72例不明原因胸腔积液的内科胸腔镜诊治分析

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[摘要] 目的 探索不明原因腔积液的病因及可弯曲内科胸腔镜的诊断及治疗价值。方法 选取该院2013年1月―2015年12月收治的胸腔积液原因待查的患者72例为研究对象，采用可弯曲内科胸腔镜对72例不明原因胸腔积液患者进行胸腔镜检查术，观察镜下表现、直视下取病理检查， 分析病因并观察手术的安全性。结果 72例不明原因胸腔积液中确诊66 例， 确诊率达 91.7%，包括胸膜转移癌34例，结核性胸膜炎30例，诊断为胸膜转移瘤的年龄显著高于结核性胸膜炎患者；积液表现为黄色和血性2种，黄色胸腔积液患者以良性病变为主，血性胸腔积液均为恶性病变；镜下表现为粟粒样结节的结核性胸膜炎特异性最高，恶性病变镜下主要表现为单发、多发肿块及大小不等的结节，其他胸膜充血、糜烂、粘连主要为结核及非特异性炎性改变；胸腔镜下分离粘连带，可显著增加患者的肺活量、肺总量；所有患者未见严重并发症。 结论 不明原因胸腔积液病因以胸膜转移瘤及结核性胸膜炎为主，患者的年龄、胸水的颜色、镜下表现对诊断具有指导意义，通过镜下粘连带分离可以改善患者肺功能，内科胸腔镜检查术是一种安全、高效的诊治技术，可做为不明原因胸腔积液的常规诊断方法。

[关键词]内科胸腔镜；不明原因胸腔积液；结核性胸膜；胸膜转移癌

[中图分类号] R561 [文献标识码] A [文章编号] 1674-0742（2016）10（c）-0188-03

[Abstract] Objective To explore the etiology of unexplained pleural effusion and the value of flexible medical thoracoscope in diagnosis and treatment. Methods 72 cases of unknown reason pleural effusion in our hospital from January 2013 to December 2015 were selected from the patients as the research object，Use flexible medical thoracoscopy in 72 cases of patients with unexplained pleural effusion to observe thoracoscopic performance， and take the pathological tissue under direct view， and analysis the cause of pleural effusion and the safety of the operation. Results 72 cases of unknown reason pleural effusion confirmed 66 cases， the diagnosis rate was 91.7%， including 34 cases with pleural metastasis carcinoma， 30 cases of tuberculous pleurisy diagnosis of pleural metastases age was significantly higher than that of patients with tuberculous pleurisy； The colour of pleura effusion？include？ hemorrhagic and yellow， yellow pleural effusion patients with benign lesions is given priority to， hemorrhagic pleural effusion in the diagnosis of malignant high specificity；Thoracoscopic performance for miliary nodules to be tuberculous pleurisy specificity； thoracoscopic performance of malignant lesions main for single and multiple mass and size of nodules； other thoracoscopic performance for pleural congestion， erosion， adhesion major for TB and nonspecific inflammatory change； Under the thoracoscope separation adhesive belt， can significantly increase patient's vital capacity and total lung capacity； all of the patients did not see serious complications.Conclusion The unexplained pleural effusion etiology is given priority to with pleural metastases and tuberculous pleuritis， patient's age，pleura effusion color， the thoracoscopic performance has a guiding significance to the diagnosis， under the thoracoscope separation adhesive belt， can significantly increase patient's lung function ； thoracoscopy is a safe and effective treatment technology， can be the routine diagnostic method of unexplained pleural effusion.