恶性胸腔积液352例临床分析.DOCVIP

临床医学论文-恶性胸腔积液352例临床分析 ?????????????????? 作者：黄斌，卢东生，陈侯腾，廖槐，谢灿茂 【关键词】? 恶性胸腔积液 ?? 　摘? 要：目的：观察恶性胸腔积液的病因分布及临床特点，并综合评价各种检查手段的诊断价值。方法：对352 例恶性胸腔积液进行回顾性分析。结果：①352例中，呼吸系统肿瘤的比例为54.0% ，其他病因依次为消化系统肿瘤 (28.0%)、血液系统肿瘤(4.5%)及乳腺-子宫附件肿瘤 (2.1%)；②常见的临床症状为咳嗽(55.7%)、气促(40.7%)、胸痛(30.7%)，右侧、左侧及双侧恶性胸腔积液比例分别占55.1%、31.6%和13.3%（P＜0.05）；③胸腔积液癌胚抗原均值35μg/L，大于5μg/L 63例（74.3%）；④胸腔积液癌细胞检查、胸膜活检、纤维支气管镜（纤支镜）检查的阳性率分别为41.6%、37.8%、 43.8%，三者联合阳性率为70.9%。结论：呼吸系统、消化系统、血液系统、乳腺- 子宫附件肿瘤是恶性胸腔积液的主要病因；进行性胸痛为恶性胸腔积液较特异性的症状；恶性胸腔积液有一定的右胸选择性；胸腔积液癌胚抗原、胸腔积液细胞学、经皮穿刺胸膜活检、纤支镜、胸腔镜检查对诊断恶性胸腔积液有重要价值，联合应用能提高阳性率。 　　关键词：胸腔积液；胸膜活检；纤维支气管镜；胸腔镜 　　Malignant Pleural Effusion：A clinical study of 352 cases 　　Abstract:Objective: To investigate the etiology and clinical character of pleural effusion，evaluating the diagnostic value of all kinds of exminations. Method: A retrospective study of malignant pleural effusion in 352 patients was performed. Result: ①The proportion of respiratory carcinoma is 54.0%，other etiologies are gastrointestinal carcinoma(28.0%)、hemaology? carcinoma(4.5%) and? breast-uterus carcinoma(2.1%). ②The common symptoms are cough(55.7%)、dyspnea(40.7%)、chest? pain(30.7%)，The proportion of right 、left and bilateral pleural effusion are55.1%、31.6% and 13.3% respectively（P0.05）③The mean value of CEA in pleural effusion is35μg/L，63 cases（74.3%）over 5μg/L ④The positive incidence of examining cancer cell in pleural effusion、pleura biopsy and fiberbronchoscopy are 41.6%、37.8%、 43.8%，the combined incidence is 70.9%. Conclusion: Respiratory carcinoma、 gastrointestinal carcinoma and hemaology carcinoma are main etiologies of malignant pleural effusion，the progressive chest? pain is a symptom in it，examining cancer cell and CEA in pleural effusion、pleura biopsy fiberbronchoscopy、pleuralscopy have important diagnostic value，and combination of them can raise the positive incidence. 　　Key words:? Pleural effusion;? Pleural biopsy;? Fiberbronchoscopy;? Pleuralscopy 　　胸腔积液是临床常见疾病，良恶性胸腔积液的鉴别对治疗与预后的判断有十分重要的意义。近年来，随着恶性肿瘤发病率的上升，癌性胸腔积液的比例有上