黎国喜 刘智 郭清

[摘要] 目的 探讨内科胸腔镜检查应用于结核性胸膜炎引发胸腔积液中的诊断价值。方法 方便抽取2018年5月—2019年11月该院收治的62例不明原因胸腔积液患者作为研究对象，给予所有患者内科胸腔镜检查并观察其镜下表现特征。结果 研究收入的62例不明原因胸腔积液患者经内科胸腔镜病理组织活检确诊患者60例，诊断符合率96.77%，结核性胸腔积液50例、非特异性炎症1例;恶性胸腔积液10例，胸腔镜表现可归结为4类：胸膜充血水肿、粟粒样结节、纤维素样粘连带和包裹性积液;恶性胸腔积液患者10例CEA胸水、CEA血高于结核性胸腔积液50例患者（50.00%、40.00%>4.00%、8.00%），结核性胸腔积液患者ADA胸水高于恶性胸腔积液患者（64.00%>30.00%），各数据组间均差异有统计学意义（χ2=53.678、28.070、23.203，P<0.05）。 结论 结核性胸腔积液的诊断难度相对于其他类型胸腔积液更高，内科胸腔镜检查可通过较为典型的胸腔镜下表现提高其诊断准确率，方法值得借鉴。

[关键词] 内科胸腔镜;结核性胸膜炎;胸腔积液;胸腔镜表现;诊断价值

[中图分类号] R521.7          [文献标识码] A          [文章编号] 1674-0742（2020）08（c）-0055-03

[Abstract] Objective To explore the diagnostic value of internal thoracoscopy in tuberculous pleurisy caused by pleural effusion. Methods A total of 62 patients with unexplained pleural effusion admitted to the hospital from May 2018 to November 2019 were convenient selected as the research objects. All patients were given medical thoracoscopy and their microscopic performance characteristics were observed. Results The 62 patients with unexplained pleural effusion received from the study were diagnosed by medical thoracoscopic pathological tissue biopsy in 60 patients， the diagnosis coincidence rate was 96.77%， 50 cases of tuberculous pleural effusion， 1 case of non-specific inflammation; 10 cases of malignant pleural effusion; the performance of thoracoscopy can be summarized into four categories： pleural congestion and edema， miliary nodules， fibrinoid adhesions and encapsulated effusion; 10 cases of malignant pleural effusion patients with CEA pleural effusion， CEA blood higher than tuberculous pleural effusion 50 cases （50.00%， 40.00%>4.00%， 8.00%）， ADA pleural fluid in patients with tuberculous pleural effusion was higher than that in patients with malignant pleural effusion （64.00%>30.00%）， and there were statistical differences significant between the data groups（χ2=53.678， 28.070， 23.203， P<0.05）. Conclusion The diagnosis of tuberculous pleural effusion is more difficult than other types of pleural effusion. Medical thoracoscopy can improve its diagnostic accuracy through more typical thoracoscopic performance. The method is worth learning.

[Key words] Internal thoracoscopy; Tuberculous pleurisy; Pleural effusion; Thoracoscopic findings; Diagnostic value

胸腔積液是临床上较为常见的一类内科疾病，其致病因素较多。临床上根据积液类型可划分为漏出性胸腔积液和渗出性胸腔积液两种。结合过往经验及文献资料，渗出性胸腔积液常见风险因素为肿瘤和结核[1-2]。结合性胸膜炎引起的胸腔积液由于胸水沉渣结核分枝杆菌阳性率相对较低，因此常规检查很难进行准确的诊断。另一方面，随着肿瘤的发病率年轻化趋势明显，结核病的临床表现无明显特异性，诊断难度也有了一定程度的提高。随着影像学技术的发展，内科胸腔镜检查以其微创、经济、安全性好的特点被广泛应用于胸膜疾病的诊断中并取得了显著的临床效果[3-4]。2018……