郭莹 鲍文华 孙涛 石峰

摘要：目的  探討胸腔镜下胸腔积液患者胸膜形态特征及其临床诊断价值。方法  回顾性分析2017年3月～2018年3月我院60例胸腔积液患者的临床资料，观察患者胸腔镜下形态学特征，分析胸腔镜诊断阳性及术后并发症情况。结果  良性胸膜胸腔镜下形态学特征：①胸膜充血、水肿;②较多的纤维粘连;③较光滑或有散在分布的灰白灰黄色粟粒结节;④少有接触性出血。恶性胸膜胸腔镜下形态学特征为：①胸膜充血、水肿不明显;②胸膜弥漫性增厚僵硬及包裹;③多发性灰白色结节，部分可融合，局部可呈白色苔藓样变;④接触性出血多见。胸膜结核胸腔镜下诊断阳性率为91.30%，肺腺癌转移瘤为88.24%，肺鳞癌转移瘤为88.89%，恶性间皮瘤为75.00%，慢性化脓性胸膜炎为100.00%。术后3.33%（2/60）并发频发房性早搏，5.00%（3/60）并发血压升高，6.67%（4/60）并发皮下气肿，1.67%（1/60）并发大出血，无死亡病例。结论  胸腔镜下的恶性间皮瘤与胸膜转移瘤胸腔积液在胸膜颜色、厚度、赘生物形态等病变特征上有差异，且诊断率较好，并发症少，安全有效。

关键词：胸腔镜;恶性间皮瘤;形态学特征

中图分类号：R561                                 文献标识码：B                                   DOI：10.3969/j.issn.1006-1959.2020.09.059

文章编号：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

胸腔肿瘤（thoracic tumor）是造成胸腔积液及胸膜病变的原因，主要包括恶性间皮瘤及胸膜转移瘤[1]。有研究显示[2]，约95%的胸膜肿瘤为转移性，其中约40%的转移瘤是肺源性，其次为乳腺癌、淋巴瘤、卵巢癌等。临床上的胸膜病变主要通过胸水脱落细胞学检查及胸膜活检术进行诊断，胸水脱落细胞学检查常因送检胸水细胞数量不满意而无法进行有意义的诊断，而胸膜活检术由于病灶分布不均或病变位于钳取盲区等因素无法进行准确诊断[3]。……