摘要
目的探讨内科胸腔镜检查对胸膜积液病因诊断的重要价值,了解结核性与癌性胸腔积液的差异。方法回顾性分析经胸腔镜检查的231例胸腔积液患者的病因构成,重点比较结核性胸腔积液104例(结核组)和癌性胸腔积液114例(癌性组)患者临床资料与胸腔镜检查结果。结果①病因构成:231例胸腔积液患者中,结核性与癌性所占比例最大(45.02%,47.62%);②临床资料:结核组患者年龄较癌性组年轻,病程较癌性组短(P<0.001),发热症状更多;结核组黄色胸水较多见(73.08%),癌性组血性胸水较多见(76.36%)。两者胸腔积液量(超声测值)无显著性差异(P=0.351)。结核组腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)较癌性组高,癌胚抗原(CEA)较癌性组低(P<0.001);③内科胸腔镜下表现:结核组以胸膜粟粒结节、广泛粘连较多见;癌性组胸膜大小不等弥漫结节较多见。结论结核性及癌性胸水是胸腔积液的常见病因,内科胸腔镜检查联合临床症状及胸水生化检测,可大大提高胸腔积液病因的诊断率,其创伤小,安全性好,值得广泛推广。
Objective To compare the different appearance of pleura between tuberculous effusion and malignant effusion and discuss the value of thoracoscopy on the evaluation of undiagnosed pleura] effusion. Methods The clinical data of 231 patients with pleural effusion which were diagnosed by guided biopsies of lesions with thoracoscopy were analysed retrospectively. Result ①Etiology： Tuberculosis and cancer were the main causes of pleural effusion in these 231 patients, and the proportion were 45. 02% and 47. 62% respectively; ②Clinieal data： The patients with tuberculosis （TB group） were younger and with shorter history than the patients with cancer （ CA group） （ P 〈 0. 001 ）. And fever was a common manifestation in TB group. Yellow pleural effusion was common in the patients of TB group （ 73.08% ） but hemorrhagic effusion was common in CA group （76.36%）. There was no statistical difference of the volume of pleura1 fluid between these two groups. The levels of pleural fluid adenosine deaminase （ADA） and lactate dehydrogenase （LDH） were higher in TB group than those in CA group but the level of pleural fluid earcino embryonic antigen（CEA） was lower than in TB group than those in CA group ; ③Thoracoseopy appearance ： Millet nodules on parietal and visceral pleurae and adhesions in pleural cavity presented commonly in TB group, and diffused nodules with different size presented commonly in CA group. Conclusion Tuberculosis and canee are the main causes of pleural effusion. Thoracoscopy is now increasingly used for the evaluation of undiagnosed pleural effusion. The advantages include the direct visualization of parietal and visceral pleurae, guided biopsies of lesions and minimally invasive operation.
出处
《中华肺部疾病杂志（电子版）》
CAS
2013年第6期32-35,共4页
Chinese Journal of Lung Diseases(Electronic Edition)
关键词
胸腔积液
胸腔镜
结核性
癌性
Pleural effusion
Thoracoseopy
Tuberculosis
Malignant
