【作者】 孙卫红； 钟爱虹； 魏淑芳；

【Author】 Fuzhou Pulmonary Hospital,Fujian,Fuzhou 350008 Sun Weihong,Zhong Aihong,Wei Shufang

【机构】 福州肺科医院；

【摘要】 目的提高结核性和恶性胸腔积液患者诊断和鉴别诊断的水平。方法我院2007年10月～2009年1月行内科胸腔镜检查的结核性和恶性胸腔积液患者116例,比较两组胸腔镜检查结果和临床资料。结果 1.临床资料和胸膜活检结果:结核性胸腔积液患者60例(结胸组),男性45例,女性15例,年龄平均(41±17)岁。病程平均61±96天。内科胸腔镜直视下胸膜活检病理符合结核39例;倾向结核11例;慢性炎症10例。恶性胸腔积液56例(恶胸组),男性36例,女性20例,年龄平均(57±13)岁;病程平均107±152天。内科胸腔镜直视下胸膜活检病理确诊原发于肺的腺癌39例,鳞癌7例,小细胞癌3例;乳腺癌转移2例;甲状腺癌和鼻咽癌转移各1例;胸膜间皮瘤2例,恶性淋巴瘤1例。结胸组与恶胸组比较,患者年龄较轻(t=5.77,P<0.01);胸腔积液大量者较少(χ~2=13.75,P<0.01);中量者较多(χ~2=13.92,P<0.01)。2.胸水性质的比较:结胸组黄色胸水较多见(χ~2=21.47,P<0.01),恶胸组血性胸水较多见(χ~2=23.88,P<0.01)。3.内科胸腔镜下表现的比较:结胸组镜下胸膜粘连、增厚、干酪样坏死和粟粒结节较多见;恶胸组胸膜多发息肉和斑片状白苔较多见。4.术后并发症:结胸组术后发热较恶胸组多见(χ~2=5.52,P<0.05)。5.结胸组胸水和血清CEA水平比恶胸组为低(P<0.05);胸水ADA比恶胸组为高(P<0.05)。结论内科胸腔镜检查联合胸水ADA、胸水和血清CEA等检测,提高了结核性和恶性胸腔积液诊断、鉴别诊断的特异性和敏感性。更多还原

【Abstract】 Objective to raise levels of diagnosis and distinguish diagnosis on tuberculous and malignant patients with pleural effusions.Methods Data of 116 patients with tuberculous or malignant pleural effusions through medical thoracoscopy in our hospital from Oct 2007 to Jan 2009 were reviewed retrospectively. Results Of the 60 patients with tuberculous pleural effusions,45 were males and 15 were females,with an average age of(41±17 ) years and average disease course of(61±96) days.Of the 60 patients,39 cases were surely diagnosed tuberculosis based upon Pleural biopsy by thoracoscopy;11 cases were possibal tuberculosis;10 cases were chronic inflammation.Of the 56 patients with malignant pleural effusions,36 were males and 20 were females,with an average age of(57±13 ) years and average disease course of(107±152) days.Of the 56 patients,39 cases were diagnosed lung adenocarcinoma,7 cases were lung scale cancer,3 cases were small cell lung cancer;2 cases were metastatic neoplasms from breast cancer;2 cases were metastatic neoplasms from the nose pharynx cancer and cancer of thyroid gland respectively;2 cases were pleural mesothelioma;1 case were lymphoma based upon Pleural biopsy by thoracoscopy.Age of the patients with tuberculous pleural effusions were more lighter than thoses with malignant pleural effusions(t=5.77,P<0.01).Plenty of pleural effusions in the patients with tuberculous pleural effusions were less than thoses with malignant pleural effusions(χ~2=13.75. P<0.01 );In quantity of pleural effusions in the patients with tuberculous pleural effusions were moer than thoses with malignant pleural effusions(χ~2=13.92,P<0.01).Yellow pleural effusions in the patients with tuberculous pleural effusions were moer than thoses with malignant pleural effusions(χ~2=21.47,P<0.01).Blood pleural effusions in the patients with tuberculous pleural effusions were less than thoses with malignant pleural effusions(χ~2=23.88,P<0.01 ).Pleura adhesion and fleshy,cheesy spoils and grain shape tubercle under Thoracoscope in the patients with tuberculous pleural effusions were moer than thoses with malignant pleural effusions.Fever after Thoracoscopy in the patients with tuberculous pleural effusions were moer than thoses with malignant pleural effusions(χ~2=5.52,P<0.05).It were higher that ADA level in pleural effusions of the patients with tuberculous pleural effusions than thoses with malignant pleural effusions(P<0.05).It were lower that CEA levels in pleural effusions and serum of the patients with tuberculous pleural effusions than thoses with malignant pleural effusions(P<0.05).Conclusion Associations of medical thoracoscopy with detection of ADA in pleural effusions,CEA in pleural effusions and serum,rise to specificity and sensitivity of diagnosis and distinguish diagnosis for tuberculous and malignant pleural effusions.更多还原