例,粟粒样结节2例,多发结节27例,多发结节至弥漫性白斑样病变3例;胸腔镜检查术后疼痛18例、皮下气肿5例、发热4例。结核性胸腔积液胸水ADA较高,而胸水及血CEA在恶性胸腔积液浓度较高(P均<0. 05)。结论内科电子胸腔镜具有微创、安全、高效的特点,对不明原因胸腔积液具有较高的诊断价值;恶性胸腔积液具有特征性镜下表型特征,正确识别恶性胸腔积液胸膜病变在内科胸腔镜下的表现对术中指导多点活检,尽早明确诊断具有重要意义。
Objective To investigate the clinical diagnostic value and the morphological features of malignant pleural effusion under thoracoscopy examination. Methods The results of pathological biopsy,the morphological features of malignant pleural effusion under medical thoracoscopy,the perioperative complications,CEA and ADA of 98 patients,who accepted the examination of flexi-rigid thoracoscopy in our hospital because of unknown pleural effusion from January 2015 to January 2018,were analyzed retrospectively. Results There were 89 cases definitely diagnosed( 90. 82%) and 36 malignant pleural effusion( 94. 74%) among 98 patients. The morphological features of malignant pleural effusion under thoracoscopy showed mainly 1 case of normal pleura,2 lesions of ulcerative erosion,1 single nodule,2 miliary nodules,27 multiple nodules and 3 multiple nodules to extensive leukoplakia like lesions.Complications of the patients underwent medical thoracosopy were mainly chest pain,subcutaneous emphysema and fever. The concentration of ADA was higher in tuberculous pleural effusion while CEA was higher in malignant pleural effusion and blood( P < 0. 05). Conclusion Medical thoracoscopy examination is a minimally invasive,safe and effective technology for diagnosis of unexplained pleural effusion with high exact diagnosis rate. It has a significant value in diagnosing unknown pleural effusion. Malignant pleural effusions have unique morphological features. The exact awareness of morphological features of malignant pleural effusions under thoracoscopy has significance for guiding precise multipoint biopsy and early diagnosis.
Objective To investigate the clinical diagnostic value and the morphological features of malignant pleural effusion under thoracoscopy examination. Methods The results of pathological biopsy,the morphological features of malignant pleural effusion under medical thoracoscopy,the perioperative complications,CEA and ADA of 98 patients,who accepted the examination of flexi-rigid thoracoscopy in our hospital because of unknown pleural effusion from January 2015 to January 2018,were analyzed retrospectively. Results There were 89 cases definitely diagnosed( 90. 82%) and 36 malignant pleural effusion( 94. 74%) among 98 patients. The morphological features of malignant pleural effusion under thoracoscopy showed mainly 1 case of normal pleura,2 lesions of ulcerative erosion,1 single nodule,2 miliary nodules,27 multiple nodules and 3 multiple nodules to extensive leukoplakia like lesions.Complications of the patients underwent medical thoracosopy were mainly chest pain,subcutaneous emphysema and fever. The concentration of ADA was higher in tuberculous pleural effusion while CEA was higher in malignant pleural effusion and blood( P < 0. 05). Conclusion Medical thoracoscopy examination is a minimally invasive,safe and effective technology for diagnosis of unexplained pleural effusion with high exact diagnosis rate. It has a significant value in diagnosing unknown pleural effusion. Malignant pleural effusions have unique morphological features. The exact awareness of morphological features of malignant pleural effusions under thoracoscopy has significance for guiding precise multipoint biopsy and early diagnosis.
引文
[1]何权瀛.胸腔积液临床诊断流程[J].临床肺科杂志,2017,22(8):1359-1363.
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[4]幸丽花,刘惟优.恶性胸腔积液诊断方法的研究进展[J].赣南医学院学报,2017,37(1):149-153,162.
[5]张廷梅,陈静,李春兰,等.结核性胸膜炎胸腔镜下表现与临床特点分析[J].临床肺科杂志,2014,19(10):1825-1827.
[6]MALDONADO F,LENTZ R J,LIGHT R W.Diagnostic approach to pleural diseases:new tricks for an old trade[J].F1000Res,2017,6:1135.
[7]WURPS H,SCHNFELD N,BAUER T T,et al.Intra-patient comparison ofparietal pleural biopsies by rigid forceps,flexible forceps and cryoprobe obtained during medical thoracoscopy:a prospective series of 80 cases with pleural effusion[J].BMC Pulm Med,2016,16(1):98.
[8]NA M J.Diagnostic tools of pleural effusion[J].Tuberc Respir Dis(Seoul),2014,76(5):199-210.
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[11]熊洁,任小平,魏声泓,等.内科胸腔镜对老年患者渗出性胸腔积液的诊断价值及安全性[J].临床肺科杂志,2017,22(1):11-14.
[12]李向南,张国俊.恶性胸腔积液治疗进展[J].肿瘤基础与临床,2015,28(1):84-86.
[13]MOHAMED S A,SHABAN M M.Diagnostic yield of medical thoracoscopy in diagnosis of exudative pleural effusion:one year prospective study[J].Egypt J Chest Dis Tuberc,2014,63(4):897-905.
[14]高亭,何小鹏,党焱,等.内科胸腔镜胸膜活检术与血清肿瘤标志物在不明原因胸腔积液中的诊断价值[J].中国内镜杂志,2016,22(12):20-25.
[15]凌玲,何艳,卓琳琅.胸腔镜下良恶性胸腔积液的鉴别诊断与胸膜炎形态特点观察[J].中国临床研究,2017,30(1):54-57.
[16]黄冠.胸水腺苷脱氨酶及癌胚抗原含量对胸腔积液性质的鉴别[J].实用医学杂志,2015,31(24):4096-4098.
[2]MISHRA A K,VERMA S K,KANT S,et al.A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion[J].South Asian J Cancer,2016,5(1):27-28.
[3]谢强,陈群,李育宏,等.可弯曲电子内科胸腔镜在恶性胸腔积液诊断中的应用[J].中国肺癌杂志,2009,12(5):422-425.
[4]幸丽花,刘惟优.恶性胸腔积液诊断方法的研究进展[J].赣南医学院学报,2017,37(1):149-153,162.
[5]张廷梅,陈静,李春兰,等.结核性胸膜炎胸腔镜下表现与临床特点分析[J].临床肺科杂志,2014,19(10):1825-1827.
[6]MALDONADO F,LENTZ R J,LIGHT R W.Diagnostic approach to pleural diseases:new tricks for an old trade[J].F1000Res,2017,6:1135.
[7]WURPS H,SCHNFELD N,BAUER T T,et al.Intra-patient comparison ofparietal pleural biopsies by rigid forceps,flexible forceps and cryoprobe obtained during medical thoracoscopy:a prospective series of 80 cases with pleural effusion[J].BMC Pulm Med,2016,16(1):98.
[8]NA M J.Diagnostic tools of pleural effusion[J].Tuberc Respir Dis(Seoul),2014,76(5):199-210.
[9]葛均波,徐永健,梅长林,等.内科学[M].第8版.北京:人民卫生出版社,2013:116-121.
[10]徐智,林科雄,姚伟,等.内科胸腔镜对548例不明病因胸腔积液的诊断价值[J].第三军医大学学报,2014,36(21):2211-2215.
[11]熊洁,任小平,魏声泓,等.内科胸腔镜对老年患者渗出性胸腔积液的诊断价值及安全性[J].临床肺科杂志,2017,22(1):11-14.
[12]李向南,张国俊.恶性胸腔积液治疗进展[J].肿瘤基础与临床,2015,28(1):84-86.
[13]MOHAMED S A,SHABAN M M.Diagnostic yield of medical thoracoscopy in diagnosis of exudative pleural effusion:one year prospective study[J].Egypt J Chest Dis Tuberc,2014,63(4):897-905.
[14]高亭,何小鹏,党焱,等.内科胸腔镜胸膜活检术与血清肿瘤标志物在不明原因胸腔积液中的诊断价值[J].中国内镜杂志,2016,22(12):20-25.
[15]凌玲,何艳,卓琳琅.胸腔镜下良恶性胸腔积液的鉴别诊断与胸膜炎形态特点观察[J].中国临床研究,2017,30(1):54-57.
[16]黄冠.胸水腺苷脱氨酶及癌胚抗原含量对胸腔积液性质的鉴别[J].实用医学杂志,2015,31(24):4096-4098.