内科胸腔镜在结核性胸膜炎中作用.docVIP

内科胸腔镜在结核性胸膜炎中作用【摘要】 目的 观察结核性胸膜炎胸腔镜下形态表现,探讨结核性胸膜炎形态特征对诊断的价值。方法 回顾分析216例确诊结核性胸膜炎患者胸腔镜下形态表现,与其他结核诊断方法及最终疗效的相关性。结果 216例结核性胸膜炎患者镜下表现为胸腔积液,胸膜充血、水肿,渗液、渗血,糜烂,纤维素及粘连,粟粒样分散结节、多发结节、结节融合,胸膜肥厚。结论 胸腔镜下结核性胸膜炎形态多样,其特征不具有结核性病变特异性,但对结核性胸膜炎的诊断具有较高临床价值。 【关键词】胸腔镜;结核性;胸膜炎 Role of medicalthoracoscopy in the diagnosisoftuberculous pleurisy ZHU Chun-li,WAN Xiong,GUI Tian-xu,et al.Department of Respiratory Medicine,Center Hospital of jiangjin,Chongqing,Jiangjin 402260, China 【Abstract】 Objective To investigate the morphological features of tuberculous pleurisy under thoracoscope and evaluate the diagnostic significance of thoracoscope for patients with tuberculous pleurisy.Methods Retrospectively analyzed of the morphological features under thoracoscope and pathological results of 216 patients who had been diagnosed as tuberculous pleurisy,compared thoracoscopy and other diagnostic methods,and its correlation with good curative effect.Results Thoracoscopic presentations of 216 patients with tuberculous pleurisy were hydrothorax,membrana pleuralis hyperaemia,hydrops,effusion,errhysis,anabrosis,formation of fibrous septa or adhesion,diffuse miliary nodules,multiple nodules,nodus coalesce,pachynsis pleurae.Conclusion The morphological features of tuberculous pleurisy are(variable)diversiform,and tuberculosis lesions arenon-specific oftuberculous.Thoracoscopy is of great value in the diagnosis for patients with tuberculous pleurisy. 【Key words】 Thoracoscopy;Tuberculous;Pleurisy ? 作者单位:402260重庆市江津中心医院呼吸内科 回顾我院1997年11月至2009年4月经胸腔镜检查,同时用病理检查、胸水TB-DNA-PCR、抗痨治疗有效等确诊结核性胸膜炎作了胸腔镜检查的216例患者,其胸腔镜下形态特征分析如下。 1 资料与方法 1.1 临床资料 本文胸腔积液患者216例,男139例,女77例;年龄15~89(43.6±18.8)岁;病史16~146 d;左侧积液83例,右侧积液108例,双侧积液25例; 术中抽取积液200~800 ml 36例,800~1600 ml 94例,1600~2400 ml 45例,2400 ml以上21例;呼吸系统症状:发热 133例,咳嗽188例,呼吸困难102例,胸痛148例;积液性状:草黄色98例,黄褐色66例,血性52例。术前作PPD,血液结核抗体,胸水常规、脱落细胞,胸水TB-DNA-PCR,胸部X线或CT检查,心肺功能检查,血凝分析等。 1.2 方法 采用Olympus TYPE260气管镜,自制穿刺导管,局麻,按胸腔镜手术操作常规安置导管,胸腔镜经导管进入胸腔,抽取胸腔积液,边抽边观察。黏稠积液用生理盐