内科胸腔镜在不同原因胸腔积液诊断中的作用
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摘要
目的评价内科胸腔镜在不同原因胸腔积液中的诊断作用。方法回顾性分析2014年12月-2017年12月在苏州市立医院行内科胸腔镜检查且确诊的57例胸腔积液患者的临床资料,并评价安全性。结果 57例患者中,恶性胸腔积液16例,结核性胸腔积液23例,炎性胸腔积液15例,不明原因积液3例。胸腔镜下恶性胸腔积液主要表现为胸膜结节(单发或多发)、胸膜充血水肿或粘连增厚;结核性胸腔积液表现为胸膜充血,粟粒样结节,多发散在黄白色结节,胸膜粘连增厚,包裹性积液,部分甚至胸膜闭锁;炎性胸腔积液镜下多表现为胸膜充血水肿,轻度粘连,脓胸时则可出现胸膜闭锁。胸腔镜后仅3例患者发生轻度皮下气肿。结论胸腔镜下不同病因胸腔积液的表现各异,内科胸腔镜能直视下判断胸膜及肺部病变情况,具有确诊率高,安全及创伤小特点。
Objective To evaluate the diagnostic value of medical thoracoscopy in pleural effusion with different causes. Methods The clinical data of 57 patients with pleural effusion diagnosed by medical thoracoscopy in our hospital from Dec 2014 to Dec 2017 were retrospectively analyzed,and the safety was evaluated. Results In 57 cases of pleural effusion,16 cases were diagnosed as malignant pleural effusion,23 cases of tuberculous pleural effusion,15 cases of inflammatory pleural effusion,and 3 cases of unknown cause effusion. The malignant pleural effusions under thoracoscopy were mainly pleural nodules( single or multiple),pleural congestion and edema,or thickening of adhesions. Tuberculous pleural effusion was characterized by pleural congestion,miliary nodules,scattered in yellowish white nodules,pleura thickening,encapsulated effusion,and even pleural atresia. Inflammatory pleural effusion was characterized by pleural congestion edema,mild adhesion,and empyema. Pleural atresia occurred. Only 3 patients developed mild subcutaneous emphysema after video-assisted thoracoscopic surgery. Conclusion The pleural effusion of different etiologies is different under thoracoscope. Thoracoscopy can directly evaluate the pleural and pulmonary lesions and determine the cause of the disease. It has the characteristics of high diagnostic rate,safety and small trauma.
Objective To evaluate the diagnostic value of medical thoracoscopy in pleural effusion with different causes. Methods The clinical data of 57 patients with pleural effusion diagnosed by medical thoracoscopy in our hospital from Dec 2014 to Dec 2017 were retrospectively analyzed,and the safety was evaluated. Results In 57 cases of pleural effusion,16 cases were diagnosed as malignant pleural effusion,23 cases of tuberculous pleural effusion,15 cases of inflammatory pleural effusion,and 3 cases of unknown cause effusion. The malignant pleural effusions under thoracoscopy were mainly pleural nodules( single or multiple),pleural congestion and edema,or thickening of adhesions. Tuberculous pleural effusion was characterized by pleural congestion,miliary nodules,scattered in yellowish white nodules,pleura thickening,encapsulated effusion,and even pleural atresia. Inflammatory pleural effusion was characterized by pleural congestion edema,mild adhesion,and empyema. Pleural atresia occurred. Only 3 patients developed mild subcutaneous emphysema after video-assisted thoracoscopic surgery. Conclusion The pleural effusion of different etiologies is different under thoracoscope. Thoracoscopy can directly evaluate the pleural and pulmonary lesions and determine the cause of the disease. It has the characteristics of high diagnostic rate,safety and small trauma.
引文
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[14]张艳,郑建,黄捷晖,等.胸腔镜下结核性胸膜炎胸膜粘连程度的判定及相关因素分析[J].南京医科大学学报(自然科学版),2012,32(10):1422-1425.
[15]KWON J S,CHA S I,JEON K N,et al.Factors influencing residual pleural opacity in tuberculous pleural effusion[J].J Korean Med Sci,2008,23(4):616-620.
[16]WRIGHTSON J M,DAVIES H E.Outcome of patients with nonspecific pleuritis at thoracoscopy[J].Curr Opin Pulm Med,2011,17(4):242-246.
[17]VENEKAMP L N,VELKENIERS B,NOPPEN M.Does‘idiopathic pleuritis'exist?Natural history of non-specific pleuritis diagnosed after thoracoscopy[J].Respiration,2005,72(1):74-78.
[18]HEAN O,SHANG-MIAO C,CHIEN-MING L,et al.Bedside pleuroscopy in the management of undiagnosed exudative pleural effusion with acute respiratory failure[J].Anaesth Intensive Care,2013,41(4):473-475.
[19]DEPEW Z S,WIGLE D,MULLON J J,et al.Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center:a collaborative medical-surgical initiative[J].Chest,2014,146(2):398-405.
[20]RAHMAN N M,ALI N J,BROWN G,et al.Local anaesthetic thoracoscopy:British Thoracic Society Pleural Disease Guideline 2010[S].Thorax,2010,65(S2):54-60.
[2]万欢英,高蓓莉,项轶.呼吸内镜基本操作与临床应用[M].北京:人民卫生出版社,2014.
[3]DEPEW Z S,VERMA A,WIGLE D,et al.Nonspecific pleuritis:optimal duration of follow-up[J].Ann Thorac Surg,2014,97(6):1867-1871.
[4]LODDENKEMPER R.Thoracoscopy--state of the art[J].Eur Respir J,1998,11(1):213-221.
[5]罗国仕,魏娜,涂明利,等.内科电子胸腔镜检查监护和并发症防治[J].中国内镜杂志,2009,15(3):284-287.
[6]ROBERTS M E,NEVILLE E,BERRISFORD R G,et al.Management of a malignant pleural effusion:British Thoracic Society pleural disease guideline 2010[J].Thorax,2010,65(S2):32-40.
[7]NA M J.Diagnostic tools of pleural effusion[J].Tuberc Respir Dis(Seoul),2014,76(5):199-210.
[8]黄鑫炎,谢灿茂.胸腔积液的诊断进展-诊断思路[J].内科急危重症杂志,2012,18(3):129-133.
[9]DIXIT R,AGARWAL K C,GOKHROO A,et al.Diagnosis and management options in malignant pleural effusions[J].Lung India,2017,34(2):160-166.
[10]WU Y B,XU L L,WANG X J,et al.Diagnostic value of medical thoracoscopy in malignant pleural effusion[J].BMC Pulm Med,2017,17(1):109-113.
[11]SAKURABA M,MASUDA K,HEBISAWA A,et al.Thoracoscopic pleural biopsy for tuberculous pleurisy under local anesthesia[J].Ann Thorac Cardiovasc Surg,2006,12(4):245-248.
[12]李成俊.不同病因胸腔积液在胸腔镜下的表现特征分析[J].中国防痨杂志,2017,39(11):1237-1240.
[13]王学亮,卞明菊.γ干扰素、IL-4、C反应蛋白与结核性胸膜炎胸膜粘连的关系[J].国际呼吸杂志,2016,36(10):742-744.
[14]张艳,郑建,黄捷晖,等.胸腔镜下结核性胸膜炎胸膜粘连程度的判定及相关因素分析[J].南京医科大学学报(自然科学版),2012,32(10):1422-1425.
[15]KWON J S,CHA S I,JEON K N,et al.Factors influencing residual pleural opacity in tuberculous pleural effusion[J].J Korean Med Sci,2008,23(4):616-620.
[16]WRIGHTSON J M,DAVIES H E.Outcome of patients with nonspecific pleuritis at thoracoscopy[J].Curr Opin Pulm Med,2011,17(4):242-246.
[17]VENEKAMP L N,VELKENIERS B,NOPPEN M.Does‘idiopathic pleuritis'exist?Natural history of non-specific pleuritis diagnosed after thoracoscopy[J].Respiration,2005,72(1):74-78.
[18]HEAN O,SHANG-MIAO C,CHIEN-MING L,et al.Bedside pleuroscopy in the management of undiagnosed exudative pleural effusion with acute respiratory failure[J].Anaesth Intensive Care,2013,41(4):473-475.
[19]DEPEW Z S,WIGLE D,MULLON J J,et al.Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center:a collaborative medical-surgical initiative[J].Chest,2014,146(2):398-405.
[20]RAHMAN N M,ALI N J,BROWN G,et al.Local anaesthetic thoracoscopy:British Thoracic Society Pleural Disease Guideline 2010[S].Thorax,2010,65(S2):54-60.