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目的提高结核性和恶性胸腔积液患者诊断和鉴别诊断的水平。方法比较经内科胸腔镜胸膜活检确诊的结核性胸腔积液60例(结胸组)和恶性胸腔积液56例(恶胸组)患者胸腔镜检查结果和临床资料。结果 1.临床表现:患者年龄:结胸组较恶胸组年轻(t=5.77,P<0.01)。胸腔积液量:结胸组大量者较少(χ2=13.75,P<0.01);中量者较多(χ2=13.92,P<0.01)。胸水性质:结胸组黄色胸水较多见(χ2=21.47,P<0.01),恶胸组血性胸水较多见(χ2=23.88,P<0.01)。2.内科胸腔镜下表现:结胸组胸膜粘连、增厚、干酪样坏死和粟粒结节较多见;恶胸组胸膜多发息肉和斑片状白苔较多见。3.胸水ADA结胸组较恶胸组为高(P<0.05);而胸水和血清CEA水平恶胸组比结胸组为高(P<0.05)。结论内科胸腔镜检查联合胸水ADA、胸水和血清CEA等检测,提高了结核性和恶性胸腔积液诊断、鉴别诊断的特异性和敏感性。
Objective To improve the diagnosis and differential diagnosis of tuberculous and malignant pleural effusion. Methods Thirty-six cases of tuberculous pleural effusion diagnosed by medical thoracoscopic pleural biopsy and 53 cases of malignant pleural effusion were retrospectively analyzed. Results 1. Clinical manifestations: Patient’s age: The patients in the cervical-chest group were younger than those in the malignant chest group (t = 5.77, P <0.01). The amount of pleural effusion: a large number of knot-chest group less (χ2 = 13.75, P <0.01); in the amount of more (χ2 = 13.92, P <0.01). Pleural effusion: The pleural fluid yellow pleural effusion more common (χ2 = 21.47, P <0.01), hyperactivity pleural effusion more common (χ2 = 23.88, P <0.01). 2. The performance of medical thoracoscopic pleural adhesions, thoracic group thickening, caseous necrosis and miliary nodules more common; evil thoracic pleura multiple polyps and patchy white moss more common. The incidence of pleural effusion in the pleural effusion group was significantly higher than that in the malignant chest mass group (P <0.05). Conclusion The medical thoracoscopy combined with pleural effusion ADA, pleural effusion and serum CEA and other tests to improve the diagnosis and differential diagnosis of tuberculous and malignant pleural effusion specificity and sensitivity.