胸腔鏡下胸腔積液患者胸膜形態特征及其診斷價值

郭瑩 鮑文華 孫濤 石峰

摘要：目的? 探討胸腔鏡下胸腔積液患者胸膜形態特征及其臨床診斷價值。方法? 回顧性分析2017年3月～2018年3月我院60例胸腔積液患者的臨床資料，觀察患者胸腔鏡下形態學特征，分析胸腔鏡診斷陽性及術后并發癥情況。結果? 良性胸膜胸腔鏡下形態學特征：①胸膜充血、水腫;②較多的纖維粘連;③較光滑或有散在分布的灰白灰黃色粟粒結節;④少有接觸性出血。惡性胸膜胸腔鏡下形態學特征為：①胸膜充血、水腫不明顯;②胸膜彌漫性增厚僵硬及包裹;③多發性灰白色結節，部分可融合，局部可呈白色苔蘚樣變;④接觸性出血多見。胸膜結核胸腔鏡下診斷陽性率為91.30%，肺腺癌轉移瘤為88.24%，肺鱗癌轉移瘤為88.89%，惡性間皮瘤為75.00%，慢性化膿性胸膜炎為100.00%。術后3.33%（2/60）并發頻發房性早搏，5.00%（3/60）并發血壓升高，6.67%（4/60）并發皮下氣腫，1.67%（1/60）并發大出血，無死亡病例。結論? 胸腔鏡下的惡性間皮瘤與胸膜轉移瘤胸腔積液在胸膜顏色、厚度、贅生物形態等病變特征上有差異，且診斷率較好，并發癥少，安全有效。

關鍵詞：胸腔鏡;惡性間皮瘤;形態學特征

中圖分類號：R561? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻標識碼：B? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2020.09.059

文章編號：1006-1959（2020）09-0182-03

Pleural Morphology and Diagnostic Value of Patients with Pleural Effusion Under Thoracoscopy

GUO Ying1，BAO Wen-hua1，SUN Tao1，SHI Feng2

（1.Department of Respiratory Medicine，the First Affiliated Hospital of Jiamusi University， Jiamusi 154000，Heilongjiang，China;

2.Department of Respiratory Medicine，the First Hospital of Qiqihar City，Qiqihar 161000，Heilongjiang，China）

Abstract：Objective? To explore the pleural morphology and clinical diagnostic value of patients with pleural effusion under thoracoscopy.Methods? The clinical data of 60 patients with pleural effusion in our hospital from March 2017 to March 2018 were retrospectively analyzed.The morphological characteristics of the patients under thoracoscopy were analyzed， and the positive diagnosis of thoracoscopy and postoperative complications were analyzed.Results? Morphological characteristics of benign pleural pleuroscopy： ①Pleural congestion and edema; ② more fibrous adhesions; ③ smoother or scattered grayish white and yellowish millet nodules; ④ less contact bleeding. The morphological characteristics of malignant pleural pleuroscopy are： ① pleural congestion and edema are not obvious; ② diffuse thickening and stiffness and wrapping of the pleura; ③ multiple gray-white nodules， part of which can be fused， and some of them can be white lichen-like changes;④ Contact bleeding is more common. The positive rate of tuberculous pleurisy diagnosis under thoracoscope is 91.30%， lung adenocarcinoma metastases 88.24%， lung squamous cell carcinoma metastases 88.89%， malignant mesothelioma 75.00%， chronic suppurative pleurisy 100.00%. A total of 60 patients with pleural effusion underwent thoracoscopy， 3.33% （2/60） complicated with frequent atrial premature beats， 5.00% （3/60） complicated with increased blood pressure， 6.67% （4/60） complicated with subcutaneous emphysema， 1.67% （1/60） complicated with massive bleeding， no deaths.Conclusion? The pleural effusions of malignant mesothelioma and pleural metastases under thoracoscope have discernible differences in pleural color， thickness， neoplastic morphology and other pathological characteristics， and the diagnosis rate is good， with fewer complications， safe and effective.

Key words：Thoracoscopy;Malignant mesothelioma;Morphological features

胸腔腫瘤（thoracic tumor）是造成胸腔積液及胸膜病變的原因，主要包括惡性間皮瘤及胸膜轉移瘤[1]。有研究顯示[2]，約95%的胸膜腫瘤為轉移性，其中約40%的轉移瘤是肺源性，其次為乳腺癌、淋巴瘤、卵巢癌等。臨床上的胸膜病變主要通過胸水脫落細胞學檢查及胸膜活檢術進行診斷，胸水脫落細胞學檢查常因送檢胸水細胞數量不滿意而無法進行有意義的診斷，而胸膜活檢術由于病灶分布不均或病變位于鉗取盲區等因素無法進行準確診斷[3]。……